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BCG Vaccine – Immunization Against Tuberculosis

The BCG vaccine is a live attenuated vaccine used worldwide to protect against tuberculosis. It is especially effective in preventing severe forms of the disease in infants and young children.

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Things worth knowing about "BCG Vaccine"

The BCG vaccine is a live attenuated vaccine used worldwide to protect against tuberculosis. It is especially effective in preventing severe forms of the disease in infants and young children.

What is the BCG Vaccine?

The BCG vaccine (Bacillus Calmette-Guérin) is a live attenuated vaccine derived from a weakened strain of Mycobacterium bovis, the bacterium responsible for bovine tuberculosis. It was developed by French scientists Albert Calmette and Camille Guérin in the early 20th century and first administered to humans in 1921. Today, the BCG vaccine is one of the most widely used vaccines in the world and is a cornerstone of the World Health Organization's (WHO) immunization programs.

Indications

The BCG vaccine is primarily used to prevent tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis. It is particularly effective in protecting against severe forms of TB, including:

Miliary tuberculosis (a life-threatening form in which bacteria spread through the bloodstream)
Tuberculous meningitis (tuberculosis affecting the brain and its membranes)

In addition to its role in TB prevention, the BCG vaccine is used in urology as an intravesical immunotherapy for non-muscle-invasive bladder cancer. A potential protective effect against other mycobacterial diseases such as leprosy has also been studied.

Mechanism of Action

The BCG vaccine activates both the innate and adaptive immune systems. The live attenuated organisms stimulate macrophages and T-lymphocytes, triggering a cellular immune response. This enables the immune system to recognize and combat mycobacteria. Recent research also suggests that the BCG vaccine can induce trained immunity, a phenomenon in which the innate immune system exhibits a long-lasting enhanced response to a variety of pathogens.

Dosage and Administration

The BCG vaccine is typically administered as a single intradermal injection (into the skin), usually in the left upper arm. The standard dose for newborns and infants is 0.05 ml, while older children and adults receive 0.1 ml. The WHO recommends vaccination as soon after birth as possible in countries with a high prevalence of tuberculosis. In countries with low TB rates, such as Germany, routine BCG vaccination has not been recommended by the Standing Committee on Vaccination (STIKO) since 1998.

Side Effects

The BCG vaccine is generally well tolerated. Possible side effects include:

Local reactions at the injection site: redness, swelling, a small nodule, or ulceration (which usually resolves within a few weeks)
Enlargement of nearby lymph nodes
In rare cases: BCGitis (localized infection) or BCGosis (systemic spread), particularly in immunocompromised individuals

Contraindications

The BCG vaccine should not be administered to:

Persons with immune deficiency (e.g., HIV infection, congenital immunodeficiency disorders, immunosuppressive therapy)
Individuals with known active tuberculosis
Newborns with a birth weight below 2000 g
Women during pregnancy

Special Notes

Following BCG vaccination, a characteristic scar often forms at the injection site, which is considered an indirect indicator of prior vaccination. A positive tuberculin skin test (Mantoux test) after BCG vaccination does not necessarily indicate a tuberculosis infection. Modern blood tests known as IGRA tests (Interferon-Gamma Release Assays) can better distinguish between a vaccine-induced reaction and a true TB infection.

References

World Health Organization (WHO): BCG vaccines: WHO position paper. Weekly Epidemiological Record, 2018.
Robert Koch Institut (RKI): Recommendations of the Standing Committee on Vaccination (STIKO) – Epidemiological Bulletin, current edition.
Colditz GA et al.: Efficacy of BCG Vaccine in the Prevention of Tuberculosis. JAMA, 1994;271(9):698–702.

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