BCG Vaccine: Information for Health Professionals

BCG Vaccine: Information for Health Professionals

HE Code: 
HE2204
Language: 
Format: 
A3 sheet folded to A4
Publication date: 
1 October 2009
Revision date: 
30 November 2014
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Information for lead maternity carers and other health professionals about which children should be offered the BCG vaccination, the vaccine's efficacy and possible side effects.

Information for health professionals

This resource explains who should and shouldn’t have the BCG vaccine, when the vaccine should be given, and who can give the vaccine. It also describes the vaccine's efficacy and possible side effects. See below for sources of more information about tuberculosis (TB) and the BCG vaccine.

PLEASE NOTE:

  • You should screen all women during pregnancy to assess whether their baby is at increased risk of catching TB.
  • BCG vaccine is free for all babies and children less than 5 years who are at increased risk of catching TB.

Who should have BCG vaccine?

Use the flowchart below to assess whether the baby or child is at increased risk of catching TB, and whether they should have the BCG vaccine.

See the table for a list of countries with TB rates of ≥ 40 per 100,000, and scroll down for a list of contraindictions to BCG vaccine.

* Household members would include regular visitors from high TB incidence countries who come to live in the household for prolonged periods – a baby or child in such a household would be eligible for BCG vaccine if such prolonged periods were likely to add up to 6 months or longer over a 5-year period.

** A baby or child is eligible for BCG vaccine if they are likely to stay in a high TB incidence country for prolonged periods during their first 5 years of life and be exposed to people with TB, if such periods were likely to add up to 3 months or longer.

See the table for a list of countries with TB rates of ≥ 40 per 100,000. 

BCG vaccine contraindications

BCG should not be given to babies or children:

  • receiving corticosteroids or other immune-suppressive treatment, including radiotherapy
  • suffering from malignant conditions such as lymphoma, leukaemia, Hodgkin's disease or other tumours of the reticulo-endothelial system
  • in whom an immune compromising disease is known or suspected, such as individuals with hypogammaglobulinaemia*
  • known or suspected to be inected with HIV, including neonates with suspected HIV infection (ie, if the mother has HIV**)
  • with a positive Mantoux test or positive Interferon Gamma Release Assay (IGRA)
  • with a significant fever
  • with generalised septic skin conditions (for eczema, choose a site free from lesions)
  • living in a household where a possible case of active TB is being investigated. (The baby or child can receive the BCG vaccine if testing confirms they are not already infected with TB.)

NOTES:

* Primary immune deficiencies in children are often not detected until after the first few weeks of life (ie, after BCG vaccine is given). A family history of immune deficiency should be sought and, if present, discussed with a paediatrician before vaccination.

** Neonates whose mothers have HIV infection must not be given BCG (or any other live vaccine) until the baby has been shown to be HIV negative, which can only be confirmed at 12–18 months of age. Discuss with the child's paediatrician prior to vaccinating.

When to give BCG vaccine

  • Neonates should receive the BCG vaccine before they leave hospital, or as soon as possible following discharge from hospital.
  • If the baby or child missed vaccination at birth, they can be vaccinated anytime up to five years of age. If older than six months of age, a pre-vaccine Mantoux test is required to detect if the baby or child is already infected with TB.

Who can give the BCG vaccine?

Only gazetted BCG vaccinators are able to administer BCG vaccine. Contact your local public health service to find out who your local gazetted vaccinators are, and the requirements for becoming gazetted.

BCG vaccine efficacy

While BCG vaccine does not prevent TB infection, it does help protect against severe or disseminated forms of childhood TB, particularly miliary and meningeal disease. Evidence suggests that BCG vaccine is less effective in older children and adults. Therefore, the BCG vaccine is recommended and funded for those babies and children less than five years of age who are at increased risk of TB.

Expected responses and adverse events

Most babies and children develop local reactions to BCG vaccine, followed by healing and scar formation within three months. Many develop low-grade adenitis that can take several months to resolve. Refer to the Immunisation Handbook for rarer complications. Report adverse events to the Centre for Adverse Reactions Monitoring (CARM).

More information

For Health Professionals

For Parents, Family and Whānau

 

Countries with tuberculosis incidence of ≥ 40 per 100,000 population (2013 World Health Organization estimates*)

Countries with tuberculosis incidence of ≥ 40 per 100,000 population (2013 World Health Organization estimates*)

Country/Territory

World Health Organization Region

Estimated number of cases

Estimated rate per 100,000 population

Afghanistan

Eastern Mediterranean

58,000

189

Algeria

Africa

32,000

81

Angola

Africa

69,000

320

Armenia

Europe

1,500

49

Azerbaijan

Europe

8,000

85

Bangladesh

South East Asia

350,000

224

Belarus

Europe

6,500

70

Benin

Africa

7,200

70

Bhutan

South East Asia

1,300

169

Bolivia (Plurinational State of)

The Americas

13,000

123

Bosnia and Herzegovina

Europe

1,700

46

Botswana

Africa

8,400

414

Brazil

The Americas

93,000

46

Brunei Darussalam

Western Pacific

240

58

Burkina Faso

Africa

9,100

54

Burundi

Africa

13,000

128

Cabo Verde Africa 710 143

Cambodia

Western Pacific

61,000

400

Cameroon

Africa

52,000

235

Central African Republic

Africa

17,000

359

Chad

Africa

19,000

151

China

Western Pacific

980,000

70

China, Hong Kong SAR

Western Pacific

5,500

76

China, Macao SAR

Western Pacific

500

88

Congo

Africa

17,000

382

Côte d'Ivoire

Africa

35,000

170

Democratic People's Republic of Korea 

South East Asia

110,000

429

Democratic Republic of the Congo

Africa

220,000

326

Djibouti

Eastern Mediterranean

5,400

619

Dominican Republic

The Americas

6,200

60

Ecuador

The Americas

8,800

56

Equatorial Guinea

Africa

1,100

144

Eritrea

Africa

5,800

92

Ethiopia

Africa

210,000

224

Fiji

Western Pacific

500

57

Gabon

Africa

7,100

423

Gambia

Africa

3,200

173

Georgia

Europe

5,000

116

Ghana

Africa

17,000

66

Greenland

Europe

110

194

Guatemala

The Americas

9,200

60

Guinea

Africa

21,000

177

Guinea-Bissau

Africa

6,600

387

Guyana

The Americas

870

109

Haiti

The Americas

21,000

206

Honduras

The Americas

4,400

54

India

South East Asia

2,100,000

171

Indonesia

South East Asia

460,000

183

Iraq

Eastern Mediterranean

15,000

45

Kazakhstan

Europe

23,000

139

Kenya

Africa

120,000

268

Kiribati

Western Pacific

510

497

Kosovo**

 

 

44

Kyrgyzstan

Europe

7,800

141

Lao People's Democratic Republic

Western Pacific

13,000

197

Latvia

Europe

1,000

50

Lesotho

Africa

19,000

916

Liberia

Africa

13,000

308

Libya

Eastern Mediterranean

2,500

40

Lithuania

Europe

2,000

65

Madagascar

Africa

53,000

233

Malawi

Africa

26,000

156

Malaysia

Western Pacific

29,000

99

Maldives

South East Asia

140

40

Mali

Africa

9,200

60

Marshall Islands

Western Pacific

190

354

Mauritania

Africa

4,500

115

Micronesia (Federated States of)

Western Pacific

190

188

Mongolia

Western Pacific

5,100

181

Morocco

Eastern Mediterranean

34,000

104

Mozambique

Africa

140,000

552

Myanmar

South East Asia

200,000

373

Namibia

Africa

15,000

651

Nauru

Western Pacific

4.7

47

Nepal

South East Asia

43,000

156

Nicaragua

The Americas

3,400

55

Niger

Africa

18,000

102

Nigeria

Africa

590,000

338

Northern Mariana Islands

Western Pacific

38

70

Pakistan

Eastern Mediterranean

500,000

275

Palau

Western Pacific

9.2

44

Panama

The Americas

1,800

48

Papua New Guinea

Western Pacific

25,000

347

Paraguay

The Americas

3,000

44

Peru

The Americas

38,000

124

Philippines

Western Pacific

290,000

292

Qatar

Eastern Mediterranean

870

40

Republic of Korea

Western Pacific

48,000

97

Republic of Moldova

Europe

5,500

159

Romania

Europe

19,000

87

Russian Federation

Europe

130,000

89

Rwanda

Africa

8,100

69

Sao Tome and Principe

Africa

180

91

Senegal

Africa

19,000

136

Sierra Leone

Africa

19,000

313

Singapore Western Pacific 2,600 47

Solomon Islands

Western Pacific

520

92

Somalia

Eastern Mediterranean

30,000

285

South Africa

Africa

450,000

860

South Sudan Africa 17,000 146

Sri Lanka

South East Asia

14,000

66

Sudan

Eastern Mediterranean

41,000

108

Swaziland

Africa

17,000

1382

Taiwan (ROC)***

 

12,600

55

Tajikistan

Europe

8,200

100

Thailand

South East Asia

80,000

119

Timor-Leste

South East Asia

5,600

498

Togo

Africa

5,000

73

Turkmenistan

Europe

3,800

72

Tuvalu

Western Pacific

23

228

Uganda

Africa

62,000

166

Ukraine

Europe

44,000

96

United Republic of Tanzania

Africa

81,000

164

Uzbekistan

Europe

23,000

80

Vanuatu

Western Pacific

160

62

Viet Nam

Western Pacific

130,000

144

Yemen

Eastern Mediterranean

12,000

48

Zambia

Africa

60,000

410

Zimbabwe

Africa

78,000

552

*Source http://www.who.int/tb/country/data/download/en/ accessed 3/12/2014

**2010 data from The Global Fund to Fight Aids, Tuberculosis and Malaria. Expanding Tuberculosis Prevention and Treatment Activities in Kosovo: Grant Performance Report (http://portfolio.theglobalfund.org/en/Grant/Index/KOS-405-G01-T) accessed 8/11/2012.

***2011 data from Centers for Disease Control, Department of Health, R.O.C. (Taiwan): 2012 Annual Report (http://www.cdc.gov.tw/uploads/fi les/201208/67addf76-0493-4d7b-aa72-cd51beff6654.pdf) accessed 8/11/2012.