Interventions for Tuberculosis Control and Elimination 2002

the largest purchaser in the world) recommend a 0.05 mL dose for infants,
and the double dose for children.
Difficulties have arisen for decision makers about the value of vaccinating
health care workers at increased risk of infection with M. tuberculosis,
particularly in settings where multidrug-resistant tuberculosis is common.
The uncertainty stems from the scarcity of data on protection against
tuberculosis among adults, and the generally low level of protection (or
none at all) among adults in clinical trials. While decision analyses appear
to favor the use of BCG vaccination in such settings, 866 such a conclusion
has been disputed, largely based on the argument that it deprives those vaccinated
from ever learning whether they have acquired tuberculous infection
or not (loss of specificity of the tuberculin test). 867 Nevertheless, in
areas where BCG has been demonstrated to provide appreciable protection
against tuberculosis among adults, where there is a high risk for health care
workers of becoming infected, and where multidrug-resistant tuberculosis
is common, a BCG vaccination policy for health care workers might deserve
consideration. Where these conditions are not met, non-vaccination of
health care workers might be more appropriate.
In summary, barring a better alternative, BCG vaccination remains a
useful adjunct for the individual protection against disabling and lethal forms
of childhood tuberculosis in most parts of the world where tuberculosis
remains highly prevalent. It cannot be expected, however, to have great
impact on the epidemiologic situation of tuberculosis. 858,859
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