The BCG vaccine: information and recommendations for use in Australia

The Bacille Calmette-Guérin (BCG) vaccine since its first use in 1921 has been the subject of much controversy as to its effectiveness and applicability. BCG vaccination is still considered an important strategy in the National Tuberculosis Programs of countries with a high burden of tuberculosis (TB) because of its benefit to infants but its effect on the control of TB has been limited. By contrast, in countries with a low prevalence of TB, significant policy differences exist both within and between countries. BCG vaccination does not prevent transmission of infection to the individual. In immune-competent neonates and infants it is accepted that BCG reduces the likelihood of TB infection progressing to disease or if disease occurs, substantially lessens the chance of a severe outcome. The benefit in older agegroups is less clear. In the Australian health worker, the BCG strategy is no longer recommended as the primary means of health care worker (HCW) protection. The preferred strategy is appropriate infection control measures, staff education and a tuberculin skin testing program that identifies and treats the at-risk infected HCW. The emergence of multi-drug resistant strains has however renewed interest in BCG in the HCW. This document provides recommendations for use of the BCG vaccine in the Australian community based on the best available evidence and consensus opinion. State and Territory TB Control Units should be consulted with regard to their BCG vaccination guidelines.