Wwe

Wwe

World Wrestling Entertainment, Inc., d/b/a WWE, is an American integrated media and entertainment company[6][7] that is primarily known for professional wrestling. WWE has also branched out into other fields, including movies, football, and various other business ventures.

The WWE name also refers to the professional wrestling promotion itself, founded in the 1950s as the Capitol Wrestling Corporation. It is the largest wrestling promotion in the world, holding over 500 events a year, with the roster divided up into various globally traveling brands,[8] and is available to about 36 million viewers in more than 150 countries. The company's global headquarters is located in Stamford, Connecticut, about 30 miles from New York City, with offices in major cities around the world.[9][10]

As in other professional wrestling promotions, WWE shows are not legitimate contests, but purely entertainment-based performance theater, featuring storyline-driven, scripted, and choreographed matches, though matches often include moves that can put performers at risk of injury, even death, if not performed correctly. This was first publicly acknowledged by WWE's owner Vince McMahon in 1989 to avoid taxes from athletic commissions. Since the 1980s, WWE publicly has branded its product as sports entertainment, acknowledging the product's roots in competitive sport and dramatic theater.

The company's majority owner is its chairman and CEO, Vince McMahon, who retains a 42% ownership of the company's outstanding stock and 70.5% of the voting power.[11][12]

The current entity, incorporated on February 21, 1980, was previously known as Titan Sports, Inc., which was founded that same year in South Yarmouth, Massachusetts. It acquired Capitol Wrestling Corporation Ltd., the holding company for the World Wrestling Federation, in 1982.

Titan was renamed World Wrestling Federation, Inc. in 1998, then World Wrestling Federation Entertainment, Inc. in 1999, and finally the current World Wrestling Entertainment, Inc. in 2002. Since 2011, the company has officially branded itself solely as WWE though the company's legal name was not changed

WWE's origins can be traced back as far as the 1950s when on January 7, 1953 the first show under the Capitol Wrestling Corporation (CWC) was produced. There is uncertainty as to who the founder of the CWC was. Some sources state that it was Vincent J. McMahon [15][16][17] while other sources cite McMahon's father Jess McMahon as founder of CWC.[18][19][20] The CWC later joined the National Wrestling Alliance (NWA) and famous New York-Promoter Toots Mondt soon joined the CWC.

Vincent J. McMahon and Toots Mondt were very successful and soon controlled approximately 70% of the NWA's booking, largely due to their dominance in the heavily populated Northeastern United States. In 1963, McMahon and Mondt had a dispute with the NWA over "Nature Boy" Buddy Rogers being booked to hold the NWA World Heavyweight Championship.[21] Both men left the company in protest and formed the World Wide Wrestling Federation (WWWF) in the process. The WWE traditionally views this date as beginning of their history.[22] Mondt left Capitol in the late 1960s and although the WWWF had withdrawn from the NWA, Vince McMahon, Sr. quietly re-joined in 1971.

Capitol renamed the World Wide Wrestling Federation to the World Wrestling Federation (WWF) in 1979.[23]

Titan Sports, Inc. (1982-1998)

Golden Age (1982-1993)

Vincent J. McMahon's son, Vincent K. McMahon, and his wife Linda, established Titan Sports, Inc., in 1980 in South Yarmouth, Massachusetts.[24][25] The company was incorporated on February 21, 1980, in the Cape Cod Coliseum offices. The younger McMahon bought Capitol from his father in 1982, effectively seizing control of the company. Seeking to make the WWF the premier wrestling promotion in the country, and eventually, the world, he began an expansion process that fundamentally changed the wrestling business.[26]

At the annual meeting of the NWA in 1983, the McMahons and former Capitol employee Jim Barnett all withdrew from the organization.[21] McMahon also worked to get WWF programming on syndicated television all across the United States. This angered other promoters and disrupted the well-established boundaries of the different wrestling promotions, eventually ending the territory system, which was in use since the founding of the NWA in the 1940s. In addition, the company used income generated by advertising, television deals, and tape sales to secure talent from rival promoters.

In an interview with Sports Illustrated, McMahon noted:

In the old days, there were wrestling fiefdoms all over the country, each with its own little lord in charge. Each little lord respected the rights of his neighboring little lord. No takeovers or raids were allowed. There were maybe 30 of these tiny kingdoms in the U.S. and if I hadn't bought out my dad, there would still be 30 of them, fragmented and struggling. I, of course, had no allegiance to those little lords.[26]

McMahon gained significant traction when he hired American Wrestling Association (AWA) talent Hulk Hogan, who had achieved popularity outside of wrestling, notably for his appearance in the film Rocky III.[27] McMahon signed Roddy Piper as Hogan's rival, and then shortly afterward Jesse Ventura as an announcer. Other wrestlers joined the roster, such as Jimmy Snuka, Don Muraco, The Iron Sheik, Nikolai Volkoff, Junkyard Dog, Paul Orndorff, Greg Valentine, and Ricky Steamboat. Many of the wrestlers who would later join the WWF were former AWA or NWA talent.

The WWF would tour nationally in a venture that would require a huge capital investment, one that placed the WWF on the verge of financial collapse. The future of McMahon's experiment came down to the success or failure of McMahon's groundbreaking concept, WrestleMania. WrestleMania was a major success and was (and still is) marketed as the Super Bowl of professional wrestling. The concept of a wrestling supercard was nothing new in North America; the NWA had begun running Starrcade a few years prior. In McMahon's eyes, however, what separated WrestleMania from other supercards was that it was intended to be accessible to those who did not watch wrestling. He invited celebrities such as Mr. T, Muhammad Ali, and Cyndi Lauper to participate in the event, as well as securing a deal with MTV to provide coverage. The event and hype surrounding it led to the term Rock 'n' Wrestling Connection, due to the cross-promotion of popular culture and professional wrestling.

The WWF business expanded significantly on the shoulders of McMahon and his babyface hero Hulk Hogan for the next several years. The introduction of Saturday Night's Main Event on NBC in 1985 marked the first time that professional wrestling had been broadcast on network television since the 1950s, when the now-defunct DuMont Television Network broadcast matches of Vince McMahon Sr.'s Capitol Wrestling Corporation. The 1980s "Wrestling Boom" peaked with the WrestleMania III pay-per-view at the Pontiac Silverdome in 1987, which set an attendance record of 93,173, a record that stood for 29 years until WrestleMania 32.[28] A rematch of the WrestleMania III main event between WWF champion Hulk Hogan and André the Giant took place on The Main Event I in 1988 and was seen by 33 million people, the most-watched wrestling match in North American television history.[29]

In 1985, Titan moved its offices to Stamford, Connecticut, though the current building was built in 1981. Subsequently, a new Titan Sports, Inc. (originally WWF, Inc.) was established in Delaware in 1987 and was consolidated with the Massachusetts entity in February 1988.[30]

New Generation (1993–1997)

The WWF was hit with allegations of steroid abuse and distribution in 1992. This was followed by allegations of sexual harassment by WWF employees the following year.[31][32] McMahon was eventually exonerated, but the allegations brought bad public relations for the WWF, and an overall bad reputation. The steroid trial cost the company an estimated $5 million at a time of record low revenues. This helped drive many WWF wrestlers over to rival promotion World Championship Wrestling (WCW), including 1980s babyface hero Hulk Hogan. During this period, the WWF promoted wrestlers of a younger age comprising "The New Generation", featuring Shawn Michaels, Diesel, Razor Ramon, Bret Hart, and The Undertaker, in an effort to promote new talent into the spotlight.

In January 1993, the WWF debuted its flagship cable program Monday Night Raw. WCW countered in September 1995 with its own Monday night program, Monday Nitro, which aired in the same time slot as Raw.[33] The two programs would trade wins in the ensuing ratings competition (known as the "Monday Night Wars") until mid-1996. At that point, Nitro began a nearly two-year ratings domination that was largely fueled by the introduction of the New World Order (nWo), a stable led by former WWF performers Hulk Hogan, Scott Hall (the former Razor Ramon), and Kevin Nash (the former Diesel).[34]

The Attitude Era (1997–2002)

As the Monday Night Wars continued between Raw Is War and WCW's Nitro, the WWF would transform itself from a family-friendly product into a more adult-oriented product, known as the Attitude Era. The era was spearheaded by WWF VP Shane McMahon (son of owner Vince McMahon) and head writer Vince Russo.

1997 ended with McMahon facing real-life controversy following Bret Hart's controversial departure from the company, dubbed as the Montreal Screwjob.[35] This proved to be one of several founding factors in the launch of the Attitude Era as well as the creation of McMahon's on-screen character, "Mr. McMahon".

Prior to the Montreal Screwjob, which took place at the 1997 Survivor Series, former WCW talent were being hired by the WWF, including Stone Cold Steve Austin, Mankind, and Vader. Austin was slowly brought in as the new face of the company despite being promoted as an antihero, starting with his "Austin 3:16" speech shortly after defeating Jake Roberts in the tournament finals at the King of the Ring pay-per-view in 1996.[36]

World Wrestling Federation, Inc. / World Wrestling Federation Entertainment, Inc. (1998-2002)

On May 6, 1998, Titan Sports, Inc. was renamed World Wrestling Federation, Inc. It was renamed World Wrestling Federation Entertainment, Inc. a year later.

On April 29, 1999, the WWF made its return to terrestrial television, airing a special program known as SmackDown! on the fledgling UPN network. The Thursday night show became a weekly series on August 26, 1999—competing directly with WCW's Thursday night program Thunder on TBS. In 2000, the WWF, in collaboration with television network NBC, announced the creation of the XFL, a new professional football league that debuted in 2001.[37] The league had high ratings for the first few weeks, but initial interest waned and its ratings plunged to dismally low levels (one of its games was the lowest-rated prime-time show in the history of American television). NBC walked out on the venture after only one season, but McMahon intended to continue alone. However, after being unable to reach a deal with UPN, McMahon shut down the XFL.[38] WWE maintained control of the XFL trademark[39][40] before McMahon reclaimed the XFL brand, this time under a separate shell company from WWE, in 2017[41] with intent to relaunch the XFL in 2020.[42]

On October 19, 1999, World Wrestling Federation, Inc. launched an initial public offering as a publicly traded company, trading on the New York Stock Exchange (NYSE) with the issuance of stock then valued at $172.5 million.[43] The company has traded on the NYSE since its launch under ticker symbol WWE.[44]

Acquisition of WCW and ECW

By the fall of 1999, the Attitude Era had turned the tide of the Monday Night Wars into WWF's favor. After Time Warner merged with AOL, Ted Turner's control over WCW was considerably reduced, and the newly merged company announced a complete lack of interest in professional wrestling as a whole and decided to sell WCW in its entirety. Although Eric Bischoff, whom Time Warner fired as WCW president in October 1999, was nearing a deal to purchase the company, in March 2001 McMahon acquired the rights to WCW's trademarks, tape library, contracts, and other properties from AOL Time Warner for a number reported to be around $7 million.[45] Shortly after WrestleMania X-Seven, the WWF launched the Invasion storyline, integrating the incoming talent roster from WCW and Extreme Championship Wrestling (ECW). With this purchase, WWF now became by far the largest wrestling promotion in the world. The assets of ECW, which had folded after filing for bankruptcy protection in April 2001, were purchased by WWE in mid-2003.[46]

World Wrestling Entertainment, Inc. / WWE (2002-present)

On May 5, 2002, the World Wrestling Federation announced it was changing both its company name and the name of its wrestling promotion to World Wrestling Entertainment (WWE). Although mainly caused by an unfavorable ruling in its dispute with the World Wildlife Fund regarding the "WWF" initialism, the company noted it provided an opportunity to emphasize its focus on entertainment.[47]

On April 7, 2011, WWE, via the WWE Corporate website, announced that the company was ceasing use of the full name World Wrestling Entertainment and would henceforth refer to itself solely as WWE, making the latter an orphan initialism. This was said to reflect WWE's global entertainment expansion away from the ring with the ultimate goal of acquiring entertainment companies and putting a focus on television, live events, and film production. WWE noted that their new company model was put into effect with the relaunch of Tough Enough, being a non–scripted program (contrary to the scripted nature of professional wrestling) and with the launch of the WWE Network (at the time scheduled to launch in 2012; later pushed back to 2014). However, the legal name of the company remains as World Wrestling Entertainment, Inc.[14]

Brand extension (2002-present)

Assessment

Assessment

Educational assessment or educational evaluation[1] is the systematic process of documenting and using empirical data on the knowledge, skill, attitudes, and beliefs to refine programs and improve student learning.[2] Assessment data can be obtained from directly examining student work to assess the achievement of learning outcomes or can be based on data from which one can make inferences about learning.[3] Assessment is often used interchangeably with test, but not limited to tests.[4] Assessment can focus on the individual learner, the learning community (class, workshop, or other organized group of learners), a course, an academic program, the institution, or the educational system as a whole (also known as granularity). The word 'assessment' came into use in an educational context after the Second World War.[5]

As a continuous process, assessment establishes measurable and clear student learning outcomes for learning, provisioning a sufficient amount of learning opportunities to achieve these outcomes, implementing a systematic way of gathering, analyzing and interpreting evidence to determine how well student learning matches expectations, and using the collected information to inform improvement in student learning.[6]

The final purpose of assessment practices in education depends on the theoretical framework of the practitioners and researchers, their assumptions and beliefs about the nature of human mind, the origin of knowledge, and the process of learning.

Types

The term assessment is generally used to refer to all activities teachers use to help students learn and to gauge student progress.[7] Assessment can be divided for the sake of convenience using the following categorizations:

Placement, formative, summative and diagnostic assessment

Objective and subjective

Referencing (criterion-referenced, norm-referenced, and ipsative (forced-choice))

Informal and formal

Internal and external

Placement, formative, summative and diagnostic

Assessment is often divided into initial, formative, and summative categories for the purpose of considering different objectives for assessment practices.

Placement assessment – Placement evaluation is used to place students according to prior achievement or personal characteristics, at the most appropriate point in an instructional sequence, in a unique instructional strategy, or with a suitable teacher[8] conducted through placement testing, i.e. the tests that colleges and universities use to assess college readiness and place students into their initial classes. Placement evaluation, also referred to as pre-assessment or initial assessment, is conducted prior to instruction or intervention to establish a baseline from which individual student growth can be measured. This type of an assessment is used to know what the student's skill level is about the subject. It helps the teacher to explain the material more efficiently. These assessments are not graded.[9]

Formative assessment – Formative assessment is generally carried out throughout a course or project. Formative assessment, also referred to as "educative assessment," is used to aid learning. In an educational setting, formative assessment might be a teacher (or peer) or the learner, providing feedback on a student's work and would not necessarily be used for grading purposes. Formative assessments can take the form of diagnostic, standardized tests, quizzes, oral question, or draft work. Formative assessments are carried out concurrently with instructions. The result may count. The formative assessments aim to see if the students understand the instruction before doing a summative assessment.[9]

Summative assessment – Summative assessment is generally carried out at the end of a course or project. In an educational setting, summative assessments are typically used to assign students a course grade. Summative assessments are evaluative. Summative assessments are made to summarize what the students have learned, to determine whether they understand the subject matter well. This type of assessment is typically graded (e.g. pass/fail, 0-100) and can take the form of tests, exams or projects. Summative assessments are often used to determine whether a student has passed or failed a class. A criticism of summative assessments is that they are reductive, and learners discover how well they have acquired knowledge too late for it to be of use.[9]

Diagnostic assessment – Diagnostic assessment deals with the whole difficulties at the end that occurs during the learning process.

Jay McTighe and Ken O'Connor proposed seven practices to effective learning.[9] One of them is about showing the criteria of the evaluation before the test. Another is about the importance of pre-assessment to know what the skill levels of a student are before giving instructions. Giving a lot of feedback and encouraging are other practices.

Educational researcher Robert Stake[10] explains the difference between formative and summative assessment with the following analogy:

When the cook tastes the soup, that's formative. When the guests taste the soup, that's summative.[11]

Summative and formative assessment are often referred to in a learning context as assessment of learning and assessment for learning respectively. Assessment of learning is generally summative in nature and intended to measure learning outcomes and report those outcomes to students, parents and administrators. Assessment of learning generally occurs at the conclusion of a class, course, semester or academic year. Assessment for learning is generally formative in nature and is used by teachers to consider approaches to teaching and next steps for individual learners and the class.[12]

A common form of formative assessment is diagnostic assessment. Diagnostic assessment measures a student's current knowledge and skills for the purpose of identifying a suitable program of learning. Self-assessment is a form of diagnostic assessment which involves students assessing themselves. Forward-looking assessment asks those being assessed to consider themselves in hypothetical future situations.[13]

Performance-based assessment is similar to summative assessment, as it focuses on achievement. It is often aligned with the standards-based education reform and outcomes-based education movement. Though ideally they are significantly different from a traditional multiple choice test, they are most commonly associated with standards-based assessment which use free-form responses to standard questions scored by human scorers on a standards-based scale, meeting, falling below or exceeding a performance standard rather than being ranked on a curve. A well-defined task is identified and students are asked to create, produce or do something, often in settings that involve real-world application of knowledge and skills. Proficiency is demonstrated by providing an extended response. Performance formats are further differentiated into products and performances. The performance may result in a product, such as a painting, portfolio, paper or exhibition, or it may consist of a performance, such as a speech, athletic skill, musical recital or reading.

Objective and subjective

Assessment (either summative or formative) is often categorized as either objective or subjective. Objective assessment is a form of questioning which has a single correct answer. Subjective assessment is a form of questioning which may have more than one correct answer (or more than one way of expressing the correct answer). There are various types of objective and subjective questions. Objective question types include true/false answers, multiple choice, multiple-response and matching questions. Subjective questions include extended-response questions and essays. Objective assessment is well suited to the increasingly popular computerized or online assessment format.

Some have argued that the distinction between objective and subjective assessments is neither useful nor accurate because, in reality, there is no such thing as "objective" assessment. In fact, all assessments are created with inherent biases built into decisions about relevant subject matter and content, as well as cultural (class, ethnic, and gender) biases.[14]

Basis of comparison

Test results can be compared against an established criterion, or against the performance of other students, or against previous performance:

Criterion-referenced assessment, typically using a criterion-referenced test, as the name implies, occurs when candidates are measured against defined (and objective) criteria. Criterion-referenced assessment is often, but not always, used to establish a person's competence (whether s/he can do something). The best known example of criterion-referenced assessment is the driving test, when learner drivers are measured against a range of explicit criteria (such as "Not endangering other road users").

Norm-referenced assessment (colloquially known as "grading on the curve"), typically using a norm-referenced test, is not measured against defined criteria. This type of assessment is relative to the student body undertaking the assessment. It is effectively a way of comparing students. The IQ test is the best known example of norm-referenced assessment. Many entrance tests (to prestigious schools or universities) are norm-referenced, permitting a fixed proportion of students to pass ("passing" in this context means being accepted into the school or university rather than an explicit level of ability). This means that standards may vary from year to year, depending on the quality of the cohort; criterion-referenced assessment does not vary from year to year (unless the criteria change).[15]

Ipsative assessment is self comparison either in the same domain over time, or comparative to other domains within the same student.

Informal and formal

Assessment can be either formal or informal. Formal assessment usually implies a written document, such as a test, quiz, or paper. A formal assessment is given a numerical score or grade based on student performance, whereas an informal assessment does not contribute to a student's final grade. An informal assessment usually occurs in a more casual manner and may include observation, inventories, checklists, rating scales, rubrics, performance and portfolio assessments, participation, peer and self-evaluation, and discussion.[16]

Internal and external

Internal assessment is set and marked by the school (i.e. teachers). Students get the mark and feedback regarding the assessment. External assessment is set by the governing body, and is marked by non-biased personnel. Some external assessments give much more limited feedback in their marking. However, in tests such as Australia's NAPLAN, the criterion addressed by students is given detailed feedback in order for their teachers to address and compare the student's learning achievements and also to plan for the future.

Standards of quality

In general, high-quality assessments are considered those with a high level of reliability and validity. Approaches to reliability and validity vary, however.

Reliability

Reliability relates to the consistency of an assessment. A reliable assessment is one that consistently achieves the same results with the same (or similar) cohort of students. Various factors affect reliability—including ambiguous questions, too many options within a question paper, vague marking instructions and poorly trained markers. Traditionally, the reliability of an assessment is based on the following:

Temporal stability: Performance on a test is comparable on two or more separate occasions.

Form equivalence: Performance among examinees is equivalent on different forms of a test based on the same content.

Internal consistency: Responses on a test are consistent across questions. For example: In a survey that asks respondents to rate attitudes toward technology, consistency would be expected in responses to the following questions:

"I feel very negative about computers in general."

"I enjoy using computers."[17]

The reliability of a measurement x can also be defined quantitatively as: {\displaystyle R_{\text{x}}=V_{\text{t}}/V_{\text{x}}}R_\text{x} = V_\text{t}/V_\text{x} where {\displaystyle R_{\text{x}}}R_\text{x} is the reliability in the observed (test) score, x; {\displaystyle V_{\text{t}}}V_\text{t} and {\displaystyle V_{\text{x}}}V_{\text{x}} are the variability in ‘true’ (i.e., candidate’s innate performance) and measured test scores respectively. {\displaystyle R_{\text{x}}}R_\text{x} can range from 0 (completely unreliable), to 1 (completely reliable).

Validity

Main article: Test validity

Valid assessment is one that measures what it is intended to measure. For example, it would not be valid to assess driving skills through a written test alone. A more valid way of assessing driving skills would be through a combination of tests that help determine what a driver knows, such as through a written test of driving knowledge, and what a driver is able to do, such as through a performance assessment of actual driving. Teachers frequently complain that some examinations do not properly assess the syllabus upon which the examination is based; they are, effectively, questioning the validity of the exam.

Validity of an assessment is generally gauged through examination of evidence in the following categories:

Content – Does the content of the test measure stated objectives?

Criterion – Do scores correlate to an outside reference? (ex: Do high scores on a 4th grade reading test accurately predict reading skill in future grades?)

Construct – Does the assessment correspond to other significant variables? (ex: Do ESL students consistently perform differently on a writing exam than native English speakers?)[18]

A good assessment has both validity and reliability, plus the other quality attributes noted above for a specific context and purpose. In practice, an assessment is rarely totally valid or totally reliable. A ruler which is marked wrongly will always give the same (wrong) measurements. It is very reliable, but not very valid. Asking random individuals to tell the time without looking at a clock or watch is sometimes used as an example of an assessment which is valid, but not reliable. The answers will vary between individuals, but the average answer is probably close to the actual time. In many fields, such as medical research, educational testing, and psychology, there will often be a trade-off between reliability and validity. A history test written for high validity will have many essay and fill-in-the-blank questions. It will be a good measure of mastery of the subject, but difficult to score completely accurately. A history test written for high reliability will be entirely multiple choice. It isn't as good at measuring knowledge of history, but can easily be scored with great precision. We may generalize from this. The more reliable our estimate is of what we purport to measure, the less certain we are that we are actually measuring that aspect of attainment.

It is well to distinguish between "subject-matter" validity and "predictive" validity. The former, used widely in education, predicts the score a student would get on a similar test but with different questions. The latter, used widely in the workplace, predicts performance. Thus, a subject-matter-valid test of knowledge of driving rules is appropriate while a predictively valid test would assess whether the potential driver could follow those rules.

Evaluation standards

In the field of evaluation, and in particular educational evaluation, the Joint Committee on Standards for Educational Evaluation has published three sets of standards for evaluations. The Personnel Evaluation Standards were published in 1988,[19] The Program Evaluation Standards (2nd edition) were published in 1994,[20] and The Student Evaluation Standards were published in 2003.[21]

Each publication presents and elaborates a set of standards for use in a variety of educational settings. The standards provide guidelines for designing, implementing, assessing and improving the identified form of evaluation. Each of the standards has been placed in one of four fundamental categories to promote educational evaluations that are proper, useful, feasible, and accurate. In these sets of standards, validity and reliability considerations are covered under the accuracy topic. For example, the student accuracy standards help ensure that student evaluations will provide sound, accurate, and credible information about student learning and performance.

In the UK, an award in Training, Assessment and Quality Assurance (TAQA) is available to assist staff learn and develop good practice in relation to educational assessment in adult, further and work-based education and training contexts

Controversy

Concerns over how best to apply assessment practices across public school systems have largely focused on questions about the use of high-stakes testing and standardized tests, often used to gauge student progress, teacher quality, and school-, district-, or statewide educational success.

No Child Left Behind

For most researchers and practitioners, the question is not whether tests should be administered at all—there is a general consensus that, when administered in useful ways, tests can offer useful information about student progress and curriculum implementation, as well as offering formative uses for learners.[23] The real issue, then, is whether testing practices as currently implemented can provide these services for educators and students.

President Bush signed the No Child Left Behind Act (NCLB) on January 8, 2002. The NCLB Act reauthorized the Elementary and Secondary Education Act (ESEA) of 1965. President Johnson signed the ESEA to help fight the War on Poverty and helped fund elementary and secondary schools. President Johnson's goal was to emphasizes equal access to education and establishes high standards and accountability. The NCLB Act required states to develop assessments in basic skills. To receive federal school funding, states had to give these assessments to all students at select grade level.

In the U.S., the No Child Left Behind Act mandates standardized testing nationwide. These tests align with state curriculum and link teacher, student, district, and state accountability to the results of these tests. Proponents of NCLB argue that it offers a tangible method of gauging educational success, holding teachers and schools accountable for failing scores, and closing the achievement gap across class and ethnicity.[24]

Opponents of standardized testing dispute these claims, arguing that holding educators accountable for test results leads to the practice of "teaching to the test." Additionally, many argue that the focus on standardized testing encourages teachers to equip students with a narrow set of skills that enhance test performance without actually fostering a deeper understanding of subject matter or key principles within a knowledge domain.[25]

High-stakes testing

Main article: High-stakes testing

The assessments which have caused the most controversy in the U.S. are the use of high school graduation examinations, which are used to deny diplomas to students who have attended high school for four years, but cannot demonstrate that they have learned the required material when writing exams. Opponents say that no student who has put in four years of seat time should be denied a high school diploma merely for repeatedly failing a test, or even for not knowing the required material.[26][27][28]

High-stakes tests have been blamed for causing sickness and test anxiety in students and teachers, and for teachers choosing to narrow the curriculum towards what the teacher believes will be tested. In an exercise designed to make children comfortable about testing, a Spokane, Washington newspaper published a picture of a monster that feeds on fear.[29] The published image is purportedly the response of a student who was asked to draw a picture of what she thought of the state assessment.

Other critics, such as Washington State University's Don Orlich, question the use of test items far beyond standard cognitive levels for students' age.[30]

Compared to portfolio assessments, simple multiple-choice tests are much less expensive, less prone to disagreement between scorers, and can be scored quickly enough to be returned before the end of the school year. Standardized tests (all students take the same test under the same conditions) often use multiple-choice tests for these reasons. Orlich criticizes the use of expensive, holistically graded tests, rather than inexpensive multiple-choice "bubble tests", to measure the quality of both the system and individuals for very large numbers of students.[30] Other prominent critics of high-stakes testing include Fairtest and Alfie Kohn.

The use of IQ tests has been banned in some states for educational decisions, and norm-referenced tests, which rank students from "best" to "worst", have been criticized for bias against minorities. Most education officials support criterion-referenced tests (each individual student's score depends solely on whether he answered the questions correctly, regardless of whether his neighbors did better or worse) for making high-stakes decisions.

21st century assessment

It has been widely noted that with the emergence of social media and Web 2.0 technologies and mindsets, learning is increasingly collaborative and knowledge increasingly distributed across many members of a learning community. Traditional assessment practices, however, focus in large part on the individual and fail to account for knowledge-building and learning in context. As researchers in the field of assessment consider the cultural shifts that arise from the emergence of a more participatory culture, they will need to find new methods of applying assessments to learners.[31]

Large-scale learning assessment

Main article: Large-scale learning assessment

Large-scale learning assessments (LSLAs) are system-level assessments that provide a snapshot of learning achievement for a group of learners in a given year, and in a limited number of domains. They are often categorized as national or cross-national assessments and draw attention to issues related to levels of learning and determinants of learning, including teacher qualification; the quality of school environments; parental support and guidance; and social and emotional health in and outside schools.[32]

Assessment in a democratic school

The Sudbury model of democratic education schools do not perform and do not offer assessments, evaluations, transcripts, or recommendations. They assert that they do not rate people, and that school is not a judge; comparing students to each other, or to some standard that has been set is for them a violation of the student's right to privacy and to self-determination. Students decide for themselves how to measure their progress as self-starting learners as a process of self-evaluation: real lifelong learning and the proper educational assessment for the 21st century, they allege. [33]

According to Sudbury schools, this policy does not cause harm to their students as they move on to life outside the school. However, they admit it makes the process more difficult, but that such hardship is part of the students learning to make their own way, set their own standards and meet their own goals.

The no-grading and no-rating policy helps to create an atmosphere free of competition among students or battles for adult approval, and encourages a positive cooperative environment amongst the student body.[34]

The final stage of a Sudbury education, should the student choose to take it, is the graduation thesis. Each student writes on the topic of how they have prepared themselves for adulthood and entering the community at large. This thesis is submitted to the Assembly, who reviews it. The final stage of the thesis process is an oral defense given by the student in which they open the floor for questions, challenges and comments from all Assembly members. At the end, the Assembly votes by secret ballot on whether or not to award a diploma.[35]

Assessing ELL students

A major concern with the use of educational assessments is the overall validity, accuracy, and fairness when it comes to assessing English language learners (ELL). The majority of assessments within the United States have normative standards based on the English-speaking culture, which does not adequately represent ELL populations.[36] Consequently, it would in many cases be inaccurate and inappropriate to draw conclusions from ELL students’ normative scores. Research shows that the majority of schools do not appropriately modify assessments in order to accommodate students from unique cultural backgrounds.[36] This has resulted in the over-referral of ELL students to special education, causing them to be disproportionately represented in special education programs. Although some may see this inappropriate placement in special education as supportive and helpful, research has shown that inappropriately placed students actually regressed in progress.[36]

It is often necessary to utilize the services of a translator in order to administer the assessment in an ELL student’s native language; however, there are several issues when translating assessment items. One issue is that translations can frequently suggest a correct or expected response, changing the difficulty of the assessment item.[37] Additionally, the translation of assessment items can sometimes distort the original meaning of the item.[37] Finally, many translators are not qualified or properly trained to work with ELL students in an assessment situation.[36] All of these factors compromise the validity and fairness of assessments, making the results not reliable. Nonverbal assessments have shown to be less discriminatory for ELL students, however, some still present cultural biases within the assessment items.[37]

When considering an ELL student for special education the assessment team should integrate and interpret all of the information collected in order to ensure a non biased conclusion.[37] The decision should be based on multidimensional sources of data including teacher and parent interviews, as well as classroom observations.[37] Decisions should take the students unique cultural, linguistic, and experiential backgrounds into consideration, and should not be strictly based on assessment results.

Universal Screening

Assessment can be associated with disparity when students from traditionally underrepresented groups are excluded from testing needed for access to certain programs or opportunities, as is the case for gifted programs. One way to combat this disparity is universal screening, which involves testing all students (such as for giftedness) instead of testing only some students based on teachers’ or parents’ recommendations. Universal screening results in large increases in traditionally underserved groups (such as Black, Hispanic, poor, female, and ELLs) identified for gifted programs, without the standards for identification being modified in any way

Bill Withers

Bill Withers

William Harrison Withers Jr. (July 4, 1938 – March 30, 2020) was an American singer-songwriter and musician who performed and recorded from 1970 until 1985.[1] He recorded several major hits, including "Ain't No Sunshine" (1971), "Grandma's Hands" (1971), "Use Me" (1972), "Lean on Me" (1972), "Lovely Day" (1977), and "Just the Two of Us" (1980). Withers won three Grammy Awards and was nominated for six more. His life was the subject of the 2009 documentary film Still Bill.[1] He was inducted into the Rock and Roll Hall of Fame in 2015.[2][3] Withers worked as a professional musician for just 15 years, from 1970 to 1985, after which he moved on to other occupations.

Early life

Withers, the youngest of six children, was born in the small coal-mining town of Slab Fork, West Virginia on July 4, 1938.[4][5] He was born with a stutter and later said he had a hard time fitting in.[6] Raised in nearby Beckley, he was 13 years old when his father died.[6] Withers enlisted in the United States Navy at the age of 17,[7] and served for nine years, during which time he became interested in singing and writing songs.[8]

He left the Navy in 1965, and relocated to Los Angeles in 1967 to start a music career.[6][7] Withers worked as an assembler for several different companies, including Douglas Aircraft Corporation, while recording demo tapes with his own money, shopping them around and performing in clubs at night. When he debuted with the song "Ain't No Sunshine", he refused to resign from his job because he believed the music business was a fickle industry.[6]

Music career

Sussex records

During early 1970, Withers's demonstration tape was auditioned favorably by Clarence Avant, owner of Sussex Records. Avant signed Withers to a record deal and assigned former Stax Records stalwart Booker T. Jones to produce Withers' first album.[6] Four three-hour recording sessions were planned for the album, but funding caused the album to be recorded in three sessions with a six-month break between the second and final sessions. Just as I Am was released in 1971 with the tracks, "Ain't No Sunshine" and "Grandma's Hands" as singles. The album features Stephen Stills playing lead guitar.[9] On the cover of the album, Withers is pictured at his job at Weber Aircraft in Burbank, California, holding his lunch box.[5]

The album was a success, and Withers began touring with a band assembled from members of the Watts 103rd Street Rhythm Band.[10] Withers won a Grammy Award for Best R&B Song for "Ain't No Sunshine" at the 14th Annual Grammy Awards in 1972. The track had already sold over one million copies and was awarded a gold disc by the RIAA in September 1971.[11]

During a hiatus from touring, Withers recorded his second album, Still Bill. The single, "Lean on Me" went to number one the week of July 8, 1972. It was Withers’s second gold single with confirmed sales in excess of three million.[11] His follow-up, "Use Me" released in August 1972, became his third million seller, with the R.I.A.A. gold disc award taking place on October 12, 1972.[11] His performance at Carnegie Hall on October 6, 1972, was recorded, and released as the live album Bill Withers, Live at Carnegie Hall on November 30, 1972. In 1974, Withers recorded the album +'Justments. Due to a legal dispute with the Sussex company, Withers was unable to record for some time thereafter

During this time, he wrote and produced two songs on the Gladys Knight & the Pips record I Feel a Song, and in October 1974 performed in concert together with James Brown, Etta James, and B.B. King in Zaire four weeks prior to the historic Rumble in the Jungle fight between Foreman and Ali.[14] Footage of his performance was included in the 1996 documentary film When We Were Kings, and he is heard on the accompanying soundtrack. Other footage of his performance is included in the 2008 documentary film Soul Power.[15]

Columbia Records

After Sussex Records folded, Withers signed with Columbia Records in 1975.[16] His first album release with the label, Making Music, included the single "She's Lonely", which was featured in the film Looking for Mr. Goodbar along with "She Wants to (Get on Down)". During the next three years he released an album each year with Naked & Warm (1976), Menagerie (1977; containing the successful "Lovely Day"), and 'Bout Love (1978).[17]

Due to problems with Columbia and being unable to get songs approved for his album, he concentrated on joint projects from 1977 to 1985, including "Just the Two of Us", with jazz saxophonist Grover Washington Jr., which was released during June 1980.[18] The song won the Grammy Award for Best R&B Song.[19] Withers next released "Soul Shadows" with the Crusaders, and "In the Name of Love" with Ralph MacDonald,[20] the latter being nominated for a Grammy for vocal performance.[19]

In 1982, Withers was a featured vocalist on the album, "Dreams in Stone" by French singer Michel Berger. This record included one composition co-written and sung by Withers,[21] an upbeat disco song about New York City entitled "Apple Pie".[22]

In 1985 came Watching You Watching Me, which featured the Top 40-rated R&B single "Oh Yeah", and ended Withers’s business association with Columbia Records. Withers stated in interviews that a lot of the songs approved for the album, in particular, two of the first three singles released, were the same songs which were rejected in 1982, hence contributing significantly to the eight-year hiatus between albums.[18] Withers also stated it was frustrating seeing his record label release an album for Mr. T, an actor, when they were preventing him, an actual singer, from releasing his own. He toured with Jennifer Holliday in 1985 to promote what would be his final studio album.[18]

His disdain for Columbia's A&R executives or "blaxperts", as he termed them, trying to exert control over how he should sound if he wanted to sell more albums, played a part in his decision to not record or re-sign to a record label after 1985, effectively ending his performing career, even though remixes of his previously recorded music were released well after his 'retirement'.[6][8][23][24][25] Finding musical success later in life than most, at 32, he has said he was socialized as a 'regular guy' who had a life before the music, so he did not feel an inherent need to keep recording once he fell out of love with the industry.[6] After he left the music industry he said that he did not miss touring and performing live and did not regret leaving music behind.[6][8]

Post-Columbia career

In 1988, a new version of "Lovely Day" from the 1977 Menagerie album, entitled "Lovely Day (Sunshine Mix)" and remixed by Ben Liebrand was released. The original release had reached #7 in the UK in early 1978, and the re-release climbed higher to #4.[26]

At the 30th Annual Grammy Awards in 1988, Withers won the Grammy for Best Rhythm and Blues Song as songwriter for the re-recording of "Lean on Me" by Club Nouveau. This was Withers' third Grammy and ninth nomination.[7] Withers contributed two songs to Jimmy Buffett's 2004 release License to Chill. Following the reissues of Still Bill on January 28, 2003, and Just As I Am on March 8, 2005, there was speculation of previously unreleased material being issued as a new album.[27] In 2006, Sony gave back to Withers his previously unreleased tapes.[28] In 2007, "Lean on Me" was inducted into the Grammy Hall of Fame.[29]

At the 56th Annual Grammy Awards in 2014, Bill Withers: The Complete Sussex & Columbia Albums Collection, a nine-disc set featuring Withers's eight studio albums, as well as his live album Live at Carnegie Hall, received the Grammy Award for Best Historical Album (sharing the award with the Rolling Stones' "Charlie Is My Darling - Ireland 1965"). The award was presented to Leo Sacks, who produced the collection, and the mastering engineers, Mark Wilder, Joseph M. Palmaccio, and Tom Ruff

In 2005, Withers was inducted into the Songwriters Hall of Fame.[7] In April 2015, he was inducted into the Rock and Roll Hall of Fame by Stevie Wonder. He described the honor as "an award of attrition" and said: "What few songs I wrote during my brief career, there ain't a genre that somebody didn't record them in. I'm not a virtuoso, but I was able to write songs that people could identify with. I don't think I've done bad for a guy from Slab Fork, West Virginia."[6][31] Later that year, a tribute concert in his honor was held at Carnegie Hall featuring Aloe Blacc, Ed Sheeran, Dr. John, Michael McDonald, and Anthony Hamilton. The concert recreated Withers's 1973 concert album, Live at Carnegie Hall, along with other of his material. Withers was in attendance and spoke briefly onstage.[32][33]

In February 2017, he made an appearance on MSNBC on Joy Reid's show to talk about the refugee crisis as well as the political climate in America.[34]

Personal life and death

Withers married actress Denise Nicholas in 1973, during her stint on the sitcom Room 222.[6] The couple made headlines following reports of domestic violence.[35][36] They divorced in 1974.[37]

In 1976, Withers married Marcia Johnson. They had two children, Todd and Kori.[6] Marcia eventually assumed the direct management of his Beverly Hills–based publishing companies, in which his children also became involved as they became adults.[38]

Withers died in Los Angeles on March 30, 2020, from heart complications. His family announced his death on April 3, 2020, saying they were "devastated by the loss of our beloved, devoted husband and father

Jalandhar

Jalandhar

Jalandhar is a city in the Indian state of Punjab. Jalandhar lies alongside the Grand Trunk Road and is a well-connected rail and road junction. Jalandhar is 146 km[2] northwest of Chandigarh, the state capital of Punjab and Haryana. It was spelled 'Jullundur' during the British period

The history of Jalandhar District comprises three periods — ancient, medieval and modern.

The city may be named after Jalandhara, a demon king, who is named in the Puranas and Mahabharata. Other possibilities include that it was the capital of the kingdom of Lava, son of Rama or that the name derives from the vernacular term Jalandhar, meaning area inside the water, i.e., tract lying between the two rivers Satluj and Beas.[4] The whole of Punjab and the area of present Jalandhar District was part of the Indus Valley Civilization. Harappa and Mohenjo-daro are the sites where remains of the Indus Valley Civilization have been found extensively. The archaeological explorations made during recent years have pushed the ancient times of Jalandhar District of Harappa period. Jalandhar was ruled by King Arjan Singh.[5]

Jalandhar was conquered by the Ghaznavids during the reign of Ibrahim of Ghazni between 1058–89.[6] It later formed part of the province of Lahore during the Delhi Sultanate and Mughal Empire. The 18th century saw upheaval in Jalandhar amidst an anarchy caused by the disintegration of the Mughals and power struggles involving Persians, Afghans and Sikhs. It was captured by the Faizullahpuria Misl in 1766, and in 1811 Ranjit Singh incorporated it within the Sikh Empire.[7]

In 1849, following the annexation of the Punjab by the East India Company, the city of Jalandhar, now spelt Jullundur, became the headquarters of the Division and District of the same name. In the mid 19th century, British officials regarded Jalandhar as densely populated and farmed to capacity. This led to the district being a chief recruitment area for settlers to colonise the newly irrigated Punjab Canal Colonies in western Punjab.[8]

The Khilafat Movement started in the district in early 1920 to bring pressure on the government to change their policy towards Turkey. Mahatma Gandhi extended sympathy and support to this movement however in response the District was declared a 'Proclaimed Area' under the Seditious Meetings Act. In 1924, Pakistani general and military dictator Muhammad Zia-ul-Haq was born in the city.

The Partition of India in 1947 saw Jalandhar become part of the new dominion of India. The resulting rioting and violence caused by Partition led to major demographic change in the district, with the exodus of the large Muslim population and the arrival of Hindus and Sikhs from newly created Pakistan

Commerce

Religious places

Famous Religious places of worship

Akshardham Mandir Surya Enclave

Arya samaj mandir, Basti Danishmanda

Baba Khaki Shah (Khurla Kingra)

Baba Lal dayal Mandir, Basti Guzan

Baba Lal dayal Mandir, Partapbagh

Chishti Qadri Darbar Hazrat Ghous Pak Ji Peeran De Peer

Church of North India (CNI) Mission Compound

Darbaar Panj Peer Ji (Near Ravidas Chowk)

Darbar Baba Peer Phalai Wala Ji

Darbar Baba Sunehri Sai Ji (Abadi Jallowal)

Darbar Peer Sakhi Sultan

Darbar Sachi Sarkar Lakha Da (Bootan Mandi, Jalandhar-Nakodar Road)

Darbar Sajjad Peer Warish Shah Ji (Hardyal Nagar)

Durga Mandir Near Ambedkar Chowk, Avtar Nagar

Durga Shakti Mandir (Deol Nagar)

Ebenezer Assembly of God Church (English/Hindi Services)

Geeta Mandir Adarsh Nagar

Geeta mandir Model town

Geeta mandir, Central Town

Gurduwara Thra Sahib (Hazara Village)

Gurdwara Chhevin Pathshahi

Gurdwara Panj Tirth Sahib (Jandu Singha)

Guru Ravidass Dham (Bootan Mandi)

Gurdwara Guru Tegh Bahadur Nagar[14]

Gurudwara Asapuran (Tagore nagar)

Gurudwara Kakipind Rama mandi

Gurudwara Makhdoompura

Gurudwara Nauwi Patshahi

Gurudwara Singh Sabha (Jalandhar Cantt)

Gurudwara Singh Sabha-Model Town

Gurudwara Talhan Sahib

Hanuman garhi mandir jaggu chowk

Hanuman Mandir, ali mohalla

Imam Nasir Mausoleum and Jamma Masjid

Jama Masjid asgar Hussain Muslim colony Jaimal Nagar

Jama Masjid Imam Nasir Gud Mandi chowk

Kali Mata Mandir Mahaver marg

Masjid Dakoha Talhaan Rd Kaki Pind

Masjid Umme Salmaa (Bootan Mandi)

Mata Chintapurni Mandir

Mata Rani Temple

Mata Vaishno Devi Mandir

Mayaan da Gurudwara (Jalandhar Cantt)

Om Divya Prem Mandir, Danishmanda

Panch Mukhi Shiv Mandir

Panchvati Temple

Radha Soami Satsang Beas,(Mission Compound Jalandhar)

Radhye sham Mandir &dharamshala

Raghuth Mandir

Ram Mandir, Pucca bagh

Sanatan Daram Mandir

Sankat Mochan Hanuman Mandir (phillar tehsil)

Sati Mata Mandir

Sati Virinda Devi

Satya rayan Mandir

Shiv Bari Mandir

Shiv Mandir

Shree Guru Ravidass Mandir (New), Basti Danishmanda

Shree Guru Ravidass mandir(old), near Peelee kothi basti danishmanda

Shri Ayyapa Mandir

Shri Baba Balak nath Ji Mandir

Shri Balmiki Mandir

Shri Dasjee Guru Mandir

Shri Devi Talab Mandir

Shri Mahalakshmi Mandir

Shri Mukteshwar Mandir, Basti Guzan

Shri Pramhans Adhiwait Mandir

Shri Ram Sarovar Mandir

Shri Siddh Baba Sodal

Shri Sidh Baba Keshav Nath Mandir (Jathere), Guru Ram Dass Enclave

Sree Ayyappa Mandir, Guru Gobind Singh Avenue

St Mary's Cathedral Church (Jalandhar Cantt)

Tulsi Mandir

Tripurmalni Mata Mandir

Viyak Mandir

Yogeshwer Dham Mandir

Leisure

Pushpa Gujral Science City

Company Bagh

Niku Park, Model Town

Model Town Market

Wonder Land[15]

Adarsh Nagar Park

Saraswati Vihar

PVR, MBD Neopolis, BMC Chowk

Big Bazaar, Vasal Tower

PVR, Curo Highstreet

Jyoti Market

Jang-e-Azadi Memorial Museum at kartarpur

Viva Collage

LPU Mart

Rangla Punjab

The Regent Park Hotel

Curo High Street Mall

Media

Doordarshan Kendra, Jalandhar is an Indian television station in Jalandhar, owned and operated by state-owned Doordarshan, the television network of Prasar Bharati (Broadcasting Corporation of India).[16] It was established in 1979 and produces and broadcasts the 24-hour Punjabi language TV channel, DD Punjabi, which was launched in 1998 and covers most of the state of Punjab, India.

The city is the region's headquarters for newspapers, national television and radio stations. These include Daily Ajit, Jagbani, Punjab Kesari, Dainik Bhaskar, Dainik Jagran, Hindustan Times, The Tribune, Hind Samachar, etc.[17][18][19][20] http://bbcnews7.com

State-owned All India Radio has a local station in Jalandhar that transmits programs of mass interest. FM local radio stations include:

Radio city 91.9 MHz

BIG FM 92.7 92.7 MHz

94.3 FM-My Fm- 94.3 MHz

Radio Mirchi 98.3 MHz

All India Radio 102.7 MHz

Healthcare

There are excellent medical facilities in Jalandhar which include treatment centers and specialist hospitals. The Municipal Corporation of Jalandhar claims that the city has over 423 hospitals,[citation needed] a claim that would make it the city with the highest number of hospitals in South Asia.

Sports

Cricket

Cricket is very popular in grounds and streets of the city. There is an international-standard stadium at Burlton Park. The Indian cricket team played a Test Match against the Pakistan cricket team on this ground on 24 September 1983.

Kabaddi

Major Kabaddi matches are usually held at Guru Gobind Singh Stadium.

Guru Gobind Singh Stadium

Guru Gobind Singh Stadium is a multi-purpose stadium in Jalandhar. It is usually used mostly for football matches and is the home stadium of JCT Mills Football Club. People can be seen jogging, playing soccer, weight-lifting, etc. in the stadium most of the time. The Punjab government has started new projects at the stadium.

Surjit Hockey Stadium

Surjeet Hockey Stadium is a field hockey stadium in Jalandhar, Punjab, India. It is named after Jalandhar-born Olympian Surjit Singh. This stadium is home of the franchise Sher-e-Punjab of the World Series Hockey.

Sports college

There is a Government Sports College in the city and it is a focus for many of the National Sports Councils. In this college, many sports are played like cricket, hockey, swimming, volleyball, basketball, etc.

عصية كالميت غيران

عصية كالميت غيران

عُصية كالميت غيران كما تعرف باختصارها بي سي جي (Bacillus Calmette–Guérin BCG) وهو لقاح ضد الـسل و يستخدم كعلاج لبعض سرطانات المثانة.

سمي هذا اللقاح بهذا الاسم نسبة إلى مخترعيها ألبرت كالميت وكميل غيران.

يتم تحضير اللقاح من الذرية الموهنة (مضعفة الفوعية) لعصية السل البقري الحية (المتفطرة البقرية) التي فقدت فوعيتها في الإنسان. تسعى العُصية الحية للاستغلال الأمثل للغداء المتوفر لها، ولذلك فعندما تدخل مضيفًا بشريًا تصبح أقل تكيفا في دم الإنسان وتفقد قدرتها على إحداث مرض. ومع ذلك فالعصيّة تشبه أسلافها البرية في توفير درجة من المناعة ضد السل البشري. فعالية لقاح بي سي جي تتفاوت من 0٪ و حتى 80٪ في منع السل (الدرن) لمدة 15 عاما. ومع ذلك يظهر أن تأثير الحصانة يختلف تبعا للمنطقة الجغرافية و المعمل الذي نمت فيه الذرية.

يتواجد اللقاح في قائمة منظمة الصحة العالمية للأدوية الأساسية، و هي قائمة بأهم الأدوية المحتاجة بصورة أساسية في نظام رعاية صحية.

الاستخدامات الطبية

يستخدم لقاح بي سي جي بصورة أساسية ضد السل (الدرن). و يمكن إعطاؤه بعد الولاد عن طريق حقنة الجلد، و هي الطريقة الموصى بها. اللقاح قادر على إحداث نتيجة إيجابية خاطئة من اختبار مانتوكس بالرغم من أن القراءة العالية غالبا ما تكون بسبب مرض نشط.

توقيت إعطاء اللقاح بالنسبة لعمر المريض و تكراره يختلف دائما من دولة لأخرى.

قوانين منظمة الصحة العالمية: منظمة الصحة العالمية توصي بإعطاء لقاح بي سي جي لكل الأطفال المولودين في الدول التي لديها سل شديد التوطن لحمايتهم من السل الدخني و التهاب السحايا السلي.

الولايات المتحدة: لم تستخدم الولايات المتحدة التطعيم الجماعي للقاح بي سي جي، و تعتمد بدلا عنه على اكتشاف و علاج عدوى السل الكامن.

فرنسا: كان لقاج بي سي جي مفروضا على الأطفال المدرسة في الفترة بين 1950 و2007 م ، و على مقدمي الرعياة الصحية في الفترة 1947 و 2010م. ومازال التطعيم متوفرا لمقدمي الرعاية الصحية الفرنسيين و الأخصائيين الاجتماعيين بناءا على حالة الفرد الشخصية.

المملكة المتحدة: قدمت المملكة المتحدة التطعيم بلقاح بي سي جي العالمي في عام 1953م. و حتى شهر يوليو 2005 لتطعيم أطفال المدارس في العمر بين 10 و 14 سنة، و جميع حديثي الولادة في المجموعات المعرضة للخطر. حيث كانت تعطى حقنة القاح مرة واحدة في حياة الفرد (حيث لا يوجد دليل يثبت فاعلية أكثر من تطعيمة لإضافة مزيد من الحماية). و يعطى أيضا لحماية الذين تعرضوا للسل من قبل. كما أن ذروة حدوث السل في مرحلة المراهقة و بداية مرحلة البلوغ، وأظهرت دراسة MRC أن فاعلية اللقاح تستمر لمدة 15 عاما كحد أقصى. و قد ألغي التطعيم الروتيني بلقاح بي سي جي لأطفال المدارس في يوليو 2005م بسبب قلة الفاعلية. في عام 1953م كان يتطلب تطعيم 94 طفلا لمنع حالة واحدة من السل، بينما في عام 1988م انخفض كثيرا المعدل السنوي للمصابين بالسل بحيث يتطلب تطعيم 12000 طفل لمنع حالة واحدة من السل.

الهند و باكستان: قدمت الهند و باكستان التطعيم الجماعي بلقاح بي سي جي في عام 1948م، كأول الدول التي تقوم بذلك خارج أوروبا.

البرازيل: قدمت البرازيل تطعيم بي سي جي العالمي في عام 1967 ـ 1968م و حتى الآن. و اعتمادا على النظام البرازيلي، يعطى لقاح بي سي جي للعاملين في المجال الصحي و الأشخاص المخالطين لمرضى السل أو الجذام.

النرويج: في النرويج كان الأخد بلقاح بي سي جي إلزاميا في الفترة 1947ـ1995م . وما زال متوفرا و يُنصح به للمجموعات المعرضة للخطر.

جنوب أفريقيا: في جنوب أفريقيا، يُعطى لقاح بي سي جي بشكل روتيني عند الولادة لجميع حديثي الولادة و يستثنى من لديهم أعراض الإصابة بمرض نقص المناعة المكتسبة. و يعطى بالجهة اليمنى من الكتف في الجسم.

وسط و جنوب أمريكا: معظم الدول في وسط و جنوب أمريكا لديها تطعيم شامل بلقاح بي سي جي. ففي الإكوادور لا يُعطى الطفل شهادة الميلاد دون أخد تطعيمة لقاح بي سي جي في السجل الطبي مع بقية التطعيمات الأخرى.

منغوليا: جميع حديثي الولادة يتم تطعيمهم بلقاح بي سي جي. في السابق كان يُعطى اللقاح أيضا عند عمر 8 سنوات و15 سنة لكن هذا لم يعد ممارسا الآن.

دول أخرى: في بعض الدول مثل الاتحاد السوفيتي السابق كان اللقاح يعطي بصورة منتظمة مدى الحياة. و في كوريا الجنوبية و سنغافورة و تايوان و ماليزيا يُعطى اللقاح عند الولادة ومرة أخرى في عمر 12 سنة. لكن تغيرت الأنظمة عام 2001م في ماليزيا و سنغافورة ليُعطى مرة واحدة فقط عند الولادة. كما أن كوريا الجنوبية أوقفت إعادة التطعيم في عام 2008م.

طريقة إعطاء اللقاح

يجب إجراء اختبار التوبركولين للجلد قبل إعطاء اللقاح. تفاعل اختبار التوبركولين للجلد يعتبر من موانع إعطاء اللقاح، بسبب الخطر العالي للالتهاب الموضعي الشديد و ظهور الندبات و ليس بسبب الاعتقاد الشائع الخاطئ بأن مفاعلات التوبركولين "مكتسب المناعة مسبقا" و لذلك لا يحتاجون للقاح. و يجب فحص الأشخاص الذين لديهم تفاعل اختبار التوبركولين لمرض الـسل النشط.

يُعطى لقاح بي سي جي حقنة واحدة في الـأدمة في مغرز الـعضلة مثلثة. في حال أُعطي اللقاح كحقن تحت الجلد، فقد يشكل الخُراج موضعي ما يعرف بـ(ورم بي سي جي) وقد يتقرح مما يحتاج للعلاج بالمضاد الحيوي عاجلا وإلا قد تنتشر العدوى مسببة الضرر الشديد لأعضاء حيوية أخرى. ومع ذلك فمن المهم التنبيه على أن وجود الخراج دليل على خطأ في إعطاء الحقنة، و تعتبر من المضاعفات الشائعة التي تحدث مع التطعيم. أجريت العديد من الدراسات عن علاج هذه الخراجات بالمضادات الحيوية وكانت نتائجها متباينة و لكنها تتفق على أنه إذا تم شفط القيح و تحليله وتبيّن عدم وجود عُصيات غير عادية فإن الخراج بشكل عام سوف يلتئم من تلقاء نفسه في غضون أسابيع.

تستخدم الندبة المميزة لتطعيم بي سي جي غالبا كدليل على المناعة المسبقة. كما يجب التفريق بين هذه الندبة وندبة تطعيمة الجدري التي تشبهها.

استخدامات أخرى

المتفطرات

الجذام: يتميز لقاح بي سي جي بخاصية الحماية ضد الجذام بنسبة 26٪-41٪ بناء على دراسات محكمة. يبلغ تأثير الحماية نسبة أعلى نوعا ما في دراسات الحالات و الشواهد و دراسات الأتراب إذ تصل إلى حوالي 60٪ تقريبا ومع ذلك لا يستخدم اللقاح بشكل خاص للتحكم بالجذام.

قرحة بورولي: لقاح بي سي جي قد يحمي أو يؤخر حدوث قرحة بورولي.

العلاج المناعي للسرطان

عدد من لقاحات السرطان تستخدم لقاح بي سي جي كلقاح مساعد لإعطاء تحفيز مبدئي للجهاز المناعي في جسم الإنسان.

يستخدم لقاح بي سي جي في علاج أنواع من سرطان المثانة السطحي. منذ أواخر 1970م توفرت الأدلة بأن تستيل اللقاح في المثانة نوع مؤثر من أنواع الـعلاج مناعي لهذا المرض. لم تتضح الآلية بعد لكن يظهر أن التفاعل المناعي الموضعي ينصب على الورم. العلاج المناعي مع لقاح بي سي جي يمنع نكسة حالات سرطان المثانة السطحي بنسبة تصل إلى 67٪.

سرطان القولون

سرطان الرئة[21][21][21][21]

ورم ميلانيني[22][22][22][22]

MPNST 

الساركويد الخيلي ( في الخيول)

الشكري النمط الأول

سكري النمط الأول: استخدمت الدراسات الطبية المبنية على عمل Denise Faustman لقاح بي سي جي لتحفيز إنتاج عامل نخر الورم ألفا، و الذي يستطيع قتل الخلايا التائية المسؤولة عن السكري النمط الأول. في المرحلة الأولى من الدراسة (مزدوجة التعمية، المراقبة بغُفّال) أعطيت جرعتان من اللقاح لثلاث من مرضى السكري النمط الأول المزمن من البالغين ونتج عنه التخلص من خلايا البنكرياس الضارة و تحفيز الخلايا التائية المُنظِّمة و ارتفاع مؤقت في إفراز الإنسولين.

النجاعة

أكثر الجوانب تضاربًا في لقاح بي سي جي هي تباين أثره بين مختلف الدراسات الطبية و التي يظهر أنها تعتمد على الجغرافيا. إذ أن الدراسات التي أجريت في المملكة المتحدة أظهرت تأثير اللقاح في الحماية بنسبة 60٪ ـ 80٪، و لكن الدراسات التي أجريت في أماكن أخرى أظهرت عدم وجود أثر له في الحماية. و يظهر أن التأثير يقل كلما اقترب المرء إلى خط الاستواء.

وجدت دراسة منهجية في عام 1994 أن لقاح بي سي جي يقلل خطر السل بنسبة 50٪ مع وجود الاختلاف في تأثير اللقاح تبعا للمنطقة الجغرافية نظرا لعوامل مثل الاختلاف الجيني في السكان و التغييرات في البيئة و التعرض لالتهابات بكتيرية أخرى و حالات أخرى في المعمل الذي ينمو فيه اللقاح بما فيها الاختلافات الجينية للذرية المستنبتة و وسط النمو.

أجريت دراستان: دراسة منهجية، و أخرى تحليلية عليا عام 2014 لتثبت أن لقاح بي سي جي قلل العدوى بنسبة 19٪ ـ 27٪ و قلل تطورها إلى سل نشط بنسبة 71٪. الدراسات المضمنة في هذه الدراسة محدودة بالتي استخدمت Interferon gamma release assay.

مدة حماية لقاح بي سي جي ليست معروفة بشكل واضح، إذ أن الدراسات التي أكّدت دوره الإيجابي لا تتفق في مدة الحماية. دراسة MRC أظهرت نسبة حماية 59٪ بعد 15 عام، و 0٪ بعد 20عام. و في دراسة أجريت على الأمريكيين الأصليين تم تطعيمهم في 1930م وجدت أنه و بعد 60 عام من التطعيم أثر للحماية مع انحسار طفيف في الفعالية.

يبدو أن تأثير لقاح بي سي جي الأكبر في منع السل الدخني أو التهاب السحايا السلي. لذا ما زال يستخدم بكثرة حتى في الدول التي يظهر تأثيره ضد السل الرئوي منعدمًا.

الآثار الضارة

التطعيم بلقاح بي سي جي يسبب بعض الألم و الندبات في مكان الحقن. من أهم المضاعفات هو الجدرة - الندبات الكبيرة البارزة في الجلد. الحقن في مكان العضلة الدالية من أكثر الأماكن في الجسم لقلة معدل المضاعفات. أيضا يمكن استخدام الألية كمكان بديل لحقن اللقاح لنتائج تجميلية أكثر.

يجب إعطاء لقاح بي سي جي حقنة داخل الأدمة، ولو أعطي تحت الجلد فقد يسبب عدوى موضعية تنتشر للعقد اللمفية الناحيّة مسببة التهاب العقد المفية القيحي و غير القيحي. و يكتفى بالعلاج التحفظي لالتهاب العقد المفية غير القيحي. أما عند وجود القيح، فقد يحتاج شفط بالإبرة. و للحالات التي لا يبرأ فيها فيُلجئ حينئذ للاستئصال الجراحي وليس فتح القيح . و من غير المألوف أن يكون خراج الثدي أو الألية بسبب دموي المنشأ أو من الوعاء اللمفي. عدوى العظام الناحية ( التهاب العظم و النقي أو التهاب العظم من لقاح بي سي جي) و عدوى لقاح بي سي جي المنتشرة تعتير من المضاعفات النادرة للتطعيم و لكنها مهددة للحياة. و قد يساعد علاج مضاد السل في المضاعفات الشديدة.

التحضير

يتم تحضير الذرية الموهنة من عصية السل البقري، حيث تزرع ثانويا المتفطرة البقرية في مُستنبت و غالبا ما يكون وسط مدلبروك 7H9.

البحث

وجد بحث حديث أجرته كلية لندن الإمبراطورية بروتينات جديدة للجدار الخلوي تثير استجابة مناعية واستخدامها مناسب كلقاح طويل الأمد ضد متفطرة السل. أظهرت الدراسة عدد قليل من هذه البروتينات و منها الذي سُمّي بـ EspC و الذي يتسبب في ردة فعل مناعية قوية وهي خاصة بمتفطرة السل.

البراهين الأولية تشير إلى أثر غير محدد للقاح بي سي جي في تقليل الوفيات في الدول ذات الدخل المنخفض، أو في تقليله مشاكل صحية أخرى بما في ذلك إنتان الدم و التهابات الجهاز التنفسي عند إعطائه في وقت مبكر مع أن الفاعلية الأكثر تزداد كلما استخدم في وقت أبكر.

BCG vaccine

BCG vaccine

Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB).[1] In countries where tuberculosis or leprosy is common, one dose is recommended in healthy babies as close to the time of birth as possible.[1] In areas where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated.[1] Adults who do not have tuberculosis and have not been previously immunized but are frequently exposed may be immunized as well.[1] BCG also has some effectiveness against Buruli ulcer infection and other nontuberculous mycobacteria infections.[1] Additionally it is sometimes used as part of the treatment of bladder cancer.[2][3]

Rates of protection against tuberculosis infection vary widely and protection lasts up to twenty years.[1] Among children it prevents about 20% from getting infected and among those who do get infected it protects half from developing disease.[4] The vaccine is given by injection into the skin.[1] Additional doses are not supported by evidence.[1]

Serious side effects are rare. Often there is redness, swelling, and mild pain at the site of injection.[1] A small ulcer may also form with some scarring after healing.[1] Side effects are more common and potentially more severe in those with poor immune function.[1] It is not safe for use during pregnancy.[1] The vaccine was originally developed from Mycobacterium bovis, which is commonly found in cows.[1] While it has been weakened, it is still live.[1]

The BCG vaccine was first used medically in 1921.[1] It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.[5] Between 2011 and 2014 the wholesale price was US$0.16 to US$1.11 a dose in the developing world.[6][7] In the United States it costs US$100 to US$200.[8] As of 2004 the vaccine is given to about 100 million children per year globally.[9]

The main use of BCG is for vaccination against tuberculosis. BCG vaccine can be administered after birth intradermally.[10] BCG vaccination can cause a false positive Mantoux test, although a very high-grade reading is usually due to active disease.

The most controversial aspect of BCG is the variable efficacy found in different clinical trials, which appears to depend on geography. Trials conducted in the UK have consistently shown a protective effect of 60 to 80%, but those conducted elsewhere have shown no protective effect, and efficacy appears to fall the closer one gets to the equator.[11][12]

A 1994 systematic review found that BCG reduces the risk of getting TB by about 50%.[11] There are differences in effectiveness, depending on region, due to factors such as genetic differences in the populations, changes in environment, exposure to other bacterial infections, and conditions in the lab where the vaccine is grown, including genetic differences between the strains being cultured and the choice of growth medium.[13][14]

A systematic review and meta analysis conducted in 2014 demonstrated that the BCG vaccine reduced infections by 19–27% and reduced progression to active TB by 71%.[15] The studies included in this review were limited to those that used interferon gamma release assay.

The duration of protection of BCG is not clearly known. In those studies showing a protective effect, the data are inconsistent. The MRC study showed protection waned to 59% after 15 years and to zero after 20 years; however, a study looking at Native Americans immunized in the 1930s found evidence of protection even 60 years after immunization, with only a slight waning in efficacy.[16]

BCG seems to have its greatest effect in preventing miliary TB or TB meningitis, so it is still extensively used even in countries where efficacy against pulmonary tuberculosis is negligible.[17]

Efficacy

A number of possible reasons for the variable efficacy of BCG in different countries have been proposed. None have been proven, some have been disproved, and none can explain the lack of efficacy in both low-TB burden countries (US) and high-TB burden countries (India). The reasons for variable efficacy have been discussed at length in a World Health Organization (WHO) document on BCG.[18]

Genetic variation in BCG strains: Genetic variation in the BCG strains used may explain the variable efficacy reported in different trials.[19]

Genetic variation in populations: Differences in genetic make-up of different populations may explain the difference in efficacy. The Birmingham BCG trial was published in 1988. The trial, based in Birmingham, United Kingdom, examined children born to families who originated from the Indian Subcontinent (where vaccine efficacy had previously been shown to be zero). The trial showed a 64% protective effect, which is very similar to the figure derived from other UK trials, thus arguing against the genetic variation hypothesis.[20]

Interference by nontuberculous mycobacteria: Exposure to environmental mycobacteria (especially Mycobacterium avium, Mycobacterium marinum and Mycobacterium intracellulare) results in a nonspecific immune response against mycobacteria. Administering BCG to someone who already has a nonspecific immune response against mycobacteria does not augment the response already there. BCG will, therefore, appear not to be efficacious because that person already has a level of immunity and BCG is not adding to that immunity. This effect is called masking because the effect of BCG is masked by environmental mycobacteria. Clinical evidence for this effect was found in a series of studies performed in parallel in adolescent school children in the UK and Malawi.[21] In this study, the UK school children had a low baseline cellular immunity to mycobacteria which was increased by BCG; in contrast, the Malawi school children had a high baseline cellular immunity to mycobacteria and this was not significantly increased by BCG. Whether this natural immune response is protective is not known.[22] An alternative explanation is suggested by mouse studies; immunity against mycobacteria stops BCG from replicating and so stops it from producing an immune response. This is called the block hypothesis.[23]

Interference by concurrent parasitic infection: In another hypothesis, simultaneous infection with parasites changes the immune response to BCG, making it less effective. As Th1 response is required for an effective immune response to tuberculous infection, concurrent infection with various parasites produces a simultaneous Th2 response, which blunts the effect of BCG.[24]

Mycobacteria

BCG has protective effects against some non-tuberculosis mycobacteria.

Leprosy: BCG has a protective effect against leprosy in the range of 20 to 80%.[1]

Buruli ulcer: BCG may protect against or delay the onset of Buruli ulcer.[1][25]

Cancer

BCG has been one of the most successful immunotherapies.[26] BCG vaccine has been the "standard of care for patients with bladder cancer (NMIBC)" since 1977.[26][27] By 2014 there were more than eight different considered biosimilar agents or strains used for the treatment of non–muscle-invasive bladder cancer (NMIBC).[26] [27]

A number of cancer vaccines use BCG as an additive to provide an initial stimulation of the person's immune systems.

BCG is used in the treatment of superficial forms of bladder cancer. Since the late 1970s, evidence has become available that instillation of BCG into the bladder is an effective form of immunotherapy in this disease.[28] While the mechanism is unclear, it appears a local immune reaction is mounted against the tumor. Immunotherapy with BCG prevents recurrence in up to 67% of cases of superficial bladder cancer.

BCG has been evaluated in a number of studies as a therapy for colorectal cancer.[29] The US biotech company Vaccinogen is evaluating BCG as an adjuvant to autologous tumour cells used as a cancer vaccine in stage II colon cancer.

Method of administration

Except in neonates, a tuberculin skin test should always be done before administering BCG. A reactive tuberculin skin test is a contraindication to BCG. Someone with a positive tuberculin reaction is not given BCG, because the risk of severe local inflammation and scarring is high, not because of the common misconception that tuberculin reactors "are already immune" and therefore do not need BCG. People found to have reactive tuberculin skin tests should be screened for active tuberculosis. BCG is also contraindicated in certain people who have IL-12 receptor pathway defects.

BCG is given as a single intradermal injection at the insertion of the deltoid. If BCG is accidentally given subcutaneously, then a local abscess may form (a "BCG-oma") that can sometimes ulcerate, and may require treatment with antibiotics immediately, otherwise without treatment it could spread the infection causing severe damage to vital organs. An abscess is not always associated with incorrect administration, and it is one of the more common complications that can occur with the vaccination. Numerous medical studies on treatment of these abscesses with antibiotics have been done with varying results, but the consensus is once pus is aspirated and analysed, provided no unusual bacilli are present, the abscess will generally heal on its own in a matter of weeks.[30]

The characteristic raised scar that BCG immunization leaves is often used as proof of prior immunization. This scar must be distinguished from that of smallpox vaccination, which it may resemble.

Adverse effects

BCG immunization generally causes some pain and scarring at the site of injection. The main adverse effects are keloids—large, raised scars. The insertion of deltoid is most frequently used because the local complication rate is smallest when that site is used. Nonetheless, the buttock is an alternative site of administration because it provides better cosmetic outcomes.

BCG vaccine should be given intradermally. If given subcutaneously, it may induce local infection and spread to the regional lymph nodes, causing either suppurative and nonsuppurative lymphadenitis. Conservative management is usually adequate for nonsuppurative lymphadenitis. If suppuration occurs, it may need needle aspiration. For nonresolving suppuration, surgical excision may be required. Evidence for the treatment of these complications is scarce.[31]

Uncommonly, breast and gluteal abscesses can occur due to haematogenous and lymphangiomatous spread. Regional bone infection (BCG osteomyelitis or osteitis) and disseminated BCG infection are rare complications of BCG vaccination, but potentially life-threatening. Systemic antituberculous therapy may be helpful in severe complications.[32]

If BCG is accidentally given to an immunocompromised patient (e.g., an infant with SCID), it can cause disseminated or life-threatening infection. The documented incidence of this happening is less than one per million immunizations given.[33] In 2007, The World Health Organization (WHO) stopped recommending BCG for infants with HIV, even if there is a high risk of exposure to TB,[34] because of the risk of disseminated BCG infection (which is approximately 400 per 100,000 in that higher risk context).[35][36]

Usage

The age of the person and the frequency with which BCG is given has always varied from country to country. The World Health Organization (WHO) currently recommends childhood BCG for all countries with a high incidence of TB and/or high leprosy burden.[1] This is a partial list of historic and current BCG practice around the globe. A complete atlas of past and present practice has been generated.[37]

Americas

United States: The US has never used mass immunization of BCG, relying instead on the detection and treatment of latent tuberculosis.

In the Canadian province of Quebec, the BCG vaccine was provided to children until the early 1960s.[citation needed]

Most countries in Central and South America have universal BCG immunizations. In Ecuador, a child cannot receive their birth certificate without having the BCG vaccine in their medical record along with other vaccinations.[38]

Brazil introduced universal BCG immunization in 1967–1968, and the practice continues until now. According to Brazilian law, BCG is given again to professionals of the health sector and to people close to patients with tuberculosis or leprosy.

Europe

France: The BCG was mandatory for school children between 1950 and 2007,[39][40] and for healthcare professionals between 1947 and 2010. Vaccination is still available for French healthcare professionals and social workers but is now decided on a case-by-case basis.[41]

Italy: BCG mass vaccination has never been performed in Italy. [37]

Norway: In Norway the BCG vaccine was mandatory from 1947 to 1995. It is still available and recommended for high-risk groups.[42]

Spain: Past national BCG vaccination policy for all from 1965 to 1981. [37]

United Kingdom: The UK introduced universal BCG immunization in 1953. From then until July 2005, UK policy was to immunize all school children aged between 10 and 14 years of age, and all neonates born into high-risk groups. The injection was given only once during an individual's lifetime (as there is no evidence of additional protection from more than one vaccination). BCG was also given to protect people who had been exposed to tuberculosis. The peak of tuberculosis incidence is in adolescence and early adulthood, and an MRC trial showed efficacy lasted a maximum of 15 years.[43] Routine immunization with BCG for all school children was scrapped in July 2005 because of falling cost-effectiveness: whereas in 1953, 94 children would have to be immunized to prevent one case of TB, by 1988, the annual incidence of TB in the UK had fallen so much, 12,000 children would have to be immunized to prevent a single case of TB.[44] The vaccine is still given to at risk healthcare professionals.[45]

Former Soviet Union. BCG was given regularly throughout life.[citation needed]

Bulgaria: The BCG vaccine is mandatory to babies and kids since 1951.[46]

Asia

South Korea, Singapore, Taiwan and Malaysia. In these countries, BCG was given at birth and again at age 12. In Malaysia and Singapore from 2001, this policy was changed to once only at birth. South Korea stopped re-vaccination in 2008.

Hong Kong: BCG is given to all newborns.[47]

Japan: In Japan, BCG was introduced in 1951, given typically at age 6. From 2005 it is administered between five and eight months after birth, and no later than a child's first birthday. BCG was administered no later than the fourth birthday until 2005, and no later than six months from birth from 2005 to 2012; the schedule was changed in 2012 due to reports of osteitis side effects from vaccinations at 3–4 months. Some municipalities recommend an earlier immunization schedule.[48]

Thailand: In Thailand, the BCG vaccine is given routinely at birth.[49]

India and Pakistan: India and Pakistan introduced BCG mass immunization in 1948, the first countries outside Europe to do so.[50]

Mongolia: All newborns are vaccinated with BCG. Previously, the vaccine was also given at ages 8 and 15, although this is no longer common practice.[citation needed]

Philippines: BCG vaccine started in the Philippines in 1979 with the Expanded Program on Immunization.

Sri Lanka: In Sri Lanka, The National Policy of Sri Lanka is to give BCG vaccination to all newborn babies immediately after birth. BCG vaccination is carried out under the Expanded Programme of Immunisation (EPI).[51]

Africa

South Africa: In South Africa, the BCG Vaccine is given routinely at birth, to all newborns, except those with clinically symptomatic AIDS. The vaccination site in the right shoulder.[52]

South Pacific

Australia: BCG is not part of routine vaccination[53].

New Zealand: BCG Immunisation was first introduced for 13 yr olds in 1948. Vaccination was phased out 1963–1990. [37]

Manufacture

BCG is prepared from a strain of the attenuated (virulence-reduced) live bovine tuberculosis bacillus, Mycobacterium bovis, that has lost its ability to cause disease in humans. Because the living bacilli evolve to make the best use of available nutrients, they become less well-adapted to human blood and can no longer induce disease when introduced into a human host. Still, they are similar enough to their wild ancestors to provide some degree of immunity against human tuberculosis. The BCG vaccine can be anywhere from 0 to 80% effective in preventing tuberculosis for a duration of 15 years; however, its protective effect appears to vary according to geography and the lab in which the vaccine strain was grown.[13]

A number of different companies make BCG, sometimes using different genetic strains of the bacterium. This may result in different product characteristics. OncoTICE, used for bladder instillation for bladder cancer, was developed by Organon Laboratories (since acquired by Schering-Plough, and in turn acquired by Merck & Co.). Pacis BCG, made from the Montréal (Institut Armand-Frappier) strain,[54] was first marketed by Urocor in about 2002. Urocor was since acquired by Dianon Systems. Evans Vaccines (a subsidiary of PowderJect Pharmaceuticals). Statens Serum Institut in Denmark markets BCG vaccine prepared using Danish strain 1331.[55] Japan BCG Laboratory markets its vaccine, based on the Tokyo 172 substrain of Pasteur BCG, in 50 countries worldwide.

According to a UNICEF report published in December 2015 on BCG vaccine supply security, global demand increased in 2015 from 123 to 152.2 million doses. In order to improve security and to [diversify] sources of affordable and flexible supply," UNICEF awarded seven new manufacturers contracts to produce BCG. Along with supply availability from existing manufacturers, and a "new WHO prequalified vaccine" the total supply will be "sufficient to meet both suppressed 2015 demand carried over to 2016, as well as total forecast demand through 2016-2018."[56]

Supply shortage

In the fall of 2011, the Sanofi Pasteur plant flooded causing problems with mold.[57] The facility, located in Toronto, Ontario, Canada, produced BCG vaccine products, made with substrain Connaught, such as a tuberculosis vaccine ImmuCYST, a BCG Immunotherapeutic – a bladder cancer drug.[58] By April 2012 the FDA had found dozens of documented problems with sterility at the plant including mold, nesting birds and rusted electrical conduits.[57] The resulting closure of the plant for over two years caused shortages of bladder cancer and tuberculosis vaccines.[59][60] On October 29, 2014 Health Canada gave the permission for Sanofi to resume production of BCG.[61] An 2018 analysis of the global supply concluded that the supplies are adequate to meet forecast BCG vaccine demand, but that risks of shortages remain, mainly due to dependence of 75 percent of WHO pre-qualified supply on just two suppliers.[62]

Preparation

A weakened strain of bovine tuberculosis bacillus, Mycobacterium bovis is specially subcultured in a culture medium, usually Middlebrook 7H9.

Dried

Some BCG vaccines are freeze dried and become fine powder. Sometimes the powder is sealed with vacuum in a glass ampoule. Such a glass ampoule has to be opened slowly to prevent the airflow from blowing out the powder. Then the powder has to be diluted with saline water before injecting.

History

The history of BCG is tied to that of smallpox. Jean Antoine Villemin first recognized bovine tuberculosis in 1854 and transmitted it, and Robert Koch first distinguished Mycobacterium bovis from Mycobacterium tuberculosis. Following the success of vaccination in preventing smallpox, established during the 18th century, scientists thought to find a corollary in tuberculosis by drawing a parallel between bovine tuberculosis and cowpox: it was hypothesized that infection with bovine tuberculosis might protect against infection with human tuberculosis. In the late 19th century, clinical trials using M. bovis were conducted in Italy with disastrous results, because M. bovis was found to be just as virulent as M. tuberculosis.

Albert Calmette, a French physician and bacteriologist, and his assistant and later colleague, Camille Guérin, a veterinarian, were working at the Institut Pasteur de Lille (Lille, France) in 1908. Their work included subculturing virulent strains of the tuberculosis bacillus and testing different culture media. They noted a glycerin-bile-potato mixture grew bacilli that seemed less virulent, and changed the course of their research to see if repeated subculturing would produce a strain that was attenuated enough to be considered for use as a vaccine. The BCG strain was isolated after subculturing 239 times during 13 years from virulent strain on glycerine potato medium. The research continued throughout World War I until 1919, when the now avirulent bacilli were unable to cause tuberculosis disease in research animals. Calmette and Guerin transferred to the Paris Pasteur Institute in 1919. The BCG vaccine was first used in humans in 1921.[63]

Public acceptance was slow, and one disaster, in particular, did much to harm public acceptance of the vaccine. In the summer of 1930 in Lübeck, 240 infants were vaccinated in the first 10 days of life; almost all developed tuberculosis and 72 infants died. It was subsequently discovered that the BCG administered there had been contaminated with a virulent strain that was being stored in the same incubator, which led to legal action against the manufacturers of the vaccine.[64]

Dr. R.G. Ferguson, working at the Fort Qu'Appelle Sanatorium in Saskatchewan, was among the pioneers in developing the practice of vaccination against tuberculosis. In 1928, BCG was adopted by the Health Committee of the League of Nations (predecessor to the World Health Organization (WHO)). Because of opposition, however, it only became widely used after World War II. From 1945 to 1948, relief organizations (International Tuberculosis Campaign or Joint Enterprises) vaccinated over 8 million babies in eastern Europe and prevented the predicted typical increase of TB after a major war.

BCG is very efficacious against tuberculous meningitis in the pediatric age group, but its efficacy against pulmonary tuberculosis appears to be variable. As of 2006, only a few countries do not use BCG for routine vaccination. Two countries that have never used it routinely are the United States and the Netherlands (in both countries, it is felt that having a reliable Mantoux test and therefore being able to accurately detect active disease is more beneficial to society than vaccinating against a condition that is now relatively rare there).[65][66]

Other names include "Vaccin Bilié de Calmette et Guérin vaccine" and "Bacille de Calmette et Guérin vaccine".

Research

Tentative evidence exists for a beneficial non-specific effect of BCG vaccination on overall mortality in low income countries, or for its reducing other health problems including sepsis and respiratory infections when given early,[67] with greater benefit the earlier it is used.[68]

In rhesus macaques, BCG shows improved rates of protection when given intravenously.[69][70]

Diabetes

BCG vaccine is in the early stages of being studied[when?] in type 1 diabetes.[71][72]

COVID-19

BCG vaccine is also in Phase 3 trials (as of March 2020) of being studied to prevent COVID-19 in health care workers in Australia and Netherlands.[73] Neither country practices routine BCG vaccination.