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Annual report Tuberculosis in Australia: bacteriologically confirmed cases, 2004 18. van Soolingen D, Hoogenboezem T, de Haas PE, Hermans PW, Koedam MA, Teppema KS, et al. A novel pathogenic taxon of the Mycobacterium tuberculosis complex, Canetti: characterization of an exceptional isolate from Africa. Int J Syst Bacteriol 1997;47:1236–1245. 19. Aranaz A, Liebana E, Gomez-Mampaso E, Galan JC, Cousins D, Ortega A, et al. Mycobacterium tuberculosis subsp. caprae subsp. nov: a taxonomic study of a new member of the Mycobacterium tubercu losis complex isolated from goats in Spain. Int J Sys Bacteriol 1999;49:1263–1273. 20. Cousins DV, Williams SN, Reuter R, Forshaw D, Chadwick B, Coughran D, et al. Tuberculosis in wild seals and characterisation of the seal bacillus. Aust Vet J 1993;70:92–97. 22. Brosch R, Gordon SV, Marmiesse M, Brodin P, Buchrieser C, Eiglmeier K. A new evolutionary scenario for the Mycobacterium tuberculosis complex. Proc Natl Acad Sci USA 2002;99:3684–3689. 23. van Soolingen D, van der Zanden AG, de Haas PE, Noordhoek GT, Kiers A, Foudraine NA, et al. Diagnosis of Mycobacterium microti infections among humans by using novel genetic markers. J Clin Microbiol 1998;36:1840–1845. 24. Kremer K, van Soolingen D, van Embden J, Hughes S, Inwald, J, Hewinson G. Mycobacterium microti: more widespread than previously thought. J Clin Microbiol 1998;36:2793–2794. 21. Cousins DV, Bastida R, Cataldi A, Quse V, Redrobe S, Dow S, et al. Tuberculosis in seals caused by a novel member of the Mycobacterium tuberculosis complex: Mycobacterium pinnipedi sp. nov. Int J Sys Evol Microbiol 2003;53:1305–1314. 108 CDI Vol 30 No 1 2006
Tuberculosis guidelines The BCG vaccine: information and recommendations for use in Australia National Tuberculosis Advisory Committee Executive summary The Bacille Calmette-Guérin (BCG) vaccine since its fi rst use in 1921 has been the subject of much controversy as to its effectiveness and applicability. BCG vaccination is still considered an important strategy in the National Tuberculosis Programs of countries with a high burden of tuberculosis (TB) because of its benefi t to infants but its effect on the control of TB has been limited. By contrast, in countries with a low prevalence of TB, signifi cant policy differences exist both within and between countries. BCG vaccination does not prevent transmission of infection to the individual. In immune-competent neonates and infants it is accepted that BCG reduces the likelihood of TB infection progressing to disease or if disease occurs, substantially lessens the chance of a severe outcome. The benefi t in older age groups is less clear. In the Australian health worker, the BCG strategy is no longer recommended as the primary means of health care worker (HCW) protection. The preferred strategy is appropriate infection control measures, staff education and a tuberculin skin testing program that identifi es and treats the at-risk infected HCW. The emergence of multi-drug resistant strains has however renewed interest in BCG in the HCW. This document provides recommendations for use of the BCG vaccine in the Australian community based on the best available evidence and consensus opinion. State and Territory TB Control Units should be consulted with regard to their BCG vaccination guidelines. Recommendations BCG vaccination is not recommended for general use in the Australian population. BCG is recommended for: 1. Aboriginal neonates in areas of high incidence of TB (e.g. Northern Territory, Far North Queensland, northern areas of Western Australia and South Australia); 2. neonates and children 5 years and under who will be travelling or living in countries or areas with a high prevalence of TB for extended periods; 3. neonates born to parents with leprosy or a family history of leprosy; In addition to these recommendations BCG may be considered in the following: 4. children over 5 years who will be travelling or living in countries or areas with a high prevalence of TB for extended periods; 5. HCWs who may be at high risk of exposure to drug resistant cases. Introduction Mass BCG vaccination in populations with a low prevalence of tuberculosis disease is no longer considered necessary. 1 Rather, such an intervention should be directed at well -defi ned, high-risk groups principally because of its direct effect in reducing the serious consequences from primary infection. The indirect population effect of mass vaccination in terms of reducing the number of infectious cases and hence limiting future transmission to the uninfected population is considered minimal in low prevalence countries. 2 In Australia, the broad-based BCG vaccination program originated at a time when the epidemiological circumstances of tuberculosis (TB) were quite different. Initially in 1948, vaccination targeted health workers, Aboriginal people and close contacts of active cases, especially children. In the 1950s the program was expanded to include all Australian school children except those from New South Wales and the Australian Capital Territory. This policy was discontinued in the mid-1980s (1991 in the Northern Territory) in favour of a more selective approach. The change occurred because of the low prevalence of TB in our community and concerns about the balance between the benefi ts and the risks. Sweden, which prior to 1975 vaccinated all newborns, is one of the few countries to have closely studied the implications of this. The observed incidence of TB in unvaccinated Swedish children from a low risk background remains low, and importantly, the risk of serious TB is still rare. 3 CDI Vol 30 No 1 2006 109
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