Vaccination - Can TB be prevented?

There is a vaccine against TB called the BCG but it does not prevent TB in all cases. In the UK it is offered only to those at particular risk of TB, mostly infants.

Wouldn't TB Alert's money be better spent on mass vaccination to prevent anyone from getting TB in the first place?

Unfortunately the BCG vaccine is just not effective enough to make a significant impact on the incidence of tuberculosis in a community for the following reasons:

• The efficacy of BCG varies enormously from region to region – from around 80% to 0%!
• Even in those regions in which it has been shown to be effective, the protection is largely restricted to childhood tuberculosis which is rarely infectious.
• BCG has little impact on the prevalence of the infectious adult tuberculosis, responsible for the spread of the disease in the community.
• BCG would have no impact on the increasing burden of HIV-related tuberculosis as the immunosuppression from HIV would annul any immunity conferred by the vaccination.

Mass BCG vaccination campaigns would, in terms of both effectiveness and cost-effectiveness, be inferior to the World Health Organisation recommended DOTS strategy in reducing the incidence of infectious cases of tuberculosis in a community and transmission of the infection.  Having said that, BCG vaccination in young children should certainly be encouraged in high-TB incidence areas, as can prevent serious and life-threatening forms of childhood tuberculosis, even though they are rarely infectious.

I didn't have a BCG vaccination when I was younger – should I have one now that the disease is on the increase in the UK ?

Most of us would have had a BCG jab when we were at school to protect against dangerous childhood forms of the disease. Usually it's given between the ages of 10 and 14. If you haven't had the vaccine, and 30% of us generally haven't, there's really no point in having it now. The BCG only really protects us when we are children, and is only effective for about 15 years. The risk for most people is small and TB is generally fully curable with antibiotics. The best way to prevent TB is to cure people who have it, then there will be fewer people to spread the disease.

Is it worth having BCG in adult age or when travelling ?

If you are under 35 years old (BCG is not usually recommended over this age) and planning to visit/stay for more than three months in a country with a high prevalence of TB, and you have not had a BCG, you are advised to get a skin test to see if BCG is needed. In this instance, usually you will have to go to a travel health clinic and pay for both the skin test and, if it is necessary, BCG.