Intended for healthcare professionals


BCG vaccination in developing countries

BMJ 2010; 340 doi: (Published 15 March 2010) Cite this as: BMJ 2010;340:c809

BCG in developing countries

In response to Professor Viroj Wiwnaitkit, I emphasise that BCG is
very useful in tropical countries because it provides important protection
against systemic mycobacterial infections (tuberculosis meningitis,
miliary tuberculosis and leprosy) [1], and non-specific protection against
non-mycobacterial infections such as bacterial pneumonia [2]. However, as
I discussed in my editorial [3], the available evidence suggests that BCG
does not provide very good protection against pulmonary (as opposed to
disseminated) tuberculosis in tropical areas were pulmonary tuberculosis
is common.

We do not have enough information about the role of BCG in
communities with a high prevalence of HIV infection, but considerable
caution is required. In HIV-infected infants, BCG vaccination has a
greatly increased risk of causing disseminated BCG infection, may not
provide protection against tuberculosis, and may lead to more rapid
progression of HIV disease [4].

1. Trunz BB, Fine P, Dye C. Effect of BCG vaccination on childhood
tuberculous meningitis and miliary tuberculosis worldwide: a meta-analysis
and assessment of cost-effectiveness. Lancet 2006;367:1173-80.

2. Roth A, Garly ML, Jensen H, Nielsen J, Aaby P. Bacillus Calmette-
Guérin vaccination and infant mortality. Expert Rev Vaccines. 2006 Apr

3. Shann F. BCG vaccination in developing countries. BMJ 2010;340:720

4. Hesseling AC, Cotton MF, Marais BJ, Gie RP, Schaaf HS, Beyers N,
Fine PE, Abrams EJ, Godfrey-Faussett P, Kuhn L. BCG and HIV reconsidered:
moving the research agenda forward. Vaccine 2007;25:6565-8.

Competing interests:
None declared

Competing interests: No competing interests

09 April 2010
Frank Shann
Professor of Critical Care Medicine
Royal Children's Hospital, Melbourne 3052, Australia