Public asked about future of BCG vaccine

Should all children continue to receive it?
  • Deborah Condon

Members of the public are being asked about their views on the future of the BCG vaccination programme in Ireland.

The Bacillus Calmette-Guérin (BCG) vaccine provides protection against tuberculosis (TB), which is caused by a bacterium called mycobacterium tuberculosis. The vaccine is provided to all children here as part of the routine childhood vaccination schedule.

TB usually affects the lungs, but can spread to other organs as well. Symptoms can include a persistent cough, sputum overproduction, weight loss, fever and night sweats.

TB is contagious and in the past, it was a very serious illness and was highly prevalent in Ireland, however it is much less common now. Some 324 cases were notified last year.

Currently Ireland is one of only two western European countries that vaccinates everyone with the BCG.

An assessment by the Health Information and Quality Authority (HIQA) has found that Ireland now meets the World Health Organization's (WHO) criteria for discontinuing universal vaccination.

HIQA assessed changes proposed by the National Immunisation and National TB Advisory Committees, at the request of the Department of Health, and concluded that selective vaccination would be more beneficial for Ireland's children.

Selective vaccination would involve vaccinating children at high risk of TB. The two groups deemed to be at high risk here are Traveller children and children born to parents from a high TB-incidence country. These two groups make up over 13% of all births in Ireland annually.

"In the context of a fall in TB incidence and diminished risk of acquiring TB, there has been a shift in the balance between the benefits and risks of offering vaccination to all infants. Falling TB incidence has decreased the potential benefit of BCG vaccination for the majority of children," explained Dr Máirín Ryan of HIQA.

She emphasised that ‘selective vaccination will continue to protect those at higher risk while avoiding unnecessary side-effects in those with a limited capacity to benefit from vaccination'.

Currently, most infants incur minor side-effects, while one in 1,200 incurs side-effects that require medical follow up. Minor side-effects include a mild ulcer at the injection site. Severe side-effects can include lymphadenitis, which is an inflammation of the lymph nodes.

"Neither vaccination programme is cost-effective, but a selective vaccination strategy would target resources to those who would benefit most. Given the continued decline in TB incidence, selective vaccination offers a better balance than universal vaccination in terms of benefits and harm," Dr Ryan noted.

A move from universal to selective vaccination would reduce the number of vaccinated infants from around 61,000 to 8,000 per year. This would also reduce the number of children suffering adverse side-effects.

"Any decision to change the BCG vaccination programme will require that the public are informed and educated on such a decision. This public consultation starts the discussion and invites feedback from all interested parties," Dr Ryan said.

Any member of the public who wishes to voice an opinion on this proposed change to the vaccination programme should click here

HIQA's full assessment document can be found here

The public consultation runs until October 21.

For more information on childhood vaccination, or to keep track of your child's vaccines, see our unique Child Immunisation Tracker here



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