Accelerated responses to BCG vaccination,the far North Queensland experience

Abstract

Background: There has been significant shortage of BCGVaccine since 2012 leading to a cohort of high-risk childrenup to the age of eight being unvaccinated. Current ATAGIrecommendation is that children over 6 months shouldreceive Tuberculin Skin Test (TST) before BCG. This neces-sitates multiple clinic attendances and probably reducesadherence. However, BCG vaccination in children withlatent Tuberculosis (LTB) simply produces an acceleratedresponse, not a more severe one, and has been found to havegreater sensitivity than TST for diagnosing LTB. In April2021, approval was given for BCG vaccination without priorTST in children up to seven. We report local experiencewith this policy.Findings: 192 children received BCG without prior TST,with parents/guardians warned to report any reactions.Twelve demonstrated an accelerated response indicatingLTB, nine occurred within 48 h and all were identifiedwithin 5 days. All were given chemoprophylaxis with3 months of Isoniazid and Rifampicin. All BCG lesions werereported healed within 3 weeks.Discussion: Giving BCG to high risk children between6 months and 7 years appears to be safe, reduces clinic visitsand workload and effectively identifies children with LTB.Current national vaccination guidelines should bereconsidered.Grant Support: Nil.