DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
See also Tuberculosis (investigation and management following exposure in pregnancy) guideline
INDICATIONS
- All babies (aged ≤12 months) with a parent or grandparent who was born in a country where the annual incidence of TB is ≥40/100,000
- All babies (aged ≤12 months) living in areas of the UK where the annual incidence of TB is ≥40/100,000
- PHE TB Official Statistics 2020 (publishing.service.gov.uk)
BCG vaccine to be given to eligible baby
- Once aged 28 days
- On receipt of screen negative severe combined immune deficiency (SCID) result (or ‘SCID not offered’ result)
Countries with incidence of TB ≥40/100,000
Afghanistan | Ecuador | Korea DPR | Niger | Tajikistan |
Algeria | El Salvador | Korea (Rep. of) | Nigeria | Tanzania |
Angola | Equatorial Guinea | Kyrgyzstan | Niue | Thailand |
Azerbaijan | Eritrea | Lao PDR | Northern Mariana Islands | Timor-Leste |
Bangladesh | Eswatini | Lesotho | Pakistan | Turkmenistan |
Benin | Ethiopia | Liberia | Palau | Tuvalu |
Bhutan | Fiji | Libya | Panama | Uganda |
Bolivia | Gabon | Lithuania | Papua New Guinea | Ukraine |
Botswana | Gambia | Madagascar | Paraguay | Uzbekistan |
Brazil | Georgia | Malawi | Peru | Vanuatu |
Brunei | Ghana | Malaysia | Philippines | Venezuela |
Burkina Faso | Greenland | Mali | Romania | Vietnam |
Burundi | Guam | Marshall Islands | Russia | Yemen |
Cambodia | Guinea | Mauritania | Rwanda | Zambia |
Cameroon | Guinea-Bissau | Micronesia | Sao Tome and Principe | Zimbabwe |
Cape Verde | Guyana | Moldova | Senegal | |
Central African Republic | Haiti | Mongolia | Sierra Leone | |
Chad | Hong Kong | Morocco | Singapore | |
China | India | Mozambique | Solomon Islands | |
Congo | Indonesia | Myanmar | Somalia | |
Congo DR | Iraq | Namibia | South Africa | |
Côte d'Ivoire | Kazakhstan | Nauru | South Sudan | |
Djibouti | Kenya | Nepal | Sri Lanka | |
Dominican Republic | Kiribati | Nicaragua | Sudan |
https://www.gov.uk/government/publications/tuberculosis-tb-by-country-rates-per-100000-people
Tuberculin testing not necessary aged <6 yr unless baby has been in recent contact with TB or has resided in high-incidence country for >3 months
CONTRAINDICATIONS
- SCID screen positive or screen performed and result pending
- Temperature >38°C or acutely unwell
- Severe eczema (give at suitable lesion-free site)
- Baby in household where an active TB case suspected or confirmed, see Tuberculosis (investigation and management following exposure in pregnancy) guideline
- Immunodeficient or on high-dose corticosteroids
- defer BCG until 3 months after stopping corticosteroids if given prednisolone 1 mg/kg/day for >2 weeks, 2 mg/kg/day for 1 week, (or equivalent doses of another corticosteroid, e.g. dexamethasone 150 micrograms = prednisolone 1 mg)
- Maternal immunosuppressive treatment during pregnancy or breastfeeding
- biologicals e.g. anti-TNFα, postpone BCG until aged 6 months
- immune-modulation therapy for treatment of COVID in pregnancy e.g. tocilizumab and sarilumab, postpone BCG until aged 6 months
- HIV positive, living in UK
- if mother HIV positive and high risk of HIV transmission [see Human immunodeficiency virus (HIV) guideline] and exclusively formula feeding, give vaccine only after baby is confirmed HIV uninfected at aged 12–14 weeks
- if mother HIV positive and very low risk or low risk of HIV transmission [see Human immunodeficiency virus (HIV) guideline] BCG can be given to baby when indicated
- if high risk of TB exposure and maternal HIV viral load <50 copies/mL after 36 weeks’ gestation, BCG can be given at birth
- encourage maternal HIV testing but do not withhold BCG if mother declines testing unless mother from sub-Saharan Africa, in which case refer to HIV team for counselling about testing
SPECIAL CASES
- No need to delay routine vaccinations
- BCG can be given simultaneously with other vaccines [including rotavirus vaccine oral or palivizumab (Synagis®) (IM but not in same arm)]
- no further immunisation should be given in arm used for BCG immunisation for ≥3 months due to risk of regional lymphadenitis
- if not given at same time, leave 4 weeks before giving other injectable live vaccines
PROCEDURE
- Dose: 0.05 mL (Note: vial contains 20 doses)
- Only to be given by health professional trained in giving BCG vaccine
Consent
- Midwife to record at booking if risk factor present
- Postnatal check for risk factor
- Ensure baby within inclusion group
- Give mother information on vaccine
- Give appropriate language leaflet TB, BCG vaccine and your baby, available from https://www.gov.uk/government/publications/tb-bcg-and-your-baby-leaflet order line: 0300 123 1002
- Department of Health guidelines state written consent is not required but follow local practice
Injection
Only staff trained to give intradermal injections to give BCG
- Hold arm at 45° to body
- At insertion of deltoid muscle near middle of left upper arm
- If skin is clean, no further cleaning is necessary
- If skin is visibly dirty, clean with soap and water
- Stretch skin between thumb and forefinger
- Introduce needle bevel upwards approximately 3 mm into superficial layers of dermis almost parallel to skin
- If considerable resistance not felt, remove needle and reinsert before giving more vaccine
- Correctly given intradermal injection results a tense blanched bleb
DOCUMENTATION
- Enter on BCG page in online Child Health Record or in Red Book and tear out yellow copy for Child Health
SEQUELAE
- Scar
- within 2–6 weeks a small papule will appear
- sometimes this ulcerates and can ooze
- site need not be protected from water
- do not cover with an impervious dressing
- can take several months to heal
- occasionally persists as keloid (particularly if given superior to insertion of deltoid)
- Adenitis:
- a minor degree of adenitis can occur in the weeks following BCG
- no treatment indicated
- Rare sequelae:
- local abscess
- chronic suppurative lymphadenopathy
- disseminated disease, if immunocompromised
- osteitis, refer to infectious diseases specialist
Refer to paediatric TB team if
- Severe local reactions
- abscesses or drainage at the injection site or
- regional suppurative lymphadenitis with draining sinuses
Refer disseminated BCG infection to paediatric TB specialist