May not be necessary

BCG vaccination is effective against forms of tuberculosis that occur commonly in childhood that have a high morbidity and mortality, such as tuberculous meningitis.1 2 Current guidelines for the United Kingdom recommend tuberculin skin testing before BCG vaccination for all children older than 3 months.3 The evidence base for this recommendation is unclear—no randomised controlled trials have been conducted to compare outcome of BCG vaccination with and without prior tuberculin skin testing, and the resulting two or three stage procedure seriously compromises uptake.

The BCG vaccine was not available in the United Kingdom from 9 August 2002—when all stocks from the monopoly supplier, Evans Vaccines, were declared potentially ineffective by the Medicines Control Agency and the Department of Health—until supplies from Denmark's State Serum Institute became accessible during December 2002. The currently available BCG vaccine is for intradermal use only. From November 1998 to July 2001 a similar loss of supply of percutaneous BCG vaccine, which is …