Volume 200 - Issue 3
Infants born in Australia to mothers from countries with a high prevalence of tuberculosis: to BCG or not to BCG?
Authors: Frank H Beard and Kristine K Macartney
Med J Aust 2014; 200 (3): 149-150. || doi: 10.5694/mja13.11307
Published online: 17 February 2014
Published online: 17 February 2014
Study highlights a need to examine BCG vaccination program delivery across Australia
To the Editor: Gwee and colleagues recently reported a lack of parental knowledge of the potential need for BCG vaccination of Australian-born infants before overseas travel to tuberculosis (TB)-endemic countries.1 We believe this study highlights the need to examine BCG program delivery across Australia but does not, as they suggest, provide data on which to recommend BCG vaccination for all infants born to mothers from high-TB-prevalence countries. Policy regarding BCG use should be informed by a better understanding of TB epidemiology and disease acquisition in young Australian children and the benefits and risks of vaccination. Only limited data on mode of disease acquisition in children are available from small case series.2
Current Australian guidelines recommend that the need for BCG vaccination should be assessed in all young children travelling to TB-endemic settings for an extended period.3,4 In Australia, BCG vaccination is predominantly provided by state and territory specialist TB services. However, it is important that all clinicians are aware of BCG guidelines. As suggested by Gwee and colleagues, travel to TB-endemic areas, particularly to visit friends and relatives, is common. In 2008, there were 185 000 overseas departures of Australian residents aged under 5 years, with 35% of these being to high-TB-incidence countries (Dr Anita Heywood, Lecturer, School of Public Health and Community Medicine, University of New South Wales, personal communication, 2013).
We recommend that clinicians assess travel plans of parents and their infants, with provision of information and referral to BCG vaccination providers as indicated. In addition, all providers should report BCG vaccination to the Australian Childhood Immunisation Register to improve our understanding of vaccine uptake. This will inform immunisation policy and education needs, with the aim to improve coverage under this targeted program.
Competing interests
No relevant disclosures.
References
- Gwee A, Rodrigo R, Casalaz D, et al. Infants born in Australia to mothers from countries with a high prevalence of tuberculosis: to BCG or not to BCG? Med J Aust 2013; 199: 324-326. CHDHDIHB
- Britton PN, Yeung V, Lowbridge C, et al. Spectrum of disease in children treated for tuberculosis at a tertiary children’s hospital in Australia. J Pediatric Infect Dis Soc 2013; 2: 224-231. i1142863
- National Tuberculosis Advisory Committee. The BCG vaccine: information and recommendations for use in Australia: National Tuberculosis Advisory Committee update October 2012. Commun Dis Intell 2013; 37: E65-E72. i1142867
- Australian Technical Advisory Group on Immunisation. Vaccine-preventable diseases: tuberculosis. In: The Australian immunisation handbook. 10th ed. Canberra: Australian Government Department of Health and Ageing, 2013. i1142868