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Handbook of Global Tuberculosis Control pp 343–357Cite as

BCG Immunization: Efficacy, Limitations, and Future Needs

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Abstract

The bacille Calmette–Guérin (BCG) vaccine is one of the oldest and most widely used vaccines. The demonstration of its protective efficacy against tuberculosis (TB) in historical British Medical Research Council trials led to routine BCG vaccination in many parts of the world. Today, BCG vaccination policies vary across countries. BCG given once only at birth is the vaccination schedule currently practiced in most countries. In response to declining TB incidence rates, a number of countries have shifted from universal to selective BCG vaccination. Many countries have stopped BCG revaccination as evidence accumulates over its failure to confer additional protection. BCG vaccination of the HIV-infected is contraindicated, although neonatal BCG vaccination in TB-endemic countries may be continued until vaccination in HIV-exposed infants can be selectively deferred. Although BCG has demonstrated substantial protection against serious forms of TB, its protective effect against pulmonary TB is partial and variable. Without better vaccines and improved diagnostic and treatment tools, it may be difficult to meet the TB-related Millennium Development Goals. Concerted efforts are required to integrate scientific advancement and political mobilization in vaccine development, clinical trials, and field implementation.

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Abbreviations

BCG:

Bacille Calmette–Guérin

BMRC:

British Medical Research Council

CI:

Confidence interval

HCW:

Healthcare workers

HIV:

Human immunodeficiency virus

HLA:

Human leukocyte antigen

IUATLD:

International Union against Tuberculosis and Lung Disease

NRAMP:

Natural resistance-associated macrophage protein

TB:

Tuberculosis

UNICEF:

United Nations Children’s Fund

USPHS:

United States Public Health Service

WHO:

World Health Organization

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Authors and Affiliations

  1. Tuberculosis and Chest Service, Department of Health, Wanchai, Hong Kong

    Kwok Chiu Chang

  2. Wanchai Chest Clinic, 1st Floor, Wanchai Polyclinic, 99, Kennedy Road, Wanchai, Hong Kong

    Kwok Chiu Chang

  3. Pneumoconiosis Clinic, Tuberculosis and Chest Service, Department of Health, 4th Floor, Shaukeiwan Jockey Club Polyclinic, 8, Chai Wan Road, Shaukeiwan, Hong Kong

    Chi Chiu Leung

Authors
  1. Kwok Chiu Chang
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  2. Chi Chiu Leung
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Correspondence to Kwok Chiu Chang .

Editor information

Editors and Affiliations

  1. Haikou VTI Biological Institute, Boston, Massachusetts, USA

    Yichen Lu

  2. Chinese Nat’l Ctr Disease Control and Prevention, Nat’l Center for TB Control & Prevention Chinese Nat’l Ctr Disease Control and Prevention, Beijing, China

    Lixia Wang

  3. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

    Hongjin Duanmu

  4. Brookline, Massachusetts, USA

    Chris Chanyasulkit

  5. Vaccine Technologies, Inc., Wellesley, Massachusetts, USA

    Amie J. Strong

  6. National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

    Hui Zhang

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Chang, K.C., Leung, C.C. (2017). BCG Immunization: Efficacy, Limitations, and Future Needs. In: Lu, Y., Wang, L., Duanmu, H., Chanyasulkit, C., Strong, A., Zhang, H. (eds) Handbook of Global Tuberculosis Control. Springer, Boston, MA. https://doi.org/10.1007/978-1-4939-6667-7_20

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  • DOI: https://doi.org/10.1007/978-1-4939-6667-7_20

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