BCG Vaccine

BCG Vaccine

The BCG vaccine protects against tuberculosis (TB), a serious infection that affects the lungs and sometimes other parts of the body, such as the bones, joints and kidneys. It can also cause meningitis.

The BCG vaccine (which stands for Bacillus Calmette-Guérin vaccine) is given in Gibraltar as part of the routine vaccination schedule. BCG vaccination is recommended for babies, children and adults under the age of 35 who are at risk of catching tuberculosis (TB). There is no evidence the BCG vaccine works for people over the age of 35.

When should babies have BCG vaccine?

The BCG vaccination is recommended for babies up to 1year old. It is usually offered soon after birth, while your baby is still in hospital.

When should older children and adults have the vaccine?

BCG vaccination is recommended for all older children and adults at risk of TB, including:

  • older children with an increased risk of TB who were not vaccinated against TB when they were babies 
  • anyone under 16 who has come from an area of the world where TB is widespread or who is going to live with local people for more than 3 months in an area with high rates of TB or where the risk of multi-drug-resistant TB is high.
  • anyone under 16 who has been in close contact with someone who has pulmonary TB (TB infection of the lung)  

The BCG vaccine is also recommended for people aged 16 to 35 who are at occupational risk of TB exposure, including:

  • laboratory staff who are in contact with blood, urine and tissue samples
  • veterinary staff and other animal workers, such as abattoir workers, who work with animals that are susceptible to TB, such as cattle or monkeys
  • prison staff who work directly with prisoners
  • staff of hostels for homeless people
  • staff who work in facilities for refugees and asylum seekers
  • healthcare workers with an increased risk of exposure to TB

How is the vaccine given?

BCG vaccination is given as an injection into the upper arm.

How well does the vaccine work?

The BCG vaccine is made from a weakened strain of TB bacteria. The vaccine triggers the immune system to protect against the disease and gives good immunity to people who receive it without actually causing the disease. It is 70 to 80% effective against the most severe forms of TB, such as TB meningitis in children.

Is the vaccine safe?

Reactions to the BCG vaccine are uncommon and generally mild, although most children develop a sore at the injection site. Once healed, the sore may leave a small scar; this is normal and nothing to worry about.

Common side effects

These include fever, headache and swollen glands.

More serious complications

These are rare and may include abscesses or bone inflammation. A serious allergic reaction (anaphylactic reaction), is very rare and all staff who give vaccinations are trained to treat allergic reactions.

The BCG vaccination scar

Almost everyone who is given the BCG vaccination will develop a raised bubble at the site of the injection, which may disappear soon afterwards and reappear about 2 to 6 weeks later as a small spot. It is normal for the spot to turn into a blister, which sometimes oozes before becoming a crusty scab. If you are worried that your child’s skin reaction is abnormal or that the spot may have become infected, contact your GP or Child Health Nurse for advice.

If your child does not develop a blister/scar after the vaccine, it does not mean that they have not responded to it. There is no need to vaccinate with BCG a second time.

Who should not have the BCG vaccine?

The BCG vaccine is not recommended for:

  • people who have already had a BCG vaccination
  • people with a past history of TB
  • people with a positive tuberculin/ Mantoux skin test 
  • people who have had a previous severe allergic reaction to any of the substances used in the vaccine
  • children under 2 years of age in a home where a case of active TB is suspected or confirmed
  • people who have a septic skin condition at the site where the injection would be given 
  • people with a weakened immune system due to a  a health condition such as HIV or on immuno-suppressant treatment (
  • steroid tablets/chemotherapy)
  • people who have cancer of the white blood cells, bone marrow or lymph nodes 
  • people who are seriously unwell – in this case, vaccination should be delayed until they recover
  • pregnant women

Can I request a BCG vaccination?

If you want BCG vaccination for yourself or your child, you will be assessed to see if you are at high risk of catching TB.

If you are not at risk, you will not be eligible for BCG vaccination.

If you are considered to be at risk, you will be need to have a specific test (tuberculin skin test/Mantoux test) and offered BCG vaccination according to local arrangements.

What is the tuberculin skin test or Mantoux test?

This test assesses your sensitivity to a substance called a tuberculin purified protein derivative (PPD) when it is injected into your skin. It will be carried out before BCG vaccination if someone:

  • is 6 years or over
  • is a baby or child under 6 with a history of residence or a prolonged stay (more than 3 months) in a country with a high rate of TB 
  • has had close contact with a person with TB
  • has a family history of TB within the last 5 years

If the Mantoux test is negative, you can go ahead and have the BCG vaccine.

If the Mantoux test is positive, it is likely that you are infected with or has active TB; in this case, you should not have the BCG vaccine, as there is no clinical benefit and may cause unpleasant side effects. 

Individuals with a strong positive Mantoux result should be referred to a TB specialist team for further assessment..