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 BCG Vaccine

BCG Vaccine Nature It is a live, bacterial, freeze–dried vaccine. It contains live attenuated, bovine strain (Danish 1331) of TB bacilli. Thus bovine strain is employed to protect against human strain, a good example of cross-immunity. It is used to protect children against childhood types of TB such as TB meningitis and military TB. However, it does not protect children against adult types of TB

Indication of BCG Vaccine

For active immunization of children against TB. 

Diluent of BCG Vaccine

 Since BCG vaccine is a freeze-dried vaccine it is always supplied along with sterile normal saline. It is used within 3 hours of reconstitution. 

Dose of BCG Vaccine

 0.05 mL for the newborn because the skin is thin and 0.1 mL for an infant above 1 month. 

Route of BCG Vaccine

 The vaccine is administered intradermally, using a ‘Tuberculin-syringe’ on the upper outer aspect of left arm above the insertion of the deltoid. This region is preferred for administrative reasons. The vaccine should not be given intramuscularly or subcutaneously because of the complications such as regional lymphadenitis or abscess. 

Schedule of BCG Vaccine

It is recommended to be given to children as early as at birth because infection with atypical TB bacilli can interfere with the development of immunity. However, it can be given along with DPT and OPV during 6th week, but in different sites. Earlier the better.

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Immunity of BCG Vaccine

Starts from 15 days and lasts for about 15 years. Protective value: Varies from 0 to 80 percent.

 Phenomena after vaccination: Wheel of 5 mm diameter at the time of injection. 

First 2 weeks - No reaction seen 

During 3rd week - Papule 

4th week - Vesicle

5th week - Pustule 

6th week - Ulcer 

7th week - Crust formation 

8th week - Scar 

The vaccinated scar is about 4 to 8 mm in diameter, circular, superficial, shiny and permanent. Overdosage can result in irregular and larger scar. BCG vaccinated individual becomes Mantoux positive.

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Complications of BCG Vaccine

Local – Abscess, ulcers, keloid. 

Regional – Axillary lymphadenitis. 

General – Disseminated BCG infection, tetanus. 

These complications can be avoided by giving the vaccine strictly intradermally and no other injection should be given for at least 6 months in the same site of vaccination, because BCG may not be well taken up. 

Contraindications—infantile eczema, acute febrile disease, infective dermatosis, keloid, steroid therapy and HIV positive child. 

Storage of the vaccine: 2 to 8°C. 

Direct BCG vaccination: This consist of giving BCG vaccine to the child without a prior tuberculin test. This was carried out under National TB control program. This used to permit a more rapid and complete coverage of the children population and also no adverse effect can occur even if BCG vaccine is given to tuberculin positive reactors. Now under UIP, BCG is given at birth. 

Limitation of BCG vaccination: BCG vaccination is less effective in controlling TB because of the partial protection and varying protective value. So the disease can be better controlled by active case finding and prompt chemotherapy. 

Drug resistance: It is of two types – Primary and Secondary. 

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Primary resistance (Pretreatment resistance): It is the presence of resistance in a TB patient much before the chemotherapy is started. Either it could be due to the infection with the resistant strain or it could be due to the appearance of new mutants while the bacilli are multiplying. In this type, usually there is resistance to only one drug. 

Secondary resistance (Acquired or Post­treatment resistance): In this type, the organisms develop resistance during the course of the treatment due to intake of drugs irregularly, incompletely and inadequately.