BCG policy and tuberculosis control in Hungary

Hungary has accomplished a resolute BCG programme since 1959 to control tuberculosis in children. High rates of child and adult tuberculosis incidence (over 200 and 300 per hundred thousand respectively) persisted before 1959. At that time the "Budapest" BCG strain received from the Pasteur Institute in 1933 was used for facultative vaccination. In 1954, vaccination became compulsory for the newborn but was not applied regularly with the "Budapest" BCG strain which showed diminished allergenic and immunogenic potency. To improve BCG policy revaccination became obligatory in 1959 up to the age of 20 years performed by specialized BCG nurses. Paris 1102, then P1173 BCG Seed-Lot strains have been used since 1960, dose: 100,000-300,000 VU in 0.1 ml i.d. route to obtain the required protective immunity (tuberculin conversion) and acceptable reactogenicity. In the scope of the systematic BCG primo and revaccination programme 7.8 million vaccinations have been performed since 1959. Between 1959 and 1970 the incidence in children dropped from 250 to 10 per hundred thousand, then to 1 per hundred thousand between 1971 and 1982. In 1982 the adult population had 21-32 per hundred thousand bacillary positive incidence and prevalence rates maintaining the risk of infection for children. Therefore, in 1983, it was decided to continue the compulsory revaccination policy to strengthen immunity for children of 10 years old and for adults of 20 years old.