BCG Vaccination (TB vaccine)
The BCG vaccine gives protection against tuberculosis (TB) infection. The BCG vaccination is particularly effective in protecting babies and young children against the more rare severe forms of TB such as TB meningitis (swelling of the lining of the brain). The BCG vaccine is 70-80% effective against the most severe forms of childhood TB, such as TB meningitis. However, it is less effective adults and in preventing the form of TB that affects the lungs. It also does not prevent the reactivation of latent TB.
What is TB?
Tuberculosis (TB) is a disease caused by germs that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. A person with TB can die if they do not get treatment.
Not everyone infected with TB bacteria becomes sick. People who are infected, but not sick, have what is called latent TB infection. People who have latent TB infection do not feel sick, do not have any symptoms, and cannot spread TB to others. But some people with latent TB infection go on to get TB disease.
The burden of TB in London
TB is a significant public health challenge in London. The city accounts for almost 40 per cent of all cases of TB in England, and one third of London boroughs are classed as high incidence by the World Health Organisation. This means that some parts of London have TB rates comparable with countries such as Algeria and Iraq. For over a decade, London has had the dubious title of ‘TB capital of Western Europe’.
BCG vaccination against TB is currently recommended for all babies born in London. See The London Assembly Health Committee report ‘Tackling TB in London’ which looks into the problems TB poses for the capital and how it can be addressed. This report states that “NHS London should set out how it plans to ensure universal BCG coverage across all London boroughs by 2017.”
Who should be offered BCG vaccination?
National Institute for Health and Care Excellence (NICE) recommends that BCG vaccination should be offered to:
- newborn babies if:
- they were born in an area where rates of TB are high [such as London]
- 1 or more of their parents or grandparents were born in a country where TB is widespread
- someone in their family has had TB in the past 5 years
- children who are 15 or under who weren’t vaccinated as newborn babies and who may be at higher risk of TB
- people who are 35 or under who haven’t been vaccinated before and have had a negative Mantoux test result if they:
- have been in close contact with someone with TB affecting their lungs or larynx
- have come to live in the UK from areas where TB is widespread
- work with animals that can get TB (such as chimpanzees or cows)
- work in prisons, homes for older people, or hostels for refugees, asylum seekers or homeless people
- plan to live or work for more than 3 months in a country where TB is widespread
- people who haven’t been vaccinated before and have had a negative Mantoux test and work regularly with patients or clinical specimens.
BCG vaccination and the vaccine stock issues in last few years
In the UK, the TB vaccine is not currently part of the routine childhood schedule. On the NHS, it is offered to people who are at higher risk of TB. Given the high levels of TB in London, there is a strong argument for all babies born in London to be given BCG. However the offer of neonatal BCG across the capital was patchy even before the recent supply problems.
At the moment there is a shortage of the only BCG vaccine licensed for use in the UK. This is because of manufacturing issues at the Statens Serum Institut (SSI) in Denmark, who make the vaccine. In June 2016 the UK Government took the decision to start using an alternative BCG vaccine made by InterVax, a Canadian company. This vaccine is similar to the SSI’s BCG vaccine, but it does not have a UK licence. This does not mean that the vaccine is unsafe or untested. It simply means that the manufacturer, InterVax, has not applied for a licence in the UK, so the vaccine has never formally been approved for use here.
The InterVax BCG vaccine is used in over 100 countries including the Netherlands, France, Belgium, Norway and Sweden. In 2015, over 51 million doses were distributed worldwide. The vaccine has been a World Health Organization (WHO) prequalified vaccine for 25 years. This means it can be used by United Nations organisations for immunisation against TB. The vaccine has a good safety record and is thought to be as effective as the SSI BCG vaccine. For more information see this leaflet from Public Health England .
It is not clear when supplies of the SSI BCG vaccine will be available again. Waiting for a licensed vaccine may mean that babies at high risk do not get vaccinated, and so will be at risk of severe forms of TB. Using the InterVax vaccine means that babies will continue to be protected.
We use exactly the same BCG vaccine NHS uses, supplied to us by the same supplier to the NHS.
Are there any side effects?
Immediately after the injection, a raised blister will appear. Within two to six weeks of the injection a small spot will appear. This may be quite sore for a few days, but it should gradually heal if you don’t cover it. It may leave a small scar.
Occasionally, your baby may develop a shallow sore where they had the injection. If this is oozing fluid and needs to be covered, use a dry dressing – never a plaster – until a scab forms. This sore may take as long as several months to heal.
If you are worried or you think the sore has become infected, see your doctor.
There was no scar or blister after my child’s BCG jab. Did it work?
A raised blister will appear in most people vaccinated with BCG, but not everyone. If your child did not have this reaction to the vaccine, it does not mean that they have not responded to it. There’s no need to vaccinate with BCG a second time.
When is it necessary to do a skin test (Mantoux Test) for TB infection before BCG vaccination?
People with a past history of TB should not receive the BCG vaccine. This is because they have an increased risk of adverse reactions to the vaccine.
A skin test is necessary prior to BCG vaccination for:
● all individuals aged six years or over
● infants and children under six years of age with a history of residence or prolonged stay (more than three months) in a country with an annual TB incidence of 40/100,000 or greater
● those who have had close contact with a person with known TB
● those who have a family history of TB within the last five years.
A message from the Mayor of London’s TB Ambassador Emma Thompson and her son Tindy on World TB Day