Volume 199 - Issue 5
Infants born in Australia to mothers from countries with a high prevalence of tuberculosis: to BCG or not to BCG?
Authors: Amanda Gwee, Ranmali Rodrigo, Dan Casalaz, Nicole Ritz and Nigel Curtis
Med J Aust 2013; 199 (5): 324-326. || doi: 10.5694/mja13.10107
Published online: 2 September 2013
Published online: 2 September 2013
To the Editor: BCG is an effective vaccine to prevent tuberculosis (TB) in young children travelling to countries with a high prevalence of TB.1 Although it does not completely mitigate the risk of developing TB, nor the need for preventive therapy after a significant TB exposure, it provides about 80% protection against the severe forms of TB that affect infants and young children.2 In Australia, ...
To the Editor: BCG is an effective vaccine to prevent tuberculosis (TB) in young children travelling to countries with a high prevalence of TB.1 Although it does not completely mitigate the risk of developing TB, nor the need for preventive therapy after a significant TB exposure, it provides about 80% protection against the severe forms of TB that affect infants and young children.2 In Australia, routine BCG vaccination ceased in 1985, and vaccination of children now effectively relies on the initiative of parents. A study in the United Kingdom reported that only 6% of parents were aware of national BCG vaccination recommendations.3 We aimed to determine the proportion of mothers from high-TB-prevalence countries giving birth in Australia who were planning to travel to these countries with their newborn child, and to assess their knowledge of the need to BCG-vaccinate their child.
Over a 13-week period (June to August 2012), we surveyed mothers from high-TB-prevalence countries with newborn infants in the postnatal ward of the Mercy Hospital for Women, Melbourne, about their travel plans, the BCG status and travel history of their other children, and their knowledge of BCG vaccine. This study was approved by the Mercy Health Human Research Ethics Committee (R11/07).
Of 290 women born in high-TB-prevalence countries who gave birth at the hospital during the study period, 266 (91.7%) completed the questionnaire (Box). Of these, 195 (73.3%) planned to travel to a high-TB-prevalence country for a duration of at least 1 month with their newborn child within 5 years. The most common planned destinations were in Asia (178, 91.3%), followed by sub-Saharan Africa (14, 7.2%), Europe (2, 1.0%) and the Middle East (2, 1.0%). Of the women who planned to travel for at least 1 month, only 20 (10.3%) knew their child should be vaccinated with BCG. The surveyed women had a total of 90 other children: 47 of these siblings had already travelled to a high-TB-prevalence country for 1 month or more, and 26 of these had not had a BCG vaccination.
In Australia, non-BCG-vaccinated children have acquired TB after travelling to a high-TB-prevalence country for as little as 4 weeks.1 Our study shows that BCG vaccination is indicated in a large proportion of infants born in Australia to mothers from high-TB-prevalence countries. These children are at increased risk of TB and other travel-related health problems as they often visit friends and relatives in their parents’ country of origin.4
Our study highlights the need to improve awareness about BCG vaccine and suggests that routine BCG vaccination should be considered for all infants born to mothers from countries with a high prevalence of TB.
Competing interests
No relevant disclosures.
References
- Ritz N, Connell TG, Curtis N. To BCG or not to BCG? Preventing travel-associated tuberculosis in children. Vaccine 2008; 26: 5905-5910. 0_CHDEBDFC
- Trunz BB, Fine P, Dye C. Effect of BCG vaccination on childhood tuberculous meningitis and miliary tuberculosis worldwide: a meta-analysis and assessment of cost-effectiveness. Lancet 2006; 367: 1173-1180. 0_i1142978
- Gordon M, Roberts H, Odeka E. Knowledge and attitudes of parents and professionals to neonatal BCG vaccination in light of recent UK policy changes: a questionnaire study. BMC Infect Dis 2007; 7: 82. 0_i1142980
- Fulford M, Keystone JS. Health risks associated with visiting friends and relatives in developing countries. Curr Infect Dis Rep 2005; 7: 48-53. 0_i1142983