There is currently a consultative proposal to change from Universal BCG vaccination to Selective BCG vaccination of children in Ireland. Selective BCG vaccination would be retained for children belonging to a high-risk population in Ireland defined as "children born to parents from a high TB incidence country and Irish Traveller children" . Would be interesting to hear of experiences in other low TB incidence countries with regard to a move to Selective BCG vaccination.
Discussion about BCG could be centered around tuberculosis risk, relative efficacy, and cost-benefit analyses, but I think the nonspecific effects of the BCG vaccine should also be taken into account here. As we learn more about how BCG changes the cytokine profile and of any protective effects of BCG against developing allergies and the development of autoimmune conditions like MS, then we may reconsider the candidate recipients and potentially repurpose the BCG vaccine.
I agree fully with the first response from Paul. It is all centered around the risk of tuberculosis in that population balanced against the potential negative sided of BCG. Countries with low tuberculosis disease burden must weight all the issues scientifically. Ghana still gives at birth and I believe we have to.
The BCG aside its low immunogenicity property mainly to adults it also exhibits some undesirable side effects. However, it continues being the only available anti-tuberculosis vaccine. The question is: what is reasonable choice, protect around 70% of chieldren against some tuberculosis manfestation or not ?
Selective BCG vaccination of children coming from a high risk country or family may quote may be better than mass vaccination of all children . But we have no experience
Thanks Paul, Dorcas, Wilmar, Vijay for your comments. The main protective effect of BCG in children would be against progression to TB disease in those infected with Mycobacterium tuberculosis and against TB meningitis and miliary TB. Van Bui et al. (Eurosurveillance, Volume 20, Issue 11, 19 March 2015) reported that there was no significant increase on TB meningitis in France following the switch to Selective BCG vaccination in children. A key component will be ensuring a high level of vaccine coverage in high-risk populations following a switch from Universal to Selective BCG vaccination. Romanus (Eurosurveillance, Volume 11, Issue 3, 01 March 2006) reported a drop in vaccine coverage to a level that was “too low to cover the risk group” following the switch to Selective BCG vaccination in Sweden. This was later rectified to an estimated 88% vaccine coverage of the high-risk population.
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