Title: BCG vaccine
Course: Level 3 - Immunization > Section: Antibacterial vaccines

BCG is a live attenuated antibacterial vaccine protects against tuberculosis. The letters, B, C and G stand for Bacillus of Calmette and Guerin. Bacillus means bacterium/germ, Calmette and Guerin are the names of the people who developed the vaccine. BCG vaccine comes in powder form and before its use, it must be reconstituted with 1ml of accompanying diluent from the same manufacturer. The reconstituted vaccine is even more sensitive to heat than the powder and must, therefore, be used within six hours or discarded. Wrap reconstituted BCG vaccine in foil or paper to protect it from sunlight.

Figure 2.1. BCG vaccine vial.

Who is eligible?

BCG vaccine is given at birth or as soon as possible after birth. It should not be given to children who have clinical AIDS.

Dosage

One dose of 0.05 ml for children less than 12 months old and 0.1 ml for children above 12 months

Route and Site

BCG vaccine is injected into the top layer of the skin (intradermal) of the upper right arm (see Figure 2.2a and 2.2b). Health workers use the same anatomical site on every child for BCG injections so that everyone knows where to look for the scar.

Figure 2.2a. Position of syringe and needle for BCG intradermal (under the skin) injection.

Figure 2.2b. Needle position for BCG vaccine intradermal injection.

Adverse events following BCG vaccine administrations

Typically, after BCG vaccines have been administered a small raised swelling appears at the injection site. The swelling usually disappears within 30 minutes. After approximately two weeks, a red sore develops which is 10mm in diameter (the size of the end of an unsharpened pencil). The sore remains for another two weeks and then heals. A small scar about 5mm across, resulting from the sore, remains for life. This is a sign that the child has been effectively immunised.

Figure 2.3 (a) presence of small sore at the injection site is a sign that the child has been adequately immunised with BCG vaccine. (b) A healed BCG vaccination scar on the arm of an adult. (Photos: supplied by DrKalidAsrat and DrBasiro Davey)

Sometimes there are abnormal side effects following BCG immunisation like swelling of glands in a child's armpit or near the elbow after BCG vaccine injection, or he / she may develop an abscess (see figure 2.4).

Reasons for abnormal side effects are the following:

- Use of un-sterile needle or syringe.
- Too much vaccine was injected.
- The vaccine was injected too deeply under the skin, instead of in to top layer.

Figure 2.4. An abscess is a rare adverse event following BCG immunisation. This one is about 1.5 cm in diameter, but they can be larger.(Photo: supplied by DrKalidAsrat)

Summary for BCG Vaccine

Characteristics | Disruptions
Vaccine type | Live- attenuated anti-bacterial vaccine
Amount(dose) given | Infants aged under 1 year, give 0.05 mg of BCG vaccine powder reconstituted in 0.05 ml of diluent; over 1 year, give 0.01 mg in 0.1 ml of diluent
The rout of administration | Intradermal (into the top layer of skin).
Site of administration | Upper right arm in top layer of skin
Number of doses | One
Schedule | At birth, or as soon as possible after birth. If not given at birth, it is better to give within the first three months, when the infant is at greatest risk of developing the most severe forms of TB, such as TB meningitis. Immunisation is ineffective at older ages.
Booster(additional) dose | None
Storage | Store between +2°C and +8°C. BCG vaccine powder may be frozen for long-term storage, but the diluent and reconstituted vaccine must never be frozen. Discard any reconstituted vaccine after 6 hours. Vaccine storage will be described in Study Session 4
Contra-indications | Contra-indications Clinically AIDs Babies or infants which include chronic lung infection, tuberculosis, persistent diarrhoea and other serious symptoms of HIV-related diseases
Adverse effect | Mild normal reaction (swelling, small sore). Rarely, severe reaction, e.g. local abscess, or swelling of glands (lymph nodes)
Management of AEFIs
- For mild cases Keep dry and clean (do not put any ointment or medicine on it)
- For severe reaction Refer or try antibiotic if bacterial infection is suspected
Special requisitions
- Correct intradermal administration is essential. A special syringe and needle are used for the administration of BCG vaccine
- Do not rub or apply anything to injection site