What is BCG?

The name stands for Bacillus Calmette Gurrain. The vaccine contains a strain/type of mycobacterium bovis which is a bacterium (germ) that causes tuberculosis (TB) in cattle. The bacteria are altered so that it does not cause a TB infection, but stimulate your immune system to make your baby resistant to disease.

When it is given?

In Malaysia as part of Expanded Programme of Immunization (EPI); it is given at birth.
It is given in school at standard one if NO SCAR is present.

Where it is given?

It is given over left arm of babies.

Reaction following vaccine

After being given the vaccine, there is a small swelling where the injection was given which will disappear within one day. However, after 6-8 weeks a swelling will appear again which look like mosquito bite. This swelling will grow in size and form nodule which then breaks open and discharges fluid. After this, an ulcer remains and heals by forming a scar. This whole process takes about 2-5 weeks.

The end point of this whole process is puckered scar which remains for lifetime.

Reaction following BCG Vaccinations
Source: http://www.healthywa.wa.gov.au/Healthy-WA/Articles/S_T/Tuberculosis-
BCG-Vaccination

Tips for parents/guardian

Please do not rub or press the injection site. Do not apply anything. In fact, bathing with soap and water is enough even when there is ulcer.

Do we still need to give BCG vaccination in Malaysia?

• Malaysia is fast becoming a developed country like America and United Kingdom. Much of the initial improvement in TB in more developed countries was related to improvement in housing, nutrition and access to treatment like what we have now.
• But we are still endemic for tuberculosis. People infected with TB in Malaysia has not declined each year. WHO (World health organization) estimates that they are nearly 20 million cases of active TB and these people cause infection in 50-100 million people each year and mostly children. The death yearly due to TB is around 3 million and 80% occurs in developing countries mostly in Asia and Africa.
• Several strains of TB bacteria have developed resistance to one or more medications taken to treat TB making it hard to treat TB.
• After the occurrence of HIV in 1980’s, more cases of TB were detected not only in Malaysia but globally. This is because HIV weakens a person’s immune system, making them more likely to develop TB infection.
• The rapid growth of international travel has allowed people to travel widely and has helped to spread the disease.

So the answer to the question is: YES we still need BCG vaccination

How effective is the vaccine?

In Malaysia, where TB is still endemic, children catch this germ early in life and develop what we call primary complex. In children younger than 5 years of age, this infection can spread and lead to severe form of tuberculosis like TB infection involving brain( TB Meningitis), TB involving multiple organs ( simultaneous infection of lung with brain and abdomen for example).This form of serious childhood TB causes death and disability unlike adult who usually have TB infection of lung.

What the vaccine does?

• It stimulates this natural process following infection i.e. IT INDUCES THE BODY TO PRODUCE PRIMARY COMPLEX.
• This lead to immunity against the disease. When a child is exposed to an adult with TB, he/she can still get infected with this wild form of TB BUT having previous BCG vaccination will help in preventing this infection from getting serious OR limit the spread.
• This means that child who has BCG vaccination is protected against severe form of TB.

However it does not PROTECT against the adult form of TB, that is, TB infection of lung or Pulmonary TB.

Any side effects of this vaccine?

This vaccine does not lead to fever. In small proportion of children, 1% – 2% of babies receiving this vaccine, glands or lymph node at the same arm where the vaccine was given can become swollen causing what we call lymph (gland) adenitis.

It usually occurs 2-4 months following vaccine and do not cause other symptoms like persistent fever or loss of appetite or weight.

If this occurs; please bring your baby to see  doctor. The doctor needs to examine the child to make sure they are no other swelling of glands elsewhere or other signs that may lead the doctor to suspect other diagnosis.

This complication called BCG related lymphadenitis usually resolve on its own without any treatment. Your doctor will be able to tell you more.

References:

• Clinical practice guidelines: Guideline on management of TB (3rd ed).(2012). Malaysia Health Technology Assessment Section (MaHTAS).
• Hussain Imam Hj Muhammad Ismail, Ng HP et al. Paediatric protocols for Malaysian Hospitals (3rd ed). Kementerian Kesihatan Malaysia.
• NHS-BCG/TB vaccine; Frequently asked questions.(2014). Retrieved June 18, 2014, from:  http://www.nhs.uk/conditions/vaccinations/pages/bcg-tb-vaccine-questions-answers.aspx