Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-28T08:29:40.479Z Has data issue: false hasContentIssue false
  • English
  • Français

Pros and Cons of BCG Vaccination in Countries with Low Incidence of Tuberculosis

Published online by Cambridge University Press:  02 January 2015

Eero O. Tala  and
Marianna M. Tala-Heikkila
Eero O. Tala*
Affiliation:
University Central Hospital, Department of Diseases of the Chest, Turku, Finland
Marianna M. Tala-Heikkila
Affiliation:
Department of Paediatrics, Turku, Finland
*
Department of Diseases of the Chest, FIN-21540 Preitilä, Finland
Get access Rights & Permissions [Opens in a new window]

Abstract

Preventive bacilleCalmette-Guérin (BCG) vaccination, together with case finding and effective chemotherapy, has formed an integral part of the tuberculosis (TB) control program in most countries. In some low-incidence countries the balance of prevention has been more on the side of chemoprophylaxis than of BCG vaccination. The time clearly has come when the strategy of mass BCG vaccination no longer is indicated medically, nor is it cost-effective. The pros and cons of the programs need to be critically evaluated against the present epidemiological background, taking into account the facts that TB, the killer disease, is recovering strength, human immunodeficiency virus infection is on the increase, and multidrug-resistant TB has changed the outcome of this previously fully curable disease.

Although no longer appropriate for mass programs, BCG vaccination still should be considered for the protection of selected risk groups in low-incidence countries. The overall efficacy may be of the order 50% to 80%, but the variation is great. Therefore, further research urgently is needed on the effectiveness of BCG as an intervention in local TB programs.

Type
From the Third International Conference on the Prevention of Infection
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 7 , July 1994 , pp. 497 - 499
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Enarsson, DA, Rouillon, A. Epidemiological basis of tuberculosis control. In: Davies, PDO, ed. Clinical Tuberculosis. London, England: Chapman & Hall Medical; 19941932.Google Scholar
2. World Health Organization. Expanded Program on Immunization. Geneva, Switzerland: World Health Organization; February 1993.Google Scholar
3. Fine, PEM. The BCG story: lessons from the past and implications for the future. Rev Infect Dis 1989;11:S353–S359.Google Scholar
4. Clemens, JD, Chuong, JJH, Feinstein, AR. The BCG controversy: a methodological reappraisal. JAMA 1983;249:2362–2369.CrossRefGoogle Scholar
5. Smith, PG. BCG Vaccination. In: Davies, PDO, ed. Clinical Tuberculosis. London, England: Chapman&Hall Medical; 1994:297–310.Google Scholar
6. Springett, WG, Sutherland, I. BCG vaccination of schoolchildren in England and Wales. Thorax 1990;45:83–88.Google Scholar
7. Sutherland, I, Lindgren, I. The protective effect of BCG vaccination as indicated by autopsy studies. Tubercle 1979;60:225–231.Google Scholar
8. Katila, ML, Brander, E, Backman, A. Neonatal BCG-vaccination and mycobacterial cervical adenitis in childhood. Turbercle 1987;68:291–296.Google Scholar
9. Ten Dam, HG. BCG vaccination. In: Reichman, LB, Hershfield, ES, eds. Lung Biology in Health and Disease: Tuberculosis. New York, NY: Marcel Dekker Inc; 1993;66:251–274.Google Scholar
10. Colditz, GA, Brewer, TF, Berkey, CS, et al. Efficacy of BCG vaccine in the prevention of tuberculosis. Meta-analysis of the published literature. JAMA 1994;271:698–702.CrossRefGoogle ScholarPubMed
11. Romanus, V, Svensson, Å, Hallander, HO. The impact of changing BCG coverage on tuberculosis incidence in Swedish-born children between 1969 and 1989. Tuberc Lung Dis 1992;73:150–161.Google Scholar
12. Trnka, L, Dankova, D, Svandova, E. Sii years' experience with the discontinuation of BCG vaccination. Tuberc Lung Dis 1993;74:167–172.Google Scholar
13. Greenberg, PD, Lax, KG. Schechter, CB. Tuberculosis in house staff. A decision analysis comparing the tuberculin screening strategy with the BCG vaccination. Am Rev Respir Dis 1991;143:490–495.CrossRefGoogle ScholarPubMed
14. Styblo, K, Meijer, J. Impact of BCG vaccination programs in children and young adults on the tuberculosis problem. Tubercle 1976;57:17–43.Google Scholar
15. Pönnighaus, JM, Fine, PE, Steme, JAC, et al. Efficacy of BCG vaccine against leprosy and tuberculosis in northern Malawi. Lancet 1992;339:636–639.Google Scholar
16. Murray, C, Styblo, K, Rouillon, A. Health Sector Priorities Review. Tuberculosis, Population, Health and Nutrition Division. Washington, DC: The World Bank; 1991.Google Scholar
17. Lotte, A, Wasz-Höckert, O, Poisson, N, Dumitrescu, N, Verron, M, Couvet, E. BCG complications: estimates of the risks among vaccinated subjects and statistical analysis of their main characteristics. Ado Tuberc Res 1984;21:107–193.Google Scholar
18. Kröger, L, Brander, E, Korppi, M, et al. Osteitis after newborn vaccination with three different bacillus Calmette-Guérin (BCG) vaccines: 29 years of experience. Pediatr Infect Dis J 1994;12:113–116.Google Scholar
19. Lallemant-Le Cour, S, Lallemant, M, Cheynier, D, et al. Bacillus Calmette-Guérin immunization in infants born to HIV-1-seropositive mothers. AIDS 1991;5:195–199.Google Scholar
20. International Union Against Tuberculosis and Lung Disease. Criteria for discontinuation of vaccination programs using bacille Calmette-Guérin (BCG) in countries with a low prevalence of tuberculosis. A statement of the International Union Against Tuberculosis and Lung Disease. October 1992.Google Scholar
21. Rouillon, A, Waaler, H. BCG-vaccination and epidemiological situation. A decision-making approach to the use of BCG. Adv Tuberc Res 1976;19:64–126.Google Scholar
22. Tala-Heikkilä, M, Nurmela, T, Tala, E, Tuominen, J. Evaluation of the BCG revaccination programme of schoolchildren in Finland. Bull Int Union Tuberc Lung Dis 1991;66:57–59.Google Scholar