This item was published during the term of a previous administration that ended in April 2007
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TB: improvements to BCG vaccination programme
06/07/2005
Changes to the BCG vaccination programme were announced today by the Department of Health in England and the Executive's Health Department in Scotland.
The current universal BCG vaccination programme delivered through schools will be replaced with an improved programme including targeted earlier vaccination for those individuals who are in greatest need, following advice from the Joint Committee on Vaccination and Immunisation (JCVI).
In almost all cases, a child catches TB via a close family member or someone they live with. The new programme will identify and vaccinate those babies and other individuals who are most likely to catch the disease including those living in areas with a high rate of TB or whose parents or grandparents have lived in a high prevalence country for TB .
Patterns of TB in the UK have changed significantly since the schools 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 sectors in society. Numbers of cases have fallen sharply to approximately 7000 cases a year concentrated in large cities and affecting specific groups.
Scotland has around 400-450 cases per year and, unlike in England, our numbers have been relatively stable for a number of years. Based on the latest data for TB in the UK, Joint Committee on Vaccination and Immunisation have recommended that all children will be better protected against TB by identifying and vaccinating those who are most likely to catch the disease.
Deputy Chief Medical Officer, Dr Aileen Keel said:
"These changes reflect the changing patterns of TB infection in this country since the 1950s, and mean we can better protect our population against TB.
"Rates of the disease are now very low in some parts of the country and children living in these areas are at an extremely low risk of infection. In other areas, rates of TB are on the increase. These changes will mean that we can target those children who are most likely to catch the disease.
"Identifying and treating TB early is the single most important part of TB control in this country. These measures will be supported by identifying and vaccinating at an early age those most at risk.
"This change to the immunisation programme brings us into line with international WHO guidelines and we have met the criteria set out by the WHO to make this change."
Dr Martin Donaghy, Medical Director of Health Protection Scotland, welcomed the move: "The need to offer BCG to all secondary schoolchildren has been questioned since the late 80's.
"Since then the JCVI, the Government's committee of experts, has regularly reviewed the evidence about TB and BCG and now come to a view that to reduce the incidence of the disease we should target infants born to families with higher risk of acquiring TB and others in high risk categories. We fully support that view.
"Better targeting of the immunisation programme coupled with our on-going action in the other areas of TB control will continue to protect the Scottish public from this infection."
Dr Syed Ahmed, a Public Health consultant in Glasgow said: "This new policy will be a refined version of the existing programme and will concentrate efforts on those children most at risk of TB disease. By protecting those most at risk, we can prevent the spread of this disease to the general population."
Fraser Ross, Chairperson of the Scottish TB Nurses Group said:
"This new development will direct services to those most at risk from tuberculosis. It will help TB Nurses across Scotland to continue to offer support and guidance in the prevention and management of TB."
BCG 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 was introduced.
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.
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, (currently no NHS Board areas in Scotland fall into that high risk category); babies whose parents or grandparents have lived in a country with a TB prevalence of 40/100,000 or higher; and unprotected new immigrants born outside the UK.
A tuberculin skin test is carried out prior to BCG vaccination. This test identifies those individuals who have already been exposed to TB and is used to determine whether they require the vaccination. The 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 at the same time as these changes to the immunisation programme.
The new programme will be introduced later this year. Parents and health professionals will be able to access information about the changes to the routine programme on the new immunisation website or by calling NHS 24.
Measures will be put in place to identify those children currently aged between six months and 14 years who are likely to catch the disease but are too old to be picked up through the new programme of identifying and vaccinating babies. This means that they will be vaccinated earlier than they otherwise would have been under the schools programme.