Is a Tuberculosis Vaccine Available?
Yes, the BCG (Bacillus Calmette-Guérin) vaccine is available and is currently the only approved vaccine for tuberculosis prevention. 1, 2
Vaccine Availability and Efficacy
The BCG vaccine has been in use for nearly a century and provides:
- High protection (>80%) against severe forms of TB in children, including tuberculous meningitis and disseminated disease 3, 1
- Variable and uncertain protection against pulmonary TB in adolescents and adults, with efficacy that remains equivocal 3
- Protection lasting at least 10 years after a single administration 4
Current Use in the United States
BCG vaccination is rarely indicated in the United States and is NOT recommended for routine immunization programs. 3, 1 The U.S. relies primarily on early identification and treatment of active TB cases, plus preventive therapy for latent infections, rather than mass vaccination 3
Specific Indications for BCG in the U.S.
BCG vaccination should be considered only in these limited circumstances:
For Children:
- Infants and children residing in settings with high likelihood of M. tuberculosis transmission 3, 1
- When the child cannot be removed from the source of infection 1
- When continually exposed to persons with infectious TB caused by strains resistant to both isoniazid and rifampin 1
- Must have tuberculin skin test <5mm induration before vaccination 5
For Healthcare Workers:
- Only on an individual basis in settings where a high percentage of TB patients have strains resistant to both isoniazid and rifampin 1
- Only after comprehensive infection-control measures have been implemented and proven unsuccessful 3, 1
Critical Contraindications
BCG is absolutely contraindicated in:
- HIV-infected individuals or other immunocompromised persons due to risk of disseminated BCG infection 3, 6, 5
- Pregnant women 5
Important Limitations
The BCG vaccine has two major drawbacks that limit its use in the U.S.:
- Uncertain effectiveness in preventing infectious pulmonary TB forms that drive transmission 3
- Interference with tuberculin skin testing, complicating the identification and management of persons with latent M. tuberculosis infection 3
Global Context
While BCG is included in immunization schedules of TB-endemic countries with nearly 90% global coverage at birth 7, its use varies widely across Europe and developed nations 4. Countries like Australia use it primarily for neonates and children at high risk of TB exposure 8.
Future Vaccine Development
Multiple novel TB vaccine candidates are currently in clinical development, including recombinant BCG vaccines, adjuvanted protein subunit vaccines, viral-vectored vaccines, and mRNA vaccines 2, 9. MTBVAC is the first live-attenuated M. tuberculosis vaccine in clinical evaluation as a potential BCG replacement 7.
Practical Guidance
Physicians considering BCG vaccination must consult with local TB control programs before administration. 3, 1, 5 The Tice strain is the only BCG vaccine licensed in the United States 5, and vaccination should only be performed by practitioners experienced in its administration 8.