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Do selective immunisation against tuberculosis and hepatitis B reach the targeted populations? A nationwide
Berit Feiring1, Ida Laake1, Tor Molden1
1Norwegian Institute of Public Health, PO Box 4404 Nydalen, 0403 Oslo, Norway.
Insights
Selective vaccination policies for tuberculosis (BCG) and hepatitis B (HBV) vaccines in Norway showed lower coverage in targeted groups compared to universal vaccines. This highlights challenges in reaching at-risk children, suggesting a need for improved strategies or consideration of universal immunization.
Area of Science:
- Public Health
- Immunology
- Epidemiology
Background:
- Selective immunization strategies aim to vaccinate children at increased risk for specific diseases.
- In Norway, BCG (tuberculosis) and hepatitis B virus (HBV) vaccines are selectively offered to children whose parents are from high-burden countries.
- The study evaluates the effectiveness of this selective vaccination policy in reaching its intended high-risk populations.
Purpose of the Study:
- To assess whether Norway's selective immunization policy for BCG and HBV vaccines successfully reaches targeted at-risk children.
- To compare the vaccine coverage rates of BCG and HBV vaccines with those of universally administered vaccines within the target groups.
Main Methods:
- A population-based study included 240,484 children born in Norway between 2007-2010 and residing until age two.
- Data on vaccinations, parental country of birth, and residency were linked using national registries.
- Coverage of BCG and HBV vaccines was compared against pertussis and measles vaccines in targeted and non-targeted populations.
Main Results:
- Approximately 16% of children were identified as target groups for BCG and HBV vaccines.
- BCG and HBV vaccine coverage (83.6% and 90.0%) in target groups were significantly lower than universal vaccines (98.6% for pertussis, 92.3% for measles).
- Vaccine coverage was highest among children with parents from South Asia and Sub-Saharan Africa; universal vaccine coverage was consistent across targeted and non-targeted groups.
Conclusions:
- Selective vaccination for BCG and HBV in Norway faces challenges, with lower coverage in targeted populations compared to universal programs.
- There is a need for enhanced identification and delivery systems for targeted vaccines.
- Universal vaccination for BCG and HBV could be considered as an alternative to improve coverage in at-risk groups.
Background:
Selective immunisation is an alternative to universal vaccination if children at increased risk of disease can be identified. Within the Norwegian Childhood Immunisation Programme, BCG vaccine against tuberculosis and vaccine against hepatitis B virus (HBV) are offered only to children with parents from countries with high burden of the respective disease. We wanted to study whether this selective immunisation policy reaches the targeted groups.
Methods:
The study population was identified through the Norwegian Central Population Registry and consisted of all children born in Norway 2007-2010 and residing in Norway until their second birthday, in total 240,484 children. Information on vaccinations from the Norwegian Immunisation Registry, and on parental country of birth from Statistics Norway, was linked to the population registry by personal identifiers. The coverage of BCG and HBV vaccine was compared with the coverage of vaccines in the universal programme.
Results:
Among the study population, 16.1% and 15.9% belonged to the target groups for BCG and HBV vaccine, respectively. Among children in the BCG target group the BCG vaccine coverage was lower than the coverage of pertussis and measles vaccine (83.6% vs. 98.6% and 92.3%, respectively). Likewise, the HBV vaccine coverage was lower than the coverage of pertussis and measles vaccine in the HBV target group (90.0% vs. 98.6% and 92.3%, respectively). The coverage of the targeted vaccines was highest among children with parents from South Asia and Sub-Saharan Africa. The coverage of vaccines in the universal programme was similar in targeted and non-targeted groups.
Conclusions:
Children targeted by selective vaccination had lower coverage of the target vaccines than of vaccines in the universal programme, indicating that selective vaccination is challenging. Improved routines for identifying eligible children and delivering the target vaccines are needed. Universal vaccination of all children with these vaccines could be considered.
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