Stopping UK BCG vaccination well justified

From autumn 2005, the long running routine programme to vaccinate school children against tuberculosis with BCG vaccine will stop. This decision brings the UK into line with much of the rest of the world and is well justified, writes Professor Paul Fine in the British Medical Journal (BMJ).

The spread of tuberculosis in the United Kingdom has changed greatly over the years since the BCG programme began. The annual risk of infection has declined from about 2% a year in 1950 to less than 1 per 1,000 today, and the disease has become restricted to segments of the population, in particular immigrant communities. The number of cases in people born in the United Kingdom reached an all time low in 2003.

Although the criteria set by the International Union against Tuberculosis and Lung Disease for shifting away from routine BCG vaccination were achieved in the 1990s, policy makers were reluctant to stop the programme in schools because of lingering concerns that increases in the prevalence of HIV and tuberculosis internationally might increase the risk of tuberculosis in the UK general population, explains the author.

This has not occurred, and it is clear that the risk of tuberculosis among immigrant communities declines over time once they have settled in the United Kingdom, and that the imported disease has not led to increases in the risk of disease for the indigenous population.

Under the new policy, BCG vaccination will be offered to infants in communities with an average incidence of tuberculosis of at least 40 per 100,000 and to unvaccinated individuals who come from, or whose parents or grandparents come from countries where the incidence exceeds 40 per 100,000.

BCG vaccination will continue to have an important role in protecting children in high risk populations from tuberculosis, says the author. Coupled with vigorous efforts to identify and treat cases, and to ascertain and offer prophylaxis to people with latent infection, the new policy should allow more efficient control of tuberculosis in the entire UK population.