15.3 BCG vaccination

Recommendations vary between countries, with some requiring staff to be BCG vaccinated if never vaccinated and TST negative.

There is limited evidence regarding the benefits of BCG vaccination in adults who have not previously had BCG vaccination [1] Citation 1. Punam Mangtani, Ibrahim Abubakar, Cono Ariti, Rebecca Beynon, Laura Pimpin, Paul E. M. Fine, Laura C. Rodrigues, Peter G. Smith, Marc Lipman, Penny F. Whiting, Jonathan A. Sterne. Protection by BCG Vaccine Against Tuberculosis: A Systematic Review of Randomized Controlled Trials. Clinical Infectious Diseases, Volume 58, Issue 4, 15 February 2014, Pages 470–480.
 https://doi.org/10.1093/cid/cit790 .

Vaccination should be considered on a case-by-case basis in the following situations [2] Citation 2. Centers for Disease Control and Prevention Fact Sheets on BCG Vaccine.
https://www.cdc.gov/tb/publications/factsheets/prevention/bcg.htm :

• Significant exposure to multidrug-resistant TB (MDR-TB): e.g. facilities treating patients with MDR-TB, detention centres, or areas with high MDR-TB prevalence.
• While corrective actions are implemented:
  • when transmission of MDR-TB to staff has occurred;
  • when IPC measures are inadequate or poorly applied.

The following information should be provided to staff considered for BCG vaccination:

• Benefits and risks of BCG vaccination.
• Impact of BCG on the interpretation of TST results in diagnosing a potential latent TB infection (LTBI).
• No complete protection conferred by the vaccine: TB may still occur if IPC measures are not applied.

BCG vaccine should only be administered if the person:

• Has never had a BCG vaccination.
• Has a HIV test negative result.
• Is not pregnant.
• Has never had active TB.
• Has a TST negative result.

For more information on BCG vaccine, see Appendix 29.