BCG (Bacillus Calmette-Guerin) VACCINATION
Information for Health Care Workers
What is Tuberculosis(TB)?
Tuberculosis (TB) is a disease caused by the bacteria Mycobacterium tuberculosis (MTB). Pulmonary (lung) TB is the most common form although disease can occur anywhere in the body. Pulmonary TB is spread from person to person when droplets are expelled into the air while coughing, sneezing, shouting or singing. People in close prolonged contact can inhale these droplets and become infected. Most people who are infected have no symptoms, but a small number of people develop active TB disease, often many years after the original infection. Health Care Workers can become infected.
What is BCG Vacccine?
BCG vaccine is a live vaccine, which may give partial protection against TB. It may take up to three months for immunity to be established after BCG vaccination. In eight major trials, effectiveness of the BCG vaccine varied from zero to 76% (average 50%). This means that although you have a BCG you are still at some risk of developing tuberculosis if exposed. In adults when BCG vaccination is followed by a negative tuberculin response, re-vaccination is not currently indicated. A BCG vaccination does not reduce the need for normal TB infection control procedures.
BCG and adults
BCG is thought to offer a degree of protection to adults but the true benefit is not clear. In children BCG vaccine may prevent them from developing severe forms of TB disease, such as TB in the brain (tuberculous meningitis).
You will need a Tuberculin Skin Test (Mantoux test) prior to vaccination
You will need a Tuberculin Skin Test (Mantoux test) prior to vaccination to ensure you are not already tuberculin skin test positive from prior infection with TB, or following BCG vaccination. People with a positive Tuberculin skin test will not benefit from the vaccine and may develop a severe reaction at the vaccination site.
One of the disadvantages following BCG vaccination
One of the disadvantages following BCG vaccination is that it often makes future Tuberculin skin tests positive. This means that the TST is less clinically useful in determining whether you are infected with Tuberculosis. For this reason, it is recommended that health care workers who are TST positive have a chest x-ray.
There are some people for whom BCG vaccination is not recommended:
People with suppressed immunity, current illness eg chicken-pox, or recent live vaccinations eg Rubella, may be advised not to have a BCG. Individual assessment is necessary prior to BCG, and you will be required to sign a Consent Form, before vaccination. Should your situation change at a later date you may be able to have the BCG within one month of a negative TST.
Are there any side effects with BCG vaccination?
As with any vaccine, side effects can occur and vary from person to person. Sometimes the vaccination site can become painful, red and swollen. This usually gets better without treatment. Swelling of the glands in the armpit or neck can also occur, which occasionally needs treatment. Very rarely the vaccination can produce widespread BCG infection. This usually happens in people who have suppressed immunity including those who are HIV positive, malnourished or have a serious medical condition. In rare cases, death has occurred.
HCWs and BCG:
See Circular No. 2003/... Health Care Workers TB Screening and Protection. Health Care Workers who decline / refuse to attend for routine tuberculin skin tests will be offered a BCG instead. Health care workers with a suppressed immune system should not have a BCG.
Tuberculin Skin Test Negative staff:
Health care workers with a negative tuberculin skin test (TST) should have regular tuberculin skin tests if they work in high or medium TB risk areas. In addition, they will be tested after exposure to a known case of infectious tuberculosis. Testing / screening involves repeating the TST. If the skin test becomes positive following exposure, then treatment can be offered to reduce the risk of developing clinical tuberculosis disease.
Since BCG does not give total protection against TB disease
Since BCG does not give total protection against TB disease health care workers should be aware of the symptoms of TB, ie persistent cough (more than 2 weeks), coughing up blood stained sputum, fevers and night sweats, malaise and unexplained weight loss. These symptoms may occur for many reasons, but if you experience them you should consult the Chest Clinic or your doctor.
What happens after the BCG vaccination?
Following the vaccination, a small red papule (spot) appears within one to three weeks. The papule tends to soften and break down, resulting in a small ulcer in most people. The ulcer may take up to three months to heal, usually leaving a small scar.
Care for the vaccination site in the following manner:
-
Allow the vaccination site to heal naturally and keep it CLEAN AND DRY do not use creams or ointments
-
If necessary, apply a sterile gauze dressing loosely but do NOT put sticking plaster, bandaids, lint or cloth directly over the vaccination site.
-
Avoid bumps and scratches to the site
-
You may continue all normal activities such as showering, swimming, sports.
IF YOU HAVE ANY CONCERNS
OR EXPERIENCE ANY SIDE EFFECTS,
PLEASE Telephone
TB Prevention & Control Service (Chest Clinic)
References:
BCG Vaccine and Consumer Medicine Information: Connaught Laboratories: Canada.
Winks M, Levy M, Westly-Wise V. and The NSW Tuberculosis Advisory Committee. (1994). Controlling Tuberculosis in New South Wales. New South Wales Health Department. North Sydney.
Barclay L. A review of BCG complications since the introduction of a different BCG vaccine. 2000. CDC: Darwin. (See http://www.nt.gov.au/nths/publich/cdc/vol5/bcg.htm )
Colditz GA, Brewer TF, Berkley CS, Wilson ME, et al Efficacy of BCG vaccine in the prevention of tuberculosis - Meta-analysis of the published literature. JAMA 1994; 271 (9): 698-702.
Grange JM. Complications of bacille Calmette-Guerin (BCG) vaccination and immunotherapy and their management. Comm Dis Pub Hlth 1998; 1 (2): 84-8.
The Role of BCG Vaccine in the Prevention and Control of Tuberculosis in the United States. MMWR: April 26, 1996 / Vol. 44 / No. RR-4. US Department of Health and Human Services.
The Australian Immunisation Handbook 7th Edition: National Health & Medical Research Council.