BCG tuberculosis (TB) vaccine

Tuberculosis (TB) is a serious infection which affects the lungs, but it can affect other parts of the body such as the bones, joints and kidneys. It can also cause meningitis.

Although TB can be a very serious disease, it is possible to make a full recovery from most forms of TB with treatment.

Read more about tuberculosis (TB).

PLEASE NOTE: We have secured a limited supply of BCG from the Serum Institute of India due to the Europe-wide shortage. Call to book in our special BCG clinics and please follow us on facebook or twitter to be alerted as soon as we have some more information.

Who should have the BCG vaccine?

The BCG vaccine (which stands for Bacillus Calmette-Guérin vaccine) protects against TB. It’s not given as part of the routine NHS childhood vaccination schedule unless a baby is thought to have an increased risk of coming into contact with TB.

This includes all babies born in some areas of inner-city London where TB rates are higher than in the rest of the country.

BCG vaccination may also be recommended for older children who have an increased risk of developing TB, such as:

  • children who have recently arrived from countries with high levels of TB
  • children who have come into close contact with somebody infected with respiratory TB

BCG vaccination is rarely given to anyone over the age of 16 – and never over the age of 35, because it doesn’t work very well in adults. It is, however, given to adults aged between 16 and 35 who are at risk of TB through their work, such as some healthcare workers.

How effective is BCG vaccination?

The BCG vaccine is made from a weakened form of a bacterium closely related to human TB. Because the bacterium is weak, the vaccine does not cause any disease but it still triggers the immune system to protect against the disease, giving good immunity to people who receive it.

The vaccine is 70-80% effective against the most severe forms of TB, such as TB meningitis in children. It is less effective in preventing respiratory disease, which is the more common form in adults.

Read about the side effects of the BCG vaccine.

Who should have the BCG (TB) vaccine?

BCG vaccination is recommended for babies and adults at risk of catching tuberculosis (TB).

Babies who should have the BCG vaccine

The BCG vaccination is recommended for all babies up to one year old who:

  • are born in areas where the rates of TB are high
  • have one or more parents or grandparents who were born in countries with a high incidence of TB
  • are likely to travel abroad

Why should I protect my child from tuberculosis with a BCG injection?

Some of the parents we 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, we are comfortable that the reactions at the injection site and also the incidence of side-effects(which is almost zero) is similar to that which we 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.

Older children and adults who should have the BCG vaccine

  • The BCG vaccination is recommended for all older children and adults at risk of TB including:
  • older children with an increased risk of TB who were not vaccinated against TB when they were babies
  • anyone under 16 who has come from an area where TB is widespread
  • anyone under 16 who has been in close contact with someone who has pulmonary TB (TB infection of the lung)
  • anyone studying healthcare orrelated subjects

Workers who should have the BCG vaccine

BCG vaccination is recommended for people under the age of 35 who are at risk of TB through their jobs including:

  • healthcare workers
  • laboratory staff who are in contact with blood, urine and tissue samples
  • veterinary staff and other animal workers, such as abattoir workers, who work with animals, such as cattle or monkeys, that are susceptible to TB
  • prison staff who work directly with prisoners
  • staff of care homes for the elderly
  • staff of hostels for homeless people
  • staff who work in facilities for refugees and asylum seekers
  • healthcare workers with an increased risk of exposure to TB

Travellers who should have the BCG vaccine

The BCG vaccine is also recommended for people under 16 years of age who are going to live and work with local people for more than three months in an area with high rates of TB.

  • Parts of the world that have high rates of TB include:
  • Africa – particularly sub-Saharan Africa (all the African countries south of the Sahara desert) and west Africa, including Nigeria and South Africa
    southeast Asia – including India, Pakistan, Indonesia and Bangladesh
  • Russia
  • China
  • South America
  • the western Pacific region (to the west of the Pacific Ocean) – including Vietnam and Cambodia

How to tell if you’re already immune to TB

Before you have the BCG vaccination, you should be tested to see if you’ve been exposed to TB before. A test, called the tuberculin skin test, or Mantoux test, should be carried out before BCG vaccination if someone is:

  • six years or over
  • a baby or child under six with a history of residence or a prolonged stay (more than three months) in a country with an annual TB incidence of 40 per 100,000 or more
  • 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

The Mantoux test assesses your sensitivity to a substance called tuberculin purified protein derivative (PPD) when it’s injected into your skin.

If your skin is sensitive to PPD tuberculin a hard red bump will develop at the site of the injection, usually within 48 to 72 hours of having the test.

If you develop this reaction (a positive test result) it shows that your immune system recognises TB because of previous exposure and you should not be vaccinated as you already have some immunity to TB. In this case, the BCG vaccine would have no clinical benefit and may cause unpleasant side effects.

If the test is negative, you can go ahead and have the BCG vaccine.

If you have a strongly positive Mantoux result, you should be referred to a TB specialist team for further assessment.

Who should not have the BCG vaccination?

The BCG vaccine is not recommended for:

  • people who have already had a BCG vaccination
  • people with a past history of TB
  • people with a positive tuberculin skin test (Mantoux)
  • people who have had a previous anaphylactic reaction (severe allergic reaction) to any of the substances used in the vaccine
  • newborn babies in a household where a case of TB is suspected or confirmed
  • people who have a septic skin condition at the site where the injection will be given
  • people who have received another live vaccine less than three weeks earlier
  • people with a weakened immune system, either as a result of a health condition such as HIV, treatments such as chemotherapy or medicines that suppress the immune system such as steroid tablets
  • people who have cancer of the white blood cells, bone marrow or lymph nodes, such as leukaemia or lymphoma
  • people who are seriously unwell (vaccination should be delayed until they recover)
  • pregnant women

BCG vaccinations are not usually offered to people over the age of 16 because the vaccine doesn’t work well in those over 16 and there’s virtually no evidence showing that it is effective in those aged over 35.

However, some people over 16 and under 35 whose work puts them at occupational risk of TB may still be offered the vaccine.