Some of the parents I see have found making the decision to protect their child against TB quite difficult. They are puzzled as to why the NHS offers BCG immunisation in some areas and not in others and they are also worried about the lack of provision for BCG immunisation for anyone over the last 18 months. The unit which manufactured BCG vaccine in Denmark stopped producing the vaccine which supplied most of Europe so many of the babies who would normally have received their BCG vaccination on the National Health Service did not get their vaccination. Supplies to the private sector were also suspended.
We are all agreed that to get maximum benefit from a vaccination to protect our most vulnerable individuals that vaccinations should be done as soon after birth as possible and ideally within the first year of life. This is because the BCG vaccine is very effective in protecting against TB meningitis which mainly affects babies. There are lots of different infections caused by tuberculosis and vaccination cannot protect against every sort of TB infection, but it is much better to have your child vaccinated than not to.
People who are particularly at risk of tuberculosis are those who travel to countries where standards of general health may be poorer such as Africa, India, and Pakistan. TB is also more common in areas where we have a lot of visitors from those areas. It is current UK policy to offer tuberculosis vaccination to those babies who were born in those areas where there is a lot of tuberculosis but not to offer it in areas where there is lower incidence. That is why if you are born in Brent or Harrow you would qualify for a BCG on the NHS but if you are slightly outside in Hillingdon or Northwood you won’t automatically be offered a BCG immunisation. It is a bit of a postcode lottery but of course you don’t just drive from Pinner to Northwood and find that the level of TB changes so dramatically.
Most of the parents wishing to immunise their babies do so because they recognise that their children will be mixing with other children from lots of different areas in nurseries, in play groups and in schools. Many of our families enjoy travelling to Asia and Africa and many have family members and friends who visit from those areas. There are also some occupations which require you to have a BCG injection, certainly if you want to study medicine or any of the allied health professions you will be required to have had a BCG immunisation. Fortunately now the NHS has arranged to import their BCG vaccine from Intervax of Canada (manufactured in Bulgaria) and is now beginning to offer a vaccination service at birth for those babies born within designated areas. Since the closure of the Denmark facility there have only been two other World Health Authority authorised sources of BCG vaccine, namely India and Bulgaria. The NHS will be using vaccine manufactured in Bulgaria, and imported by Intervax, Canada. Doctors in the private sector have been using vaccine imported from India. Both these facilities provide vaccine which is identical to that vaccine manufactured in Denmark. At Harrow Health Care Centre we have been using the vaccine manufactured in India for a year. On two surveys of response to vaccination, I am comfortable that the reactions at the injection site and also the incidence of side-effects(which is almost zero) is similar to that which I had observed when using the Denmark sourced vaccination product. We will continue to provide BCG immunisations for those children who live outside the areas designated as high risk by the NHS and of course also to any children who find it difficult to access BCG on catch up.
Dr Jane Woyka
Harrow Health Care Centre