BCG--mass or selective vaccination?

After years of decline, notifications of tuberculosis in England and Wales have recently increased. BCG immunization forms part of the programme of measures to control tuberculosis in this country. All tuberculin negative 10-13-year-old schoolchildren are offered vaccination. In addition BCG is offered selectively at any age to those considered to belong to groups at increased risk of tuberculosis. While the protective effect of BCG immunization in the population of this country is well established, the cost-effectiveness of the School's BCG programme has been the subject of considerable debate. If the rate of tuberculosis notifications in the 15-29-year-old age group within the white majority population, the major group to whom any potential benefit of the Schools' programme applies, continues to decline, serious consideration should be given to discontinuing this programme while strengthening the programme of selective immunization.