Your editorial, "Tuberculin testing before BCG vaccination may not be
necessary", BMJ 2003; 243-244 indicates some advantages
in not tuberculin testing older children prior to giving BCG. Some
potential problems should also be mentioned. In subjects already
tuberculin positive the Koch's phenomenon from giving BCG, as a rule,
produces a larger and often more unsightly scar. The general
public has become more aware that scars in subjects properly selected and
properly given BCG are usually circular and 5mm. or
less in diameter with a smooth surface. Litigation in the NHS is ever
increasing and there are now several examples of
compensation being paid to subjects with unsightly BCG scars because of
being wrongly selected and/or having BCG incorrectly
administered. Your proposals could increase the possibility of litigation
due to more unsightly scars.
Regarding the number of visits required, especially in the Schools BCG
programme, there would still be two needed, one to give
BCG and one to identify those with the Koch's phenomenon. Possibly a third
to confirm healing of the latter as not all such
reactions heal as readily as your editorial implied.
Competing interests:
I am a member of the Dept of Health's working party to develop the disposable Heaf testing device
Competing interests:
No competing interests
12 August 2003
John A Lunn
Former member of the Joint Committee on Vaccination and Immunisation
Rapid Response:
Tuberculin testing before giving BCG
Your editorial, "Tuberculin testing before BCG vaccination may not be
necessary", BMJ 2003; 243-244 indicates some advantages
in not tuberculin testing older children prior to giving BCG. Some
potential problems should also be mentioned. In subjects already
tuberculin positive the Koch's phenomenon from giving BCG, as a rule,
produces a larger and often more unsightly scar. The general
public has become more aware that scars in subjects properly selected and
properly given BCG are usually circular and 5mm. or
less in diameter with a smooth surface. Litigation in the NHS is ever
increasing and there are now several examples of
compensation being paid to subjects with unsightly BCG scars because of
being wrongly selected and/or having BCG incorrectly
administered. Your proposals could increase the possibility of litigation
due to more unsightly scars.
Regarding the number of visits required, especially in the Schools BCG
programme, there would still be two needed, one to give
BCG and one to identify those with the Koch's phenomenon. Possibly a third
to confirm healing of the latter as not all such
reactions heal as readily as your editorial implied.
Competing interests:
I am a member of the Dept of Health's working party to develop the disposable Heaf testing device
Competing interests: No competing interests