3j.6 When is the BCG vaccine recommended?
Description
This article is from the Childhood Vaccinations FAQ, by Lynn Gazis-Sax lynng@alsirat.com with numerous contributions by others.
3j.6 When is the BCG vaccine recommended?
BCG vaccine is given in developing countries because it is easy to
administer, inexpensive, and rarely has serious side effects. Some
industrialized countries (e.g. Great Britain, France, Scandinavia)
have also used it, for vaccination of children in general and of
household contacts of people with TB. Others (e.g. the US, the
Netherlands) have not.
Because of the low rate of new infections, the availability of
low-cost isoniazid prophylaxis for people who are exposed, and the
availability of effective treatment which quickly make patients
non-contagious and cures them, the BCG vaccine hasn't been considered
necessary in the US. There might be some changes in these
recommendations with the increase in multiple-drug-resistant strains
(one misc.kids poster reports that her city college system is now
requiring TB shots). In the meantime, the FDA has approved a new
combination tuberculosis drug, Rifater, which combines isoniazid,
rifampin, and pyrazinamide, in hopes of making it easier for patients
to take their medication and thus increasing patient compliance
(antibiotic treatment which is discontinued too early increases the
development of drug resistant TB strains).
In the US, the AAP, ACIP, and the American Thoracic Society recommend
BCG for infants and children intimately exposed to TB that is
"persistently untreated, ineffectively treated, or resistant to
isoniazid and rifampin and who cannot be removed from the source of
exposure or placed on long-term preventive therapy." The AAP and ACIP
also recommend it for children in groups with a rate of new TB
infections greater than 1% annually "and for whom the usual
surveillance and treatment programs have failed or are not feasible."
(_AHFS Drug Information_) ACIP also recommends vaccination for
children who are continually exposed to a patient who is infected with
a strain of TB which is resistant to isoniazid and rifampin (MMWR,
April 26, 1996). It is recommended for travel only for people who will
be in a high risk environment for a long time without access to TB
skin testing. It is currently not recommended for health care workers
(skin testing and isoniazid is considered to be enough), but this
recommendation is periodically reevaluated because of the incidence of
TB in AIDS patients.
BCG also has some use against certain tumors (in particular, bladder
cancer).
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From J Thompson (jet14@columbia.edu):
The TB "shots" a poster on misc.kids referred to ("one misc.kids
poster
reports that her city college system is now requiring TB shots") are
most likely PPD, not BCG. I believe that all schools receiving federal
funding (and I know that all schools I have attended) require either a
PPD or the (less accurate but easier to administer) "tine test" as
part of the pre-matriculation physical.
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