Interventions for Tuberculosis Control and Elimination 2002

Number of cases
30
20
10
0
Gothenburg strain produced in: Cessation of mass
Sweden Denmark BCG vaccination
1950 1955 1960 1965 1970 1975 1980 1985 1990
Year of report
WHO discourages re-vaccination because there is no evidence of its
usefulness. 862 Lack of evidence is, however, not synonymous with lack of
efficacy. Re-vaccination at school entry is likely to be inefficient (even if
it were efficacious), because it falls into the period in life when the risk
of tuberculosis is lowest.
Finally, concerning HIV infection, the WHO has concluded after careful
review of available data, that BCG vaccination schemes do not need to
be altered unless HIV infection is symptomatic (AIDS). 721 This, too, seems
to be a reasonable recommendation given the lack of evidence of an
increased frequency of serious adverse events in BCG-vaccinated children
who also have acquired HIV infection from their mother. However, it
appears that HIV infection lowers the protective effect against extrapulmonary
tuberculosis. 863 In industrialized countries, where the need for BCG
vaccination is generally lower, it is usually recommended not to give BCG
vaccination to individuals known to have HIV infection. 864
The freeze-dried vaccine should be kept refrigerated and protected from
light, and diluted only immediately before vaccination. In most countries,
BCG vaccine is given by the intradermal route, generally by injection with
a 25 or 26 gauge needle, in the deltoid insertion region of the upper arm. 865
Most manufacturers (including all those who provide vaccine for UNICEF,
125
BCG osteitis
Childhood
tuberculosis
Figure 76. Osteitis due to BCG vaccination and incidence of pulmonary tuberculosis
among Swedish-born children, Sweden 1949-1993. 703