This document is designed to advise Department of Health staff in Western Australia of a change to the recommended use of BCG vaccine for Tuberculosis Control.

BCG vaccination is no longer recommended for newborn Aboriginal and Torres Strait Islanders.  Previous policy recommended that these newborn children did receive BCG vaccination. The justification for this change of policy is summarised in appendix A.

BCG Indications

BCG vaccination should not be offered routinely to Australian residents. However, it is indicated in the following people:

§      Newborn children of parents with leprosy or a family history of leprosy.

§      Children under the age of 6 who are going to live in another country with a high incidence of tuberculosis (defined as an annual incidence of > 50 per 100 000 population, see http://apps.who.int/globalatlas/dataQuery/default.asp)

- for more than 6 months,

- or who will be making repeated visits to a country with a high incidence of tuberculosis for longer than 3 months at a time.

§      Newborn children of migrants who have arrived from countries with a high incidence of tuberculosis (see definition above) in the last 5 years, or newborn children who have household contact with people who have arrived from a high incidence country in the last 5 years.

BCG vaccination can be considered for persons not included in these indications.  However, care should be taken to adequately inform all persons of the potential risks and low efficacy of the vaccine, especially in adults.

It is recommended that the decision to give BCG outside of the above indications should be discussed with the Medical Director or Clinical Nurse Manager of the Tuberculosis Control Program.

BCG Contra-indications

BCG vaccination is no longer recommended in newborn Aboriginal and Torres Strait Islander children living north of the Tropic of Capricorn in WA. The justification for this change of policy is summarised in appendix A.

BCG vaccination is not recommended for Health Care Workers.

BCG vaccination is not recommended when requested by employers as a pre-requisite of employment and were there is no clinical indication. Examples of employers insisting on BCG vaccination that is outside of WA policy include:

§      Overseas employers of health care workers in low incidence countries

§      Employers in other industries (e.g. airline stewards)

§      Agencies placing students overseas in low incidence countries (e.g. France )

General Considerations

§      BCG vaccination should only ever be administered by appropriately trained health care providers.

§      Informed consent must be obtained from the individual or parent/guardian.

§      A risk assessment should be undertaken before giving BCG vaccination.

§      Other than infants less than 6 months of age who have not travelled outside Australia, BCG vaccination should be preceded by a Mantoux skin test (or equivalent tuberculin test), and should not be given if the result is 5mm induration or greater. For individuals older than 15 years of age, a two-step* Mantoux test is recommended to establish tuberculin negativity.

§      A record of the BCG vaccination (including name, date of birth, date of vaccination, dose, and batch number of vaccine) must be kept, with a copy given to the recipient.

§      BCG vaccination pamphlets are available from the Perth Chest Clinic.

*Two-step mantoux testing requires repeating a Mantoux test 1-3 weeks after an initial negative test where a booster reaction is expected. The booster effect occurs when an individual’s ability to react to tuberculin has waned but the Mantoux boosts the immunological memory of mycobacterial antigens. Retesting will produce a larger (boosted) response and should be considered the true result.

Inquiries regarding BCG vaccination should be directed to:

Perth Chest Clinic

17 Murray Street

Perth WA 6000

Tel: (08) 9219 3222

Fax: (08) 9219 3200

Regional Population / Public Health Units including:

Perth-North 9345 7700                   

Perth South 9431 0200

Wheatbelt  9622 4320

Goldfields 9080 8200

Great Southern 9842 7500

Kimberley 9194 1630

Midwest / Gascoyne 9941 0570 / 9956 1985

Pilbara 9172 8333

Southwest 9781 2350