Bacillus Calmette–Guérin or the BCG  vaccine is one of the oldest vaccines first used in humans in 1921. It continues to be the only effective vaccine against tuberculosis. BCG is currently the only available TB vaccine. 

Schedule/Age of Vaccination

BCG vaccine should be given by 1 month of age, preferably at birth to avoid any miss-outs.BCG vaccination can be safely given even in healthy preterm infants born after 32–36 weeks. Children as old as 5 years should be given a dose of BCG if they have missed it earlier. Children more than 5 yrs of age need to be tested with a Tuberculin Skin test before deciding for BCG administration.

Vaccine Characteristics 

BCG vaccine is usually administered by intradermal injection. Correct vaccine administration technique by a trained health worker is important to ensure correct dosage and optimal BCG vaccine efficacy and safety. BCG vaccine should be injected in a clean, healthy area of skin. The vaccine should be given preferably in the lateral aspect of the upper arm. 

Alcohol should not be used to clean the skin or to clean the area after vaccination. In case a mild blood ooze is seen, it should be cleaned with a dry swab or cotton. Use of alcohol can decrease the efficacy of the vaccine.

LOCAL REACTION at BCG Vaccination site

The injected site usually shows no visible change for several days. Subsequently, a papule develops after 2–3 weeks, which increases to a size of 4–8 mm by the end of 5–6 weeks. This papule often heals with ulceration and results in a scar after 6–12 weeks. The ulcer at vaccination site may persist for a few weeks before formation of the final scar. No treatment is required for this condition. 

Approximately, 10% of vaccine recipients do not develop a scar and that does not mean that protection has not been achieved. 

Adverse events

Include local reactions such as injection site abscess, severe ulceration or Lymphnode enlargement. The severity of BCG reactions increase with the age of child at time of vaccination

Co-administration of Vaccines 

There is evidence that BCG vaccine can be safely co-administered with diphtheria-pertussis-tetanus (DTP), polio, hepatitis B, Haemophilus influenzae type b (Hib) and measles and rubella vaccines. BCG vaccine is not available in combination with other vaccines. 

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