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Immunisation - BCG

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Overview

All aspects of BCG immunisation are under the jurisdiction of the Ministry of Health. Neonatal BCG is recommended and funded for infants at increased risk of TB, defined as those who:

  • will be living in a house or family/whanau with a person with either current TB or a history of TB
  • have one or both parents or household members or carers, who within the last five years lived for a period of six months or longer in countries with a TB rate ≥ 40 per 100,000
  • during their first five years will be living for three months or longer in a country with a TB rate of ≥ 40 per 100,0001

Infants born before 34 weeks' gestation should have their BCG vaccination delayed until 34 weeks' post conceptual age.2 Babies born after this or with low birth weight appear to produce an adequate response based on tuberculin skin test responses.3-5

Contraindications

BCG vaccine should NOT be given to individuals:

  • receiving corticosteroids or other immunosuppressive treatment, including radiotherapy (see section 4.3)
  • suffering from malignant conditions such as lymphoma, leukaemia, Hodgkin's disease or other tumours of the reticulo-endothelial system
  • in whom an immune-compromising disease is known or suspected, such as individuals with hypogammaglobulinaemia -primary immune deficiencies in children are often not detected until after the first few weeks of life (ie, after BCG vaccine is given), so a family history of immune deficiency should be sought and, if present, discussed with a paediatrician before vaccination
  • known to be infected with HIV, including neonates where the mother's HIV status is unknown-maternalHIV infection should be excluded prior to neonatal vaccination; testing should have been offered as part of the National Antenatal HIV Screening Programme, and infants born to HIV-infected mothers should be under the care of a paediatrician
  • aged under 8 months, whose mothers took anti-tumour necrosis factor (anti-TNF) therapies (eg, infliximab) during pregnancy -BCG vaccination should be delayed until the infant is at least 8-9months old; these drugs may cross the placenta and cause immunosuppression in the infant
  • with a positive tuberculin skin test reaction or who have a positive IGRA
  • with generalised infected skin conditions.

Currently NICU does not have a gazetted nurse to administer BCGs. Babies who meet the criteria for BCG will have the Neonatal BCG Assessment Form completed. This form will be forwarded to the Auckland Regional Public Health Service (ARPHS) who will contact the family with an appointment for vaccination. To book a BCG appointment phone 0800 367224 Booking clerk BCG team.

References

  1. Ministry of Health 2014. Immunisation Handbook 2014, page 480
  2. Sedaghatian MR, Hashem F, Moshaddeque Hassain M. 1998. Bacille Calmette Guerin vaccination in pre-term infants. International Journal of Tuberculosis and Lung Disease 2(8): 679-82.
  3. Thayyil-Sudhan S, Kumar A, Singh M, et al.1999. safety and effectiveness of BCG vaccination in preterm babies. Archives of Diseases in Childhood: Fetal and Neonatal Edition 81(1): F64-6.
  4. Sedaghatian MR, Kardouni K. 1993. Tuberculin response in infants after BCG vaccination at birth. Archives of Disease in Childhood 69(3 Spec no):309-11
  5. Ferreira AA, Bunn- Moreno MM, Sant'Anna CC, et al. 1996. BCG vaccination in low birthweight newborns: analysis of lymphocyte proliferation, il-2 generation and intradermal reaction to PPD. Tubercle and Lung Disease 77(5): 476-81.

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Document Control

  • Date last published: 05 October 2015
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years