The BCG vaccine, or vaccine against tuberculosis, has not been compulsory for the entire population since 2007. It remains so for certain professions at risk and strongly recommended from birth for certain children.

The BCG vaccine (named after its inventors, Bacille de Calmette and Guérin) is the vaccine against tuberculosis. It is a live attenuated vaccine: it contains live bacteria of the bacillus, modified so that they can no longer induce the disease.

Since the disappearance of the multipuncture form of the BCG vaccine (Monovax) in 2005, only one BCG vaccine has existed: intradermal BCG SSI, derived from the Danish strain Copenhagen 33.

Tuberculosis is an infectious disease caused by Koch’s Bacillus, which mainly affects the lungs. This is called the pulmonary form of tuberculosis. Only this form can be contagious through the airways, via the droplets emitted during coughing and sneezing. Only 5 to 10% of people infected with the bacillus will develop the disease.

Tuberculosis will then manifest itself through various symptoms: persistent fever, night sweats, cough with sometimes coughing up blood, weight loss, fatigue. The treatment combines several antibiotics over a prolonged period (usually 6 months).

In France, it has been a notifiable disease since 1964.

For a long time, vaccination against tuberculosis was compulsory for all children entering the community, but since a 2007 decree (1), it is no longer so. However, it is strongly recommended for children with a risk factor, namely:

• children living in Ile-de-France, Guyana or Mayotte;
• children born in a country where tuberculosis is strongly present or whose parent is from one of these countries (Africa, Asia including the countries of the Near and Middle East, the countries of Central and South America, the countries Central and Eastern Europe, Bulgaria, Latvia, Lithuania, Poland, Portugal, Romania);
• children who must stay at least 1 month in one of these countries;
• children living in disadvantaged social conditions (precarious, overcrowded housing, etc.);
• children with a family history of tuberculosis.

Due to their professional activity, some people must be vaccinated against tuberculosis (except contraindication attested by a medical certificate):

• students of medicine, dental surgery and pharmacy, student midwives, students of medical and social professions;
• people working in medical biology analysis laboratories;
• prison staff;
• nursing staff in health establishments and services;
• professionals in the social sector;
• childminders;
• firefighters (2).

In children at risk, vaccination is recommended from 1 month, ideally during the 2nd month, and until the age of 15 years. For children born in Guyana or Mayotte or those with a family member suffering from recent tuberculosis (less than 5 years old), vaccination is recommended as soon as they leave the maternity ward. A single injection is sufficient, no booster is necessary. 

The vaccine against tuberculosis can be carried out at the attending physician, in PMI or in a vaccination center. On medical prescription, it is covered at 65% by Health Insurance. The act of vaccination is chargeable but paid for by the doctor, free in PMI and vaccination center.

It is recommended to make the injection in the deltoid region, at the junction of the middle and upper thirds of the arm. After vaccination, it is advisable to leave the child’s arm uncovered in order to promote healing, and to put on clothes that do not tighten. Showering and bathing are authorized from the day of vaccination.

The main objective of the BCG vaccine is to protect children from severe forms of tuberculosis, mainly tuberculous meningitis, which can cause serious sequelae. For this purpose, its effectiveness is estimated at more than 75% (3).

Even if vaccination has allowed a strong and constant decrease in tuberculosis cases in France, the disease has not completely disappeared. In 2015, 4536 cases were reported (compared to 31 in 167) (1972).

BCG vaccine is contraindicated in:

• pregnant women ;
• infants under 2 kg;
• people with an allergy to any of the components;
• people who have had tuberculosis;
• people with immunosuppression.

Like any vaccine, the BCG vaccine can rarely cause an allergic reaction. Different events should lead to consultation as soon as possible:

• a rash;
• swelling of the eyes and face;
• difficulty swallowing or breathing
• a drop in blood pressure and loss of consciousness.

In addition, in the weeks following vaccination, it is common for the bitten area to be a little hard. Ulceration and a slight discharge of fluid may also appear, sometimes associated with a lymph node under the armpit (this is called satellite lymphadenopathy). It is advisable not to squeeze the ulceration and not to apply anything on it, apart from a dry sterile compress (5). It is recommended to consult only if the area is hard to the touch measures more than 3 cm, if the child is hampered in his movements and / or if the lymph node is visible to the naked eye and suppurates.

Abscesses and lymphadenopathy heal without anti-infective treatment or surgery in the vast majority of cases, recalls Afssaps (current ANSES) (6). On the other hand, the permanent persistence of a scar is the rule for the BCG vaccine, observes the health authority.