BCG vaccination in developing countries

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c809 (Published 15 March 2010)
Cite this as: BMJ 2010;340:c809

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  1. Frank Shann, professor of critical care medicine
  1. 1Intensive Care Unit, Royal Children’s Hospital, Parkville, VIC 3052, Australia
  1. shannf{at}netspace.net.au

    Important interactions occur with other vaccines, vitamin A, and the organisms that cause fatal pneumonia

    BCG vaccine is given to more than 100 million infants each year, making it one of the most widely used vaccines.1 In the linked randomised controlled trial (doi:10.1136/bmj.c671), Roth and colleagues assess whether revaccinating children at 19 months reduces overall child mortality.2

    A single dose of BCG provides useful protection against systemic mycobacterial infections, such as tuberculous meningitis, miliary tuberculosis, and leprosy.1 3 It is less effective against pulmonary tuberculosis—effectiveness varies greatly between trials, but geographical latitude and study validity explained 66% of this variance in one meta-analysis.4 BCG was less effective near the equator, in lower quality trials, and in rural areas, but effectiveness was not influenced by age at vaccination or the strain of BCG used.4 5 BCG may be of less benefit to people living in tropical or rural areas because they have greater contact with environmental mycobacteria. These organisms may have heterologous (non-specific) immunological effects that provide some protection against tuberculosis but also reduce the effectiveness of BCG.5

    Because BCG provides useful protection against tuberculous meningitis and miliary tuberculosis in children, the World Health Organization recommends that it be given as soon as possible after birth to all infants living in areas where tuberculosis is highly endemic.1 WHO also recommends that BCG be given only …

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