TB Manual

We agree with the recommendation of the National Advisory Committee on Immunization (NACI)¹⁶² that BCG vaccination should not be given routinely to all Canadians.

We also agree with the NACI recommendation²¹ that BCG vaccination should be given to newborns in First Nations and Inuit communities, or other communities where:

1. the average annual rate of smear-positive pulmonary TB was >15/100,000 population or the average annual rate of culture-positive pulmonary TB was >30/100,000 during the previous 3 years; or,

2. the annual risk of TB infection is >0.1%, or,

3. early identification and treatment of latent TB infection (LTBI) are not available.

The annual risk of TB infection of 0.1%, is the threshold suggested by the International Union Against Tuberculosis and Lung Disease; below that threshold they have recommended selective discontinuation of BCG vaccination programs.¹⁵⁹ If BCG vaccination is currently offered to all infants in a community that does not meet one of the criteria described, the vaccination program should be discontinued as soon as a program of early detection and treatment of LTBI can be implemented.

For an infant to receive BCG, the child’s mother should be HIV negative, and there should be no evidence or known risk factors for immunodeficiency in the child.

We agree with the NACI recommendation¹⁶³ that if BCG vaccination is delayed more than 6 months after birth, a TST test is recommended, and the vaccine should be given only to TST-negative infants. For infants aged between 2 months and 6 months, an individual assessment of the risks and benefits of TST prior to BCG vaccination is indicated.

Recommendations

• In populations receiving BCG vaccination in infancy, we conditionally recommend that all newborns should be screened for severe combined immunodeficiency (poor evidence).

• We strongly recommend against revaccination with BCG (good evidence).

Good practice statement

• In jurisdictions with newborn severe combined immunodeficiency screening, BCG vaccination should be delayed until the results of the screen are available.

• Given that the BCG vaccine does not provide a high degree of protection, TB disease should still be considered in any BCG-vaccinated infant or child with a clinical presentation suggestive of TB.

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