What is the BCG vaccine?
The Bacille Calmette-Guérin (BCG) vaccine is given to children under five years of age who have a higher risk of catching TB.
All children receive the BCG vaccine at birth in South Africa (not in Europe and the Americas). It is a live vaccine given to stimulate the baby’s immune system to build antibodies to protect against TB. The vaccine is protective against more severe forms of TB (like TB meningitis and TB lymph nodes) but not considered effective against Pulmonary TB.
TB is an infectious disease caused by bacteria that affects the lungs, and sometimes other parts of the body such as the brain covering layer (known as the meninges)- this can lead to a condition known as meningitis, which has devastating consequences in infants and babies. Because TB is common in South Africa, the BCG vaccine is part of the routine vaccination schedule.
Where and when is the vaccine administered?
BCG has been used in South Africa since 1973. It has routinely been given intradermally in the right deltoid region (upper arm) at birth to all infants. It is part of the scheduled immunization of all infants, and it is available at all state clinics and hospitals.
Sometimes, a test may need to be done before receiving the BCG vaccine, especially in older children who might not have been vaccinated. If there is a chance your child has already been infected with TB, the doctor will arrange for a TB skin test (Mantoux test). If the skin test is positive (that is, your child may have previously been infected with TB) the BCG vaccine should not be given. If the skin test is negative, your child will be able to receive the BCG vaccine.
What to do if your child did not get the BCG vaccine at birth?
Usually, babies who were not given the BCG vaccine at birth will be immunised when they are taken to the clinic at the next immunisation visit, at 6 weeks of age. Any baby under 1 year who did not get the BCG vaccine at birth must be taken to the nearest clinic, where the vaccine will be given.
What to expect after the BCG vaccination?
Reactions to vaccines (vaccine side effects) sometimes occur. The usual reaction to BCG vaccination is redness and/or a small lump at the injection site, followed by a small ulcer (an open sore) a few weeks later. The ulcer is usually less than a centimetre in diameter and may last from a few weeks to a few months before healing to a small, flat scar.
Care of the injection site
Keep the area clean and dry.
It is OK to bathe your child as usual. Carefully pat the area dry after washing.
A wound dressing with gauze may be used if the area starts to ooze.
Use a sterile alcohol swab to clean the area, if required.
Do not apply ointment, antiseptic creams, or sticking plasters (e.g. Band-Aids).
When to see a doctor
There are some rare side effects associated with the BCG vaccine. If any of the following occur, see your doctor:
A large abscess (collection of pus) at the injection site.
Tenderness and swelling under the left arm – this could indicate an infection of the glands (called the axillary lymph nodes).
Very noticeable scarring of the skin at the injection site, known as keloid scarring.
Is the BCG vaccine safe?
Immunisation saves millions of lives every year. Immunisation/vaccination protects adults and children from dangerous diseases by working with your body’s natural defences to build protection. Vaccines also helps prevent and control infectious disease outbreaks. The Department of Health of South Africa strongly advises mothers to protect their children from infectious diseases by getting them vaccinated from birth to when they are 12 years old. Although side effects following immunisations may occur, they are usually mild and clear up quickly.
Vaccination is free of charge at all government/state health facilities.
Take home message
BCG vaccine is given at birth to all babies in South Africa. It is safe and can help prevent extra-pulmonary TB infection which has devastating consequences in babies.
This article is written by Dr. Itumeleng Buti (MBChB)
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