Is BCG vaccination against tuberculosis still indicated?

More than 70 years after the introduction of BCG vaccination into clinical practice many questions remain to be answered. Major trials produced conflicting results regarding the degree of protection of this vaccine against tuberculosis. Several factors which may contribute to the inconsistent results of these trials, are discussed. In developing countries continuation of routine BCG vaccination of infants is highly recommended considering the ease of administration, low cost, wide availability and safety on the one hand and the protection provided particularly against haematogenous spread of tuberculosis on the other hand. In developed countries the vaccine is reserved for high risk groups since the prevalence of tuberculosis in the general population declined dramatically during the past decades. However, as the incidence of tuberculosis in the Western world no longer decreases steeply and indeed increases again in some countries, and because (para-) medical personnel risks to be among the prime victims of this re-emergence of tuberculosis, rigorously sustained preventive measures to protect this professional category deserve renewed interest. Among those, BCG vaccination can be considered, especially in case of a high prevalence of multidrug-resistant tuberculosis, but also for the Belgian situation with a high degree of non-immune health care workers. Therefore, we believe that BCG vaccination still has a future.