Transcript Changes to the BCG vaccination programme

Changes to the BCG vaccination
programme in England
Dr Bernadette Purcell
CCDC
Health Protection Agency
TB: changing epidemiology in UK
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1913: 117,139 new cases E & W
1987: 5086 new cases E & W
2004: 7,000 (London 3,000)
Resurgence asstd with changing
epidemiology
2003, 2/3 of TB pts born abroad
Deteriorating TB control worldwide
TB notifications and deaths in England &
Wales 1940-2003
Tuberculosis - Notifications and Deaths, England and Wales, 1982 2003
Sources:
Statutory notifications of Infectious Diseases (NOIDS), Office for National Statistics (notifications of infectious disease deaths)
Prepared by:
Communicable Disease Surveillance Centre (CDSC), Health Protection Agency Centre for Infections
Tuberculosis case reports and rates by age group and sex, England,
Wales and Northern Ireland, 2003
Tuberculosis rates by place of birth (born in UK vs. born abroad)
England and Wales, 1999 - 2003
Tuberculosis rates in persons born in the UK by age group,
England and Wales, 1999 - 2003
Tuberculosis rates in persons born abroad by age group, England
and Wales, 1999 - 2003
Tuberculosis case reports by ethnic group (%), England and Wales,
1999 – 2003
History of the vaccine
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BCG was introduced in the UK in the 1950s.
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It was given at school leaving age, then 14 years,
because peak incidence of TB was in young adults.
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This approach of vaccinating at secondary school age
was unique, with all other countries either vaccinating all
infants or infants selectively.
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1960s selective BCG introduced to protect children of
new immigrants.
1960s – August 2005
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In the 1960s
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an additional programme of selective
neonatal BCG immunisation was introduced
to protect infants who were likely to catch the
disease.
Up to August 2005
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10-14 years (varied locally, e.g. 12-14 in B&H)
neonates at high risk receive BCG
BCG Schools Programme
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Now stopped
Was introduced in the 1950s
Unique to the UK
Given at school leaving because the peak
incidence at that time was in young adults.
50,000 cases reported each year in the UK
Cases occurred across most sections of
society
What are the changes?
CMO letter – 6th July and 18 August 2005
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All infants (0-12 months) living in areas where the incidence of
TB is 40/100,000 or greater.
All infants (0-12 months) with a parent or grand parent who was
born in a country with a TB prevalence of 40/100,000 or higher
Previously unvaccinated new immigrants from high prevalence
countries for TB – list of countries provided by the DoH
Children who would otherwise have been offered BCG through
the schools programme will now be screened for TB risk factors,
and tested and vaccinated if appropriate
The contact, occupational and travel related recommendations
about BCG remain unchanged
Why the changes?
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Reduced total number of cases of TB
Most cases occur in cities and/or affect
specific groups
BCG protects against serious childhood TB, it
is not as effective in preventing infectious
forms of TB in adults.
Can protect young children who are at risk of
infection against most serious forms of TB if
given as soon as possible after birth.
What changes? - moving
from Heaf test to Mantoux
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The UK - Heaf test since the introduction of the BCG
vaccination in the 1950s
Involves inoculating a minute amount of a high
concentration of tuberculin into the skin using a
multiple puncture device
The UK only country in the world to widely use the
Heaf test
Mantoux test now replaces Heaf Test
Mantoux test involves injecting a small quantity of
tuberculin into the skin of the forearm.
The test is the international gold standard and the
advice of the JCVI is to move to the Mantoux test
East Sussex
Hastings & St.Leonards
and Bexhill & Rother
Newborn babies referred by
local Midwifes and Health
Visitors to Kate Dadswell
and Julia Paulin (TB HVs) @
Arthur Blackman Clinic,
Hastings.
Tel:01424 852735
Eastbourne
Newborn babies referred
by local Midwifes and
Health Visitors to Liz
Harper and Chris
Hobbs @Eastbourne
DGH Tel: 01323
413850