A brief history
Tuberculosis was historically known as consumption. Robert Koch identified the bacterium responsible in 1882, and Calmette and Guerin developed BCG in 1921. The vaccine is particularly useful against severe forms of TB in young children.
How does it spread?
TB spreads through the air from someone with infectious disease in the lungs or throat. Risk is greater with prolonged close exposure, particularly in poorly ventilated spaces. People with latent TB infection have no symptoms and do not pass it to others, although infection can later become active.
Symptoms and possible complications
Pulmonary TB can cause a persistent cough, fever, night sweats, weight loss and sometimes coughing up blood. TB can also affect the brain, bones and other organs. It is treatable, but requires a course of specific antibiotics. Persistent symptoms or known close exposure warrant medical assessment; vaccination is not treatment for existing TB.
Where it may be relevant
- Infants and children meeting UK risk criteria
- Previously unvaccinated people with occupational or travel-related exposure after assessment
- People who may require a tuberculin skin test before vaccination
Dose schedules
The clinician will select the appropriate licensed schedule after reviewing age, health, previous doses and departure date.
BCG vaccination
Eligible person
Pre-vaccination testing is required for some ages and exposure histories.
Who may be eligible
- People meeting age and exposure criteria who do not have evidence of previous BCG or TB infection
- Those with an appropriate negative pre-vaccination test when testing is required
Who may not be eligible
- Anyone with a confirmed severe allergic reaction to a previous dose or a vaccine ingredient
- People who are acutely unwell with a significant fever may need vaccination deferred
- Pregnancy, breastfeeding, immune suppression and current medicines must be reviewed individually
- Pregnancy and significant immune suppression are contraindications because BCG is live
- People with previous BCG, active TB or a positive tuberculin test should not be revaccinated routinely
Potential side effects
- A local papule, ulcer and eventual small scar are expected
- Temporary local lymph-node swelling can occur
- Injection-site discomfort
Important risks and precautions
- A severe allergic reaction is very rare and requires urgent treatment
- Protection is not absolute, so relevant food, water, bite or exposure precautions remain important
- The exact product and schedule must be confirmed during a clinical assessment
- Persistent ulceration, abscess, significant lymphadenitis or disseminated BCG infection are uncommon but require assessment
Clinical references