Only certain children should get BCG vaccine

HIQA recommends selective vaccination
  • Deborah Condon

Only certain newborn babies who have an increased risk of contracting tuberculosis (TB) should receive the BCG vaccination, the Health Information and Quality Authority (HIQA) has recommended.

The Bacillus Calmette-Guérin (BCG) vaccine provides protection against 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.

HIQA has just published a health technology assessment on this topic, advising the Minister for Health that Ireland should move away from its current policy of universal vaccination to a selective strategy instead. It said that this advice is based ‘on the best available evidence'.

"Selective vaccination would focus resources on those who are at higher risk of contracting TB; one in eight newborns will continue to be eligible for the vaccine. This includes infants born in, or whose parents are from, a country with a high incidence of TB, those in contact with patients with active respiratory TB, and members of an at-risk group, such as the Traveller community in Ireland," explained HIQA's director of Health Technology Assessment, Dr Máirín Ryan.

She noted that it would be important to consult with groups who are considered at higher risk ‘to determine the most acceptable and efficient way to identify those eligible for vaccination'.

She also pointed out that such a change in the vaccination schedule should only come about ‘if appropriate preventative and protective measures are in place'.

"If selective vaccination is adopted, the most efficient method of delivering the programme needs to be determined to ensure best use of available resources and to minimise the impact of discontinuing universal vaccination," she commented.

Dr Ryan said that a selective programme ‘would achieve a better balance between risks and benefits than the existing universal strategy, while continuing to protect those at higher risk from TB'.

"Falling TB incidence has decreased the potential benefit of BCG vaccination for the majority of children. Selective vaccination would continue to protect those at higher risk while avoiding unnecessary side-effects in those with a limited capacity to benefit from vaccination," she insisted.

She acknowledged that there have been issues with the supply of the BCG vaccine in recent years, however she emphasised that parents should continue to get their children vaccinated ‘until such time that the policy is changed and an enhanced programme of preventative measures is in place'.

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