BCG Vaccination Recommendations for Tuberculosis Prevention
BCG vaccination is primarily recommended for children with continuous exposure to untreated or ineffectively treated TB patients and healthcare workers in specific high-risk settings with multidrug-resistant TB, but is not routinely recommended for most individuals in the United States. 1
Recommended Recipients of BCG Vaccination
Children
- BCG vaccination should be considered for infants and children with negative tuberculin skin tests in the following circumstances:
- Continuous exposure to an untreated or ineffectively treated patient with infectious pulmonary TB, when the child cannot be separated from the infectious patient or given long-term preventive therapy 2
- Continuous exposure to a patient with infectious pulmonary TB caused by M. tuberculosis strains resistant to both isoniazid and rifampin, when the child cannot be separated from the infectious patient 2
Healthcare Workers (HCWs)
BCG vaccination should be considered on an individual basis for HCWs in settings where:
- A high percentage of TB patients are infected with M. tuberculosis strains resistant to both isoniazid and rifampin
- Transmission of such drug-resistant strains to HCWs is likely
- Comprehensive TB infection-control precautions have been implemented but have not been successful 2
BCG vaccination is not recommended for HCWs in settings where the risk for M. tuberculosis transmission is low 2
Contraindications for BCG Vaccination
BCG vaccination is not recommended for:
- Persons infected with HIV 2, 1
- Immunocompromised individuals 1
- Persons on immunosuppressive therapy 1
- Pregnant women (unless at immediate excessive risk of TB exposure) 1
Efficacy of BCG Vaccination
- High efficacy (80-100%) for preventing serious forms of TB in children, such as tuberculous meningitis and miliary TB 1
- Variable and equivocal efficacy (0-80%) for preventing pulmonary TB in adolescents and adults 1
- Recent meta-analysis shows 18% overall effectiveness against all forms of TB, with significant protection only in children under 5 years (37% effectiveness) 3
- Significant protection against pulmonary TB (19% effectiveness) but not against extrapulmonary TB 3
Important Considerations
Interference with TB Testing
- BCG vaccination interferes with tuberculin skin test interpretation, making future TB screening more difficult 1
- This interference is a significant drawback in TB control programs that rely on skin testing 2
Primary TB Prevention Strategies
The preferred strategies for TB prevention and control are:
- Comprehensive infection-control measures to reduce M. tuberculosis transmission
- Prompt identification, isolation, and treatment of persons with active TB
- Tuberculin skin testing to identify newly infected individuals
- Preventive therapy with appropriate medications for infected persons 2
Travel Considerations
- For children traveling to high TB prevalence countries, BCG vaccination may be considered, though recommendations vary widely 4
- The risk of travel-associated TB should be evaluated on an individual basis
Adverse Effects of BCG Vaccination
- Local reactions (ulceration, muscular soreness, erythema) in 1-10% of vaccinees
- Regional lymphadenitis
- Rare but serious complications such as disseminated BCG infection and BCG osteitis 1
BCG vaccination remains an important tool for TB prevention in specific high-risk populations, particularly for protecting young children against severe forms of TB. However, its use must be carefully considered in the context of comprehensive TB control strategies and the individual's risk profile.