Who gets the BCG Vaccine in the UK?

Tuberculosis is an extremely infectious bacterial condition with a high mortality rate amongst active sufferers of the disease. Treatment of the condition is complicated by the fact that a long-term regime of antibiotics are needed, and if this dosing is interrupted, drug resistant strains of the bacteria flourish and pose serious health risks. Because of these facts, prevention of TB is very much a priority across the world. BCG is currently the vaccine of choice used in the UK to immunise against TB infections, and in this article we look at who receives the vaccine from the NHS.

BCG usage in the UK

BCG was first introduced into the NHS’ childhood vaccination scheme in 1953, and until 2005 the vaccine was administered to all children at the age of 13. Because BCG is a live vaccine, it can effectively induce immunity with a single dose given at this age. The incidence of TB peaks during adolescence, which is why children were immunised at the beginning of their teenage years.

Since 2005 however the administration of the BCG vaccine in the UK has changed dramatically. Now the BCG vaccine is offered shortly after birth, particularly to children in high risk areas of the UK like certain parts of London. The vaccine can still be administered to older children if the early immunisation was missed.

Conditions for immunisation

Children who fit into certain categories need to undergo a Mantoux test before the vaccine is given. These categories include:

• Children at or above the age of 6 years.
• Children under the age of 6 who have resided for more than three months in any country with an annual incidence of more than 40 cases of TB per 100,000 members of the population.
• Any child who has a family history of tuberculosis within 5 years of the date of the relevant appointment.
• Any child who has come into close contact with a person carrying an active tuberculosis infection.

The test is a simple one that involves injecting a protein called PPD tuberculin into the skin. If a child are infected with the bacterium that causes TB, the site of injection will form a hard red bump within 3 days of the test. The Mantoux test is administered because 9 out of 10 people infected with T are carry a latent, asymptomatic infection. A positive test result (indicating infection with TB), indicates that the child should not be vaccinated and should instead be receiving treatment.

If a child suffering from a TB infection is given BCG they will not benefit from the injection, but would instead suffer side effects.

At-risk occupations

BCG vaccines are advised for under 35s who work in an environment wherein there is an increased risk of exposure to tuberculosis. Examples of people working in such capacities include laboratory staff exposed to TB samples, care staff, prison staff, animal workers, healthcare workers, and staff working an asylum or refugee facilities.

Who shouldn’t have the vaccine?

As mentioned above, anyone suffering from tuberculosis should not have the vaccine.

BCG is not generally recommended to anyone over the age of 16 unless they are travelling to a particularly high risk location like certain parts of Africa, or are working in an at-risk occupation as detailed above. This is because there is no strong evidence to support the effectiveness of the BCG vaccine in over-16s.

BCG is not advised for anyone who…

• Has had a past history of tuberculosis
• Has experienced a strong allergic reaction (anaphylaxis) to a vaccination in the past
• Lives in close proximity to a known case of TB
• Suffers from a skin condition around the area of injection
• The immunocompromised (HIV sufferers, steroid users, cancer patients receiving treatment)
• Are extremely ill
• Is suffering from blood cancer (leukaemia )
• Is suffering from a cancer of the lymph nodes (lymphoma)
• Is pregnant (except in certain cases where a doctor feels the benefits outweigh the risks)

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