Tuberculosis

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The BCG vaccine (Bacillus Calmette-Guerin) was introduced into the UK in 1953. The vaccine has modified small amounts of the TB bacterium. The injection is usually given into the left upper arm. The vaccine is thought to give more than 70% protection against TB. So, although it is a good vaccine, it does not guarantee protection against TB. Some people still develop TB even if they have had the BCG vaccine.

After having the injection, it is normal to develop a red lump over the injection site. This may increase in size for a few weeks before settling down into a scab. It is not necessary to cover the site with a bandage unless it oozes. If this happens, use a dressing just until the oozing stops. After several weeks the scab goes and you are left with a small scar.

Introduction

BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease. BCG is used in many countries with a high prevalence of TB to prevent childhood tuberculous meningitis and miliary disease. However, BCG is not generally recommended for use in the United States because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity. The BCG vaccine should be considered only for very select persons who meet specific criteria and in consultation with a TB expert. Recommendations

Children

BCG vaccination should only be considered for children who have a negative tuberculin skin test and who are continually exposed, and cannot be separated from, adults who

Health Care Workers. BCG vaccination of health care workers should be considered on an individual basis in settings in which

Health Care Workers considered for BCG vaccination should be counseled regarding the risks and benefits associated with both BCG vaccination and treatment of latent TB infection (LTBI).

Contraindications

Immunosuppressed Persons. BCG vaccination should not be given to persons who are immunosuppressed (e.g., persons who are HIV-infected) or who are likely to become immunocompromised (e.g., persons who are candidates for organ transplant).

Pregnant Women

BCG vaccination should not be given during pregnancy. Even though no harmful effects of BCG vaccination on the fetus have been observed, further studies are needed to prove its safety.

Testing for TB in BCG-Vaccinated Persons

Many foreign-born persons have been BCG-vaccinated. BCG vaccination may cause a positive reaction to the tuberculin skin test (TST), which may complicate decisions about prescribing treatment.

Despite this potential for BCG to interfere with test results, the TST and the QuantiFERON®-TB Gold test (QFT-G) are not contraindicated for persons who have been vaccinated with BCG.

The presence or size of a TST reaction in these persons does not predict whether BCG will provide any protection against TB disease.

Furthermore, the size of a TST reaction in a BCG-vaccinated person is not a factor in determining whether the reaction is caused by LTBI or the prior BCG vaccination.

Atypical TB