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U.S. Department of Health and Human Services

  

Core Curriculum on Tuberculosis, 2000

Chapter 9
BCG Vaccination

Recommendations for the Use of BCG Vaccine

The use of BCG vaccination as a TB prevention strategy in the United States is limited because its effectiveness in preventing infectious forms of TB is uncertain. In 1993 and 1994, two meta-analyses of the published results of BCG vaccine clinical trials and case-control studies confirmed that the protective efficacy of BCG for preventing serious forms of TB in children is high (i.e., >80%). 1, 2 These analyses, however, did not clarify the protective efficacy of BCG for preventing pulmonary TB in adolescents and adults; this protective efficacy is variable, from 0% to 80%. 3 Furthermore, BCG immunization may cause a positive reaction to the tuberculin skin test. Thus, it may complicate decisions about prescribing treatment for infection for BCG-vaccinated persons who have a positive skin-test result.

CDC guidelines do not recommend including BCG vaccination in immunization programs or TB control programs. BCG vaccine should be considered only for selected persons who meet specific criteria. These criteria are seldom met and therefore the use of the BCG vaccination should be undertaken only after consultation with local health authorities and experts in the management of TB. First, BCG vaccine should be considered for an infant or child who has a negative tuberculin skin-test result if the following circumstances are present:

  • The child is exposed continually to an untreated or ineffectively treated patient who has infectious pulmonary TB, and the child cannot be separated from the presence of the infectious patient or given long-term primary treatment for infection;

         or

  • The child is exposed continually to a patient who has infectious pulmonary TB caused by M. tuberculosis strains resistant to isoniazid and rifampin, and the child cannot be separated from the presence of the infectious patient.

Second, BCG vaccination of health care workers should be considered on an individual basis in settings in which

  • A high percentage of TB patients are infected with M. tuberculosis strains resistant to both isoniazid and rifampin;
  • Transmission of such drug-resistant M. tuberculosis strains to health care workers and subsequent infection are likely; and
  • Comprehensive TB infection-control precautions have been implemented and have not been successful.

Vaccination with BCG should not be required for employment or for assignment of health care workers in specific work areas. Health care workers considered for BCG vaccination should be counseled regarding the risks and benefits associated with both BCG vaccination and TB preventive therapy.

BCG is contraindicated in persons who have an impaired immune response (e.g., persons who have HIV infection, congenital immunodeficiency, leukemia, lymphoma, or generalized malignancy) or who are immunosuppressed because of high-dose steroid therapy, alkylating agents, antimetabolites, or radiation therapy. HIV infection should be ruled out before BCG vaccine is administered to persons in groups at high risk for HIV infection. It is also prudent to avoid giving BCG vaccination to pregnant women, although no harmful effects of BCG on the fetus have been observed.

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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