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DHSS decides to discontinue the Schools’ BCG vaccination 14 December 2005

    The DHSS has made a decision to discontinue the Schools’ BCG programme. BCG, a vaccine which provides partial protection against Tuberculosis (TB) was routinely offered to all children aged 10 to 14 in the Isle of Man (and the UK).

    A detailed review of the current distribution of TB revealed that the picture of TB is changing across the world. Based on these findings a recommendation was made to the Joint Committee on Vaccination and Immunisations (JCVI) that the routine school BCG programme should be discontinued. This has already been implemented in the UK.

    The DHSS in the Isle of Man has accepted the recommendations that:

    1. the routine Schools’ BCG programme be discontinued
    2. increased emphasis be placed on identifying and vaccinating those at high risk of TB.

    These changes are based on scientific evidence and the changing picture of TB across the UK. It has become clear that those who were vaccinated as a part of the Schools’ BCG programme are at very low risk of TB. There is also uncertainty about the effectiveness of BCG – it is likely to provide 50-70% protection – the degree of protection offered is greater for some forms of disease such as TB meningitis and much less for the respiratory form of the disease, which is common in adults.

    Dr Parameswaran Kishore said,

    “This is not a cost saving exercise at all. I have looked at the evidence presented to the JCVI and I am convinced that for scientific reasons it is no longer necessary to offer routine BCG vaccinations to Manx school children. It is important that our vaccination policy takes on board changes in the distribution of diseases – last year we changed from Oral Polio Vaccination (OPV) – to Injectable or Inactivated Polio Vaccination (IPV) based on changes in the risk of acquiring polio. This year we are making changes to the BCG programme based on changing epidemiology of TB. The UK and Isle of Man satisfy the criteria set by the International Union against Tuberculosis for discontinuing universal BCG vaccination. In short it is no longer necessary to offer routine vaccination for those aged 10-14 years. We will re-direct our efforts to target those at high risk of TB”.

    Notes

    TB is an airborne, bacterial infection that usually affects the lungs but can affect any part of the body, especially the brain, bone and lymph glands. About 90% of people who are exposed to the TB bacteria never get ill.

    The BCG (Bacille Calmette-Guerin) has been used in the UK since 1953. At that time there were 50,000 cases of TB per year affecting all sectors of the population.

    In 2004 there were approximately 7,000 cases of TB in the UK concentrated around large cities and affecting specific groups of the population. TB has changed from being a disease affecting the population in general to one affecting specific sub-groups within the population.

    The Joint Committee on Vaccinations and Immunisations (JCVI), a body of scientific experts which provides advice on Immunisation and Vaccination matters to the Government Departments in the UK, has recommended that BCG vaccination is targeted for:

    • All babies who live in an area with over 40 cases of TB per 100,000 population. (The Isle of Man does not come into this category)
    • All babies whose parents of grandparents have lived in a country with a TB incidence of 40/100,000 or greater; e.g. sub-Saharan Africa, Indian subcontinent and South East Asia.

    This follows on from the recommendation of the International Union against Tuberculosis which has set the following criteria for the discontinuation of routine BCG.

    • A well functioning TB control programme
    • A reliable TB reporting system for five years or more
    • An average sputum positive TB rate of 5/100,000 or less, OR a TB meningitis rate in children under 5 years of age or less than 1 per million population over the previous 5 years OR an annual risk rate of 0.1% or less
    • Due consideration of the effect of HIV on TB.

    The Isle of Man satisfied the above criteria and it is no longer necessary to offer routine BCG vaccinations in the Isle of Man. BCG is also given for other reasons such as travel to high prevalence areas for a month or longer, occupational risks and as a part of contact tracing. There are no changes with regard to these.

    14th December 2005

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