Tuesday, 16 March 2010

The BCG Vaccine - is it worth getting?

I found this box of unused vaccines against Tuburculosis (aka the BCG vaccine) sitting in our refrigerator yesterday.  In the days prior to leaving for Madagascar, the Frenchman, being French, was intent on getting the Bambino jabbed with the BCG vaccine.  I think that France is the only country that actually even recommends this vaccine anymore.  You certainly never hear about it in the UK, Canada, the States or Australia.  (Oh yeah, I think they maybe still recommend it in Romania.  And Mexico).

I managed to convince the Frenchman to give a pass on this vaccine for the Bambino, for a few reasons.  Yes, there is tuberculosis in Madagascar.  But the BCG vaccine is not known for being that effective in preventing transmission of tuberculosis. Clinical trials in the UK have shown an efficacy of about 60 to 80 percent (which is already not great for a vaccine).  The efficacy rate falls as you get closer to the equator, sometimes to zero percent effectiveness.  No one really knows why.  But according to the World Health Organization, the BCG vaccines currently in use are produced at several sites around the world and are not identical to one another.   And it is not known whether the vaccines produced at one site are more effective than the vaccines produced at other sites

Since 2007, a new and apparently improved BCG vaccine is being used.  I haven't seen any data to suggest that it is, indeed, any more effective than the old vaccine.  And lookie here, The World Health Organization questions the safety of the current BCG vaccine.  From the WHO site:

BCG is widely used and the safety of this vaccine has not been a serious issue until recently.  There is concern that the use of the vaccine in persons who are immune-compromised may result in an infection caused by the BCG itself.  Also, even among immune competent persons, local reactions, including ulceration at the site of vaccination may result in shedding of live organisms which could infect others who may be immune-compromised.
The other thing that bothers me about the BCG vaccine is it can result in false positives on future tubuculin skin tests - which means that if your child ever wants to, say, work in the health care industry one day, he will have to get an X-ray to prove that he or she does not have TB!  The skin test won't suffice.

And then there is the post-vaccine bump, puss and permanent scar left on your child's arm.

My cousin Wolfgang, who happens to be a microbiologist and a travel doctor in Berlin, doesn't have a problem with the BCG vaccine per se but he does recognize its lack of effectiveness.  When I talked to him about whether to have the Bambino vaccinated, he recommended testing the Bambino for TB once a year, instead, using the tuburculin skin test.  If the test result is negative, no TB.  If the test result is positive, the child then gets an x-ray to ensure that he has simply developed immunity to TB (this is what usually happens when you are exposed to TB) and does not actually have TB.  If the child has developed TB, then the TB gets treated.   Most of the American parents that I have met here have chosen this route for their children.

Since arriving in Madagascar last July, I have surveyed lots of families of a few different nationalities about the BCG vaccine.  So far, all of the French parents that I have met have had their children vaccinated with the BCG vaccine and all but one of the non-French families have refused the BCG vaccine for their children (the one non-French vaccinated child I know was born in Mexico, where they give the BCG vaccine routinely at birth) -yet more evidence that the way you parent really is a cultural thing, even when it comes to vaccines!

Wednesday, 10 March 2010

Circumcision and HIV/AIDS - Is the link really that relevant?

If I see one more article suggesting that all infant boys should be circumcised so as to reduce their chances of getting HIV/AIDS, I am going to scream.  Honestly, think about this one people.  Circumcision is an excruciatingly painful procedure for most babies who undergo it (no, the EMLA cream does not work and most parents don't bother asking for the penile block).  Moreover, the procedure removes a tissue containing something like ten thousand nerve endings, reducing sexual pleasure by thirty to fifty percent. 

As for those studies that conclude that it reduces transmission of STDs such as HIV, I urge you to read more about them.  Their conclusions are of questionable value, both in terms of the sample size of the men who did end up getting HIV and in terms of their applicability to North America and Europe.

But let's just say that circumcision really will reduce your boy's chances of getting HIV in the future.  Please ask yourself this before you have anyone mutilate his penis:

Would you have your baby girl circumcised for the same reason? 

Seriously, if it could be shown that circumcising your baby daughter would reduce of her chances of getting or transmitting HIV in the future, would you have her circumcised?  Because the pain is the same or worse for a boy and, as with female circumcision, removing your son's foreskin will deprive him of a great source of pleasure in the future.