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Improvements to BCG immunisation programme announced
Jul 7, 2005, 17:50, Reviewed by: Dr.
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The new programme will identify and vaccinate babies and older people who are most likely to catch the disease, especially in those living in areas with a high rate of TB or whose parents or grandparents were born in a TB high prevalence country.
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By Department of Health, UK,
Changes to the BCG vaccination programme were announced today by the Chief Medical Officer, Sir Liam Donaldson.
Following advice from the Joint Committee on Vaccination and Immunisation (JCVI) the current universal BCG vaccination programme delivered through schools will be replaced with an improved programme of targeted vaccination for those individuals who are at greatest risk.
The new programme will identify and vaccinate babies and older people who are most likely to catch the disease, especially in those living in areas with a high rate of TB or whose parents or grandparents were born in a TB high prevalence country.
Patterns of TB in the UK have changed significantly since the BCG programme was first introduced in the 1950s. At that time, 50,000 cases of TB were reported each year in the UK with cases occurring across most groups of people in society. Numbers of cases are now approximately 7000 a year. Although they have increased overall since the early 1990s, cases now tend to be concentrated in large cities and in specific population groups.
Based on the latest UK data, the JCVI has recommended that identifying and vaccinating those who are most likely to catch the disease is the most effective policy in the present circumstances.
Chief Medical Officer, Sir Liam Donaldson said:
"These recommendations reflect the changing patterns of TB infection in this country and mean we can better protect children and others who are at higher risk.
"Rates of the disease are now very low in many parts of the country and children living in these areas are at an extremely low risk of infection. However, in other areas, rates of TB are on the increase. The changes that we are implementing mean that we will target those children who are most likely to catch the disease earlier than they would have been identified through the schools programme.
"Vaccination with BCG is only one part of TB control. Identifying and treating people with TB disease early is the most important measure and is stressed in the TB Action Plan I published last year. We are one of the first countries in the world to have a comprehensive TB Action Plan. The plan set out a range of measures to tackle and ultimately eliminate TB. It also included a promise to review the BCG vaccination programme.
"This change to the vaccination programme brings us into line with international guidelines on TB control".
The new programme will be introduced from September this year. Parents and health professionals will be able to find information about the changes on the immunisation website or by calling NHS Direct on 0845 4647.
We are asking Primary Care Trusts to put programmes in place to identify those children who should have been immunised in the new programme but have not yet had the vaccine and will not now be picked up in the schools programme. This means that those who are at risk, will be vaccinated earlier than they otherwise would have been under the old programme. 
- Department of Health, UK
Link to NHS immunisation website
1. BCG (Bacillus Calmette Gu�rin) was first introduced in the UK in the 1950s, and recommended for secondary school age children. At that time, 50,000 cases of TB were reported each year in the UK and the cases occurred across most sectors of society. The age at which immunisation was recommended represented the most effective use of the vaccine for the epidemiology at the time. In the 1960s selective immunisation of neonates who were at higher risk of TB was introduced.
2. The UK approach of vaccinating at secondary school age is unique. Other countries either vaccinate all infants or vaccinate infants selectively depending on patterns of TB in those countries or do not use BCG at all.
3. The JCVI recommends that the following risk groups be offered BCG vaccination:
* all babies living in areas where the incidence of TB is 40/100,000 or greater
* babies whose parents or grandparents have lived in a country with a TB prevalence of 40/100,000 or higher
* unvaccinated new immigrants from countries with a high TB prevalence
4. A tuberculin skin test is carried out prior to BCG vaccination in people older than 12 months of age. This test is used to determine whether they require the vaccination. One technique currently used in the UK is the Heaf method. The standard technique used worldwide is the Mantoux test and the UK will switch to this method for all tuberculin skin tests at the same time as these changes to the immunisation programme.
5. The only manufacturer of Heaf strength PPD will no longer be supplying tuberculin PPD. We are therefore recommending that Mantoux testing replaces Heaf.
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