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!

12 comments:

Kristy said...

i love reading your blog! We went ahead and got our children the BCG vaccine while in Taiwan as we thought we may move to China at some time. We did not get them vaccinated for Chickenpox while in Taiwan however because we had heard that the effectiveness of the vaccine in Taiwan had bad reviews.

Can't wait to read more~

JJHP said...

Hi, this is your oldest brother. Interesting reading, I think I'll become a regular.

J.

The Globetrotter Parent said...

I knew I recognized those initials! Yikes, the family has found me out!

Nathalie said...

This is the most useful travel vaccination site, I've come across:

http://wwwnc.cdc.gov/travel/destinations/list.aspx#I

Many of the recommend vaccines aren't just for exotic or tropical diseases. Measles is practically non-existent in Europe and North America, but not so in other countries. While I had MMR and DTP as a kid growing up in the US in the 70s, I and none of my generation who got the routine jabs, would have had Hep A and Hep B, which are now recommended if you travel to certain destinations, and what our kids get as a matter of course (actually Hep A is only standard since 2006 in the US...)

A said...

Thought you might be interested to know that a new blood test is available to check for TB infection:
http://en.wikipedia.org/wiki/QuantiFERON
For people who have had the BCG vaccine, Quantiferon supposedly does not have the high false positive rate associated with the skin test.

The Globetrotter Parent said...

Thanks for letting me know!

The Globetrotter Parent said...

Nathalie,
Hep A is not standard in Europe and we did not have our children vaccinated against it before coming to Madagascar. Hep A is a harmless disease for children so I don't see the point of the vaccine for a child under 12.

marshall said...
This comment has been removed by a blog administrator.
A Homeschool Story said...

Ah, just the impetus I needed to insist on not being re-tested for TB. I love your blog. I married a Frenchman too, and THE VACCINE question comes up in a slightly heated way in our house once in awhile. It's all cultural, lol!!!

It's gotta be hard to be married to a sort of crunchy, homebirth, homeschooling opinionated American (who is also the mother of your five children, so pretty much in charge!) I look forward to reading more.

Kristien said...

Dear all,

Please help me with my research on the BCG vaccine by going to following link and participate in my online survey:

https://qtrial.qualtrics.com/SE/?SID=SV_5hGOtXcGom0LZ0o

Your participation will be of great value to my research and will be highly appreciated!!!

It only takes a few minutes to fill in.

Many Thanks,

Kristien

April said...

Japan recommends it too. Stumbled across this page in researching whether or not to allow it for my child.

BigDog said...

Hi there, I stumbled on this thread when doing a search for BCG.

In the US and most of Canada we no longer give the BCG, but not because it isn't effective, but simply the matter of cost.

TB can be tested for cheaply (About $25 for a skin test at local US clinics), and cured with simple antibiotics.

The vaccine costs a few dollars, but the need for a gold blood test means a cost of about $75 every time you need to be tested. This means a lifetime of triple testing costs for a disease that pretty much extinct in the US (outside of immigrants and travelers).

Healthcare workers like myself who work in Microbiology labs can have relatively high exposures and the CDC does recommend the BCG for us if wanted.

Secondly, the BCG vaccine is the number one reason Leprosy has declined so quicikly in Africa and India as study after study have shown that it is possibly even MORE effective at preventing Leprosy as it is TB.

TB prevention is variable by latitude, likely due to vaccine development being from European TB strains, but its effectiveness against Leprosy can be reason enough for 2nd and 3rd world countries to continue vaccinating with BCG.

Lastly, BCG has been shown to reduce and prevent weaponized forms of TB and Leprosy, both of which historically were used in Bio-weapon research. If god forbid, there's ever attacks in unvaccinated areas, the host countries have stockpiles of BCG to distribute.

BCG works. No vaccine is 100%. As a lab worker and world traveler I'm quite happy getting the BCG to reduce risks I may be exposed to. People who don't have my job, travel goals, or who have compromised immune systems though will find their doctors likely recommend no vaccine since they don't need it.

It all depends who you are and what you do. :)