The Disease
TB is an infectious disease that used to be known as “consumption” because of the way it slowly consumed sufferers. Unlike many infectious diseases, TB is surprisingly difficult to catch; only a third of people who are in prolonged close contact with a person with TB become infected. Once infected with TB, just 4% (1 in 25) will develop the disease within a year and a further 4% will develop TB within their lifetime. The remainder – the large majority – are able to keep the disease under control and remain reasonably healthy.1
Tuberculosis most commonly attacks the lungs, typically causing a cough, fever and weight loss, though the disease can affect most parts of the body.2 Over 8,000 people a year get TB in the UK, of whom under 400 die as a result of it. It affects all age groups; 400 children under the age of 15 are diagnosed with the disease every year.3 The vast majority of people catching TB can be successfully treated with a six to nine month course of antibiotics.
TB is most common in inner cities, areas of poverty and homelessness, and in families originating from areas with high rates of TB such as the Indian subcontinent.4
Nearly half of all the cases of TB in the UK occur in London. However, rates of TB in some London boroughs, such as Newham, Brent, Hackney and Ealing are much higher than others, such as Richmond, Bexley and Bromley. There are also a few TB hotspots outside London, such as Leicester and Slough.
The Vaccine
The BCG vaccine is a live version of TB (like the measles, mumps and rubella vaccines) that has been altered or “attenuated” to be made relatively safe. BCG stands for Bacille Calmette Guérin, named after its discoverers. It has been part of the UK immunisation schedule since 1953. For most of this period, the vaccine has been offered to all 10 to 14 year old schoolchildren, who first had to have a tuberculin skin test, to ensure that they were not already immune to TB. In 2005, the UK policy on BCG vaccination changed, so that the vaccine is now offered to:
- All babies living in areas with a high rate of TB (with 40 or more new cases a year per 100,000 population)
- Babies whose parents or grandparents were born in a country with a high rate of TB
- Babies living with a family member who has had TB recently
- New immigrants to the UK from countries with a high rate of TB
Effectiveness
The BCG vaccine is 80% effective when given to teenage schoolchildren, and around 60% effective in British Asian babies.5 6 Though there is uncertainty how effective the vaccine is in UK babies from other ethnic groups, it does appear to be good at preventing the more serious types of TB such as TB meningitis.7 8 9
Side effects
Because the BCG vaccine is injected just under the skin, side effects at the site of the injection are common. A lump will normally develop at the injection site (usually on the left upper outer arm). This can become ulcerated and may bleed, or ooze pus, requiring a dressing to be applied. A small permanent scar is normal (see below).10
Because BCG is a ‘live’ vaccine, it can cause all the same complications as TB, but much less commonly. Up to 1 in 50 vaccine recipients get swollen and painful lymph nodes (glands) in the neck or armpit; if severe they occasionally become infected, leading to an abscess requiring surgical draining.11 12
The most serious side effect of BCG vaccination is to get a widespread TB-like infection. This very rare, though occasionally fatal, complication occurs in around 1 in 200,000. 13 It is more common in babies with impaired immune systems, but this may be difficult to detect in the newborn. 14 Various hypersensitivity and skin reactions can also occur.15
The BCG, as a live vaccine, should not be given to those with an impaired immune system, including those suspected of being HIV positive. No one who has had TB should be vaccinated, nor should babies who live with someone with active TB.
Tuberculin skin testing before BCG immunisation – the Mantoux test
A skin test is necessary before BCG immunisation for:
- All adults and children over 6 years of age
- Babies and children under six years of age who have lived or stayed over 3 months in a country with a high incidence of TB
- Anyone who has had close contact with someone with TB
- Anyone with TB in the family within the last 5 years
Having a BCG vaccination
The BCG vaccine is given in a different way to all the other common childhood immunisations. The vaccine, usually given into the left upper outer arm, must be injected only just beneath the surface of the skin (intradermally) so that a small lump appears on the skin as the injection is being given. The lump will increase in size over the next few weeks, during which it will scale and crust over; a small ulcer sometimes occurs, which may ooze and require a protective dressing. The lesion then slowly heals over several months resulting in a characteristic flat circular scar.
No further immunisation should be given into the same arm for at least three months.
The Choices
The supply of single and small combination vaccines may change over time. At BabyJabs we are on the constant lookout for safe and effective vaccines to offer your child. We may obtain different vaccines to those listed above. We will only offer you alternative vaccines if we are completely confident of their safety and efficacy.
Go back to vaccines at a glance
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1 Lauzardo M. Ashkin D. Phthisiology at the dawn of the new century. Chest 2000; 117(5): 1455-73.
2 Graham Davies E et al. Manual of Childhood Infections. Royal Colleges of Paediatrics and Child Health. 2001.
3 Health Protection Agency. Enhanced surveillance of tuberculosis http://www.hpa.org.uk/web/HPAweb&Page&HPAwebAutoListName/Page/1204707145336 (downloaded November 4, 2008).
4 Springett VH. Tuberculosis--epidemiology in England and Wales. British Medical Journal 1972; 1(797): 422-3.
5 Packe GE. Innes JA. Protective effect of BCG vaccination in infant Asians: a case-control study. Archives of Disease in Childhood 1988; 63(3): 277-81.
6 Anonymous. BCG and vole bacillus vaccines in the prevention of tuberculosis in adolescence and early adult life. Bulletin of the World Health Organization 1972; 46(3): 371-85.
7 ten Dam HG. Hitze KL. Does BCG vaccination protect the newborn and young infants? Bulletin of the World Health Organization 1980; 58(1): 37-41.
8 Rodrigues LC. Noel Gill O. Smith PG. BCG vaccination in the first year of life protects children of Indian subcontinent ethnic origin against tuberculosis in England. Journal of Epidemiology & Community Health 1991; 45(1): 78-80.
9 Rodrigues LR, Diwan VK, Wheeler JG. Protective effect of BCG against Tuberculous meningitis and military tuberculosis: A meta-analysis. International Journal of Epidemiology 1993; 22: 1154-1158.
10 Immunisation Against Infectious Disease 1996 - "The Green Book". HMSO. Available at http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/GreenBook/GreenBookGeneralInformation/
GreenBookGeneralArticle/fs/en?CONTENT_ID=4097254&chk=isTfGX.
11 Daoud W. Control of an outbreak of BCG complications in Gaza. Respirology 2003; 8(3): 376-8.
12 Teo SS. Smeulders N. Shingadia DV. BCG vaccine-associated suppurative lymphadenitis. Vaccine 2005; 23(20): 2676-9.
13 Lotte A et al. Second IUATLD study on complications induced by intradermal BCG-vaccination. Bulletin of the International Union Against Tuberculosis & Lung Disease 1988; 63(2): 47-59.
14 Deeks SL et al. Serious adverse events associated with bacille Calmette-Guérin vaccine in Canada. Pediatric Infectious Disease Journal 2005; 24(6): 538-41.
15 Grange JM. Complications of bacille Calmette-Guérin (BCG) vaccination and immunotherapy and their management. Communicable Disease & Public Health 1998; 1(2): 84-8.
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