BCG Vaccine

Question 1

What type of vaccine is BCG?

Answer 1

Live attenuated; administered intradermally

Question 2

What strain of bacteria is the BCG vaccine derived from?

Answer 2

Mycobacterium bovis (live attenuated)

Question 3

To whom is the BCG vaccine offered? (6)

Answer 3

1. all neonates and infants (0-12 mo) living in areas of the UK where annual incidence of TB is 40 cases per 100,000 or more
2. all neonates and infants (0-12 mo) with a PARENT OR GRANDPARENT born in a country where the annual incidence of TB is 40 cases per 100,000 or more. The same applies to older children but if they are 6 years old or older they require a tuberculin skin test first
3. previously unvaccinated tuberculin-negative CONTACTS of cases of respiratory TB
4. previously unvaccinated children (<16 years) with CLOSE CONTACT to cases of sputum smear-positive pulmonary or laryngeal TB
5. previously unvaccinated children (<16 years) who were BORN IN, or LIVED for at least 3 mo in a country where the annual incidence of TB is 40 per 100,000 or more
6. previously unvaccinated individuals at OCCUPATIONAL RISK (irrespective of age) including:
   - healthcare workers or laboratory staff who have direct contact with patients or potentially infectious clinical materials
   - prison staff
   - staff of care homes for the elderly
   - those working with homeless people, people with drug and alcohol misuse, refugees and asylum seekers
   - veterinarians handling animals that could be infected

Question 4

Is re-vaccination with BCG recommended?

Answer 4

No
Although protection provided by BCG may decrease with time, there is no evidence that repeat vaccination offers significant additional protection and therefore repeat vaccination is not recommended

Question 5

What are the contraindications to the BCG vaccine? (6)

Answer 5

1. HIV infection (although vaccination may be offered in some other immunosuppressed individuals)
2. Previous BCG vaccination
3. Past history of TB
4. Pregnancy
5. Positive TB skin test
6. Age >35 yo

Question 6

Under what circumstances is the BCG vaccine offered to travelers?

Answer 6

EITHER: (all of the below)

1. Previously unvaccinated
2. Tuberculin-negative
3. Under 16 yo
4. Intent to travel for 3 months or more in a country where TB incidence is 40/100,000 or more OR risk of multi-drug resistant TB is high

OR: (all of the below)

1. Healthcare workers at high risk of exposure
2. Intent to travel for 3 months or more in a country where TB incidence is 40/100,000 or more OR risk of multi-drug resistant TB is high

**risk of tourists acquiring TB infection is low and BCG is not required if no other factors are present

Question 7

How is previous TB infection assessed in patients with a history of BCG vaccine?

Answer 7

Because BCG vaccine gives a positive Mantoux test (tuberculin skin test), individuals with a history of BCG vaccination must be tested for TB infection using the interferon-gamma blood test (IGRA)

Question 8

What must be done first before someone is administered the BCG vaccine?

Answer 8

Must have a tuberculin skin test to rule out past infection with TB
(Exception is children <6 yo who have had no contact with TB)

Question 9

Why isn’t the BCG vaccine routinely given?

Answer 9

The vaccine offers limited protection against TB and is therefore reserved for high-risk cases eg infants with exposure from parents or grandparents, or workers with high-risk occupational exposure

Question 10

Is the BCG vaccine contraindicated in breastfeeding women?

Answer 10

No
Although there is theoretical risk of live vaccine being present in breast milk, vaccination is not contraindicated for women who are breastfeeding when there is significant risk of exposure to disease

Question 11

What is an uncommon side-effect associated with the BCG vaccine?

Answer 11

Lymphadenitis suppurative