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Changes to the BCG vaccination programme in England

Changes to the BCG vaccination programme in England. Dr Bernadette Purcell CCDC Health Protection Agency. TB: changing epidemiology in UK. 1913: 117,139 new cases E & W 1987: 5086 new cases E & W 2004: 7,000 (London 3,000) Resurgence asstd with changing epidemiology

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Changes to the BCG vaccination programme in England

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  1. Changes to the BCGvaccination programme in England Dr Bernadette Purcell CCDC Health Protection Agency

  2. TB: changing epidemiology in UK • 1913: 117,139 new cases E & W • 1987: 5086 new cases E & W • 2004: 7,000 (London 3,000) • Resurgence asstd with changing epidemiology • 2003, 2/3 of TB pts born abroad • Deteriorating TB control worldwide

  3. TB notifications and deaths in England & Wales 1940-2003

  4. Tuberculosis - Notifications and Deaths, England and Wales, 1982 - 2003 Sources: Statutory notifications of Infectious Diseases (NOIDS), Office for National Statistics (notifications of infectious disease deaths) Prepared by: Communicable Disease Surveillance Centre (CDSC), Health Protection Agency Centre for Infections

  5. Tuberculosis case reports and rates by age group and sex, England, Wales and Northern Ireland, 2003

  6. Tuberculosis rates by place of birth (born in UK vs. born abroad) England and Wales, 1999 - 2003

  7. Tuberculosis rates in persons born in the UK by age group, England and Wales, 1999 - 2003

  8. Tuberculosis rates in persons born abroad by age group, England and Wales, 1999 - 2003

  9. Tuberculosis case reports by ethnic group (%), England and Wales, 1999 – 2003

  10. History of the vaccine • BCG was introduced in the UK in the 1950s. • It was given at school leaving age, then 14 years, because peak incidence of TB was in young adults. • This approach of vaccinating at secondary school age was unique, with all other countries either vaccinating all infants or infants selectively. • 1960s selective BCG introduced to protect children of new immigrants.

  11. 1960s – August 2005 • In the 1960s • an additional programme of selective neonatal BCG immunisation was introduced to protect infants who were likely to catch the disease. • Up to August 2005 • 10-14 years (varied locally, e.g. 12-14 in B&H) • neonates at high risk receive BCG

  12. BCG Schools Programme • Now stopped • Was introduced in the 1950s • Unique to the UK • Given at school leaving because the peak incidence at that time was in young adults. • 50,000 cases reported each year in the UK • Cases occurred across most sections of society

  13. What are the changes?CMO letter – 6th July and 18 August 2005 • All infants (0-12 months) living in areas where the incidence of TB is 40/100,000 or greater. • All infants (0-12 months) with a parent or grand parent who was born in a country with a TB prevalence of 40/100,000 or higher • Previously unvaccinated new immigrants from high prevalence countries for TB – list of countries provided by the DoH • Children who would otherwise have been offered BCG through the schools programme will now be screened for TB risk factors, and tested and vaccinated if appropriate • The contact, occupational and travel related recommendations about BCG remain unchanged

  14. Why the changes? • Reduced total number of cases of TB • Most cases occur in cities and/or affect specific groups • BCG protects against serious childhood TB, it is not as effective in preventing infectious forms of TB in adults. • Can protect young children who are at risk of infection against most serious forms of TB if given as soon as possible after birth.

  15. What changes? - moving from Heaf test to Mantoux • The UK - Heaf test since the introduction of the BCG vaccination in the 1950s • Involves inoculating a minute amount of a high concentration of tuberculin into the skin using a multiple puncture device • The UK only country in the world to widely use the Heaf test • Mantoux test now replaces Heaf Test • Mantoux test involves injecting a small quantity of tuberculin into the skin of the forearm. • The test is the international gold standard and the advice of the JCVI is to move to the Mantoux test

  16. Hastings & St.Leonards and Bexhill & Rother Newborn babies referred by local Midwifes and Health Visitors to Kate Dadswell and Julia Paulin (TB HVs) @ Arthur Blackman Clinic, Hastings. Tel:01424 852735 Eastbourne Newborn babies referred by local Midwifes and Health Visitors toLiz Harper and Chris Hobbs @Eastbourne DGH Tel: 01323 413850 East Sussex

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