To B(CG) or not to B(CG)

Due to the long waiting list in our borough (and admittedly, my not booking the appointment straight away) Pip’s BCG vaccination is next month. I’d assumed this one would be like all his other routine vaccinations – a bit of distress but a quick recovery, putting our trust in the NHS and ultimately not really thinking about it that much. I am not opposed to vaccinations in the slightest; in fact I believe we are incredibly lucky to live in a country that offers them, and it had never occurred to me to think about turning one down until now. Surely the benefit outweighs any perceived risk? The whole anti-vax argument exhausts me, and I’m not squeamish either about the necessary evil of essentially injecting the virus into yourself (and thanks Elly for sending me this sensible article debunking such scary-sounding vaccine ingredients such as latex rubber and formaldehyde).

But last week, one of my NCT friends announced that at the eleventh hour she had cancelled her baby’s BCG appointment. This completely threw me! I therefore made the resolution to do some digging in an attempt to make a slightly more informed decision than usual.

What is the BCG vaccination?

Embarrassingly, until now I didn’t know that the jab was to combat tuberculosis. Tuberculosis, or TB, is a serious lung condition which can also lead to meningitis. A brief background: Messieurs Calmette and Guerin developed the vaccine around a hundred years ago in Lille, and the first BCG was administered in 1921. The letters BCG stand for “Bacillus Calmette–Guerin” and the syringe consists of a live bovine tuberculosis bacillus.

BCG

So far, so delightful. Interestingly, the jab is not generally given to people over the age of 16 – and never above 35 – as it doesn’t seem to be effective in adults. The BCG is not just another routine baby immunisation, however: it seems to be a completely different syringe of fish to the others on the schedule and not just because it is administered into the baby’s arm rather than the thigh.

If it’s that important, why doesn’t everyone get it?

One thing that perplexes me about the BCG vaccination is that whether you are offered it, and indeed when you can actually get it, depends entirely on where you live. Statistics tell me that in 2011, 40% of TB cases in the UK were located in London. However, rather than just offering the vaccine to everyone in London, it depends on which borough you are in. In Lambeth, for example, babies are given the BCG jab pretty much straight away in hospital. In Wandsworth, where Pip lives (although, incidentally, not where he was born!) they seem to be more relaxed about it – hence the long waiting list.

This doesn’t allow for moving from borough to borough, or indeed from place to place in the country – what if you are born in a low risk area that does not offer the BCG, then move to London with no immunity? It’s like mobile phones on planes. If it was truly risky to have them switched on, surely passengers would have to hand them over on boarding. Likewise, if there is a clear and present danger of contracting TB, surely every baby in the UK – no matter what – would be offered the immunisation? Perhaps upon moving to a high-risk area and registering with a new GP, this is checked. That would seem sensible. But in the meantime it seems slightly arbitrary… I wonder whether eventually some of the lower risk areas may eventually go up the rankings, as less people are immune, so the herd is unsafe if an contagious outsider enters and thus potentially increases the number of cases.

Complicating the matter is that entire countries, too, do not routinely vaccinate against TB. The slightly large region that is the USA, for example? What is that about? A keen student asked this very question on Yahoo which led me to The Centers for Disease Control and Prevention, part of the Department of Health in the US. Their advice is that “BCG is not generally recommended for use in the United States because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity. The BCG vaccine should be considered only for very select persons who meet specific criteria and in consultation with a TB expert.” Eek! The bottom line seems to be, TB is extremely rare over in the States and it isn’t cost-effective to immunise people.

Incidentally, this is why our routine school vaccinations in the UK finished nearly ten years ago – it stopped being financially worth it as TB was becoming increasingly rare. However, a few years ago the infection started getting “out of control” again (as ever, thanks Daily Mail) and babies’ immunisations were introduced.

My NCT friend is American which probably lent some weight to her decision, and Pip is a quarter American himself, but that being said we all currently live in London which is apparently plague-ridden!

BCG stats

Number of TB notifications in UK major cities, 2010

Scarred for life

Until 2005, the jab was administered to all 13 year olds in the UK. You may remember getting it at school. I don’t have any recollection of this joy, but Mr Cath does (apparently, everyone ran around afterwards punching each other in the arm… ahh, boys!) You can tell straight away whether someone has had the BCG as it is characterised by an indented scar in the upper arm. Babies are no different. It is likely that Pip will also be left with a mark, and while it may be very small and not a big deal for him in the future, the idea of hurting my baby to the point where it leaves a permanent scar fills me with horror.

Another friend is going private for her daughter to have the BCG jab in her foot. Her reasoning is that she might want to wear a strapless wedding dress one day! Slightly extreme, but it goes to show the significance of the mark – this is no little pinprick.

Months of suffering

At Pip’s previous vaccinations, he yelped and then as the pain faded his recovery was rapid. Certainly, by the next day he was right as rain. While a blister and an oozing scab do not necessarily equal pain, I think it’s inarguable that they do equal something not right with the world! And recovery from the BCG takes MONTHS! We see a little boy at swimming every week who has had an angry red swelling on his arm since November. He does seem perfectly happy and certainly more comfortable at being dunked under than Pip; nevertheless, I cringe every time I see it. I have also heard of scabs oozing through to babies’ clothes. Again, this is something I would find very difficult to inflict on my little boy!

Does it actually do anything?

So, pain, seeping and scarring must at the very least ensure complete immunity, right? Wrong. The NHS admits that the jab is only “70-80% effective against the most severe forms of TB, such as TB meningitis in children.” So if 10 babies are immunised and are later exposed to TB at their local nursery, chances are that 2 or 3 of those babies will become infected anyway!

I don’t like those odds (as a point of comparison, the first MMR jab protects around 90% of children, and then the second one does the same which brings the immunity rate up to nearly 100%).

Nevertheless, it should be noted that TB seems to be quite tricky to catch in the first place and you need to be in prolonged contact with an infected person before coming down with it yourself. According to a consultant paediatrician at the Portland (the site of the foot-jab!) “only a third of people who are in close contact with a person with TB will become infected.” Although he does note that children are especially susceptible, this means that (a) you would have to be one of those original 3 children who are not immune despite the jab AND (b) you would be the unlucky one to get infected even if you all have prolonged contact.

Slightly better odds.

The alternative: contracting TB

The number one concern for anyone choosing not to vaccinate their baby is, I think, what if they came down with said disease? Does the risk of this happening really outweigh any worries about a little jab? Basically, if we did decide not to immunise Pip then we need to fully prepare ourselves that he might one day get TB. As unlikely and as rare as that may be, there is still a possibility.

In the UK, people do still die of TB, but the majority make a full recovery as long as they are diagnosed and treated with antibiotics. In fact, as our friend the lung specialist at St Barts’ hospital asserts, with treatment you are “virtually guaranteed to be cured.”

So if Pip did contract tuberculosis, chances are he’d be ok.

It’s the bit about it leading to meningitis that scares me more – we all know how dangerous that one can be.

And even if it didn’t lead to meningitis, it would still be tuberculosis. My little boy with TB? Hmm… far easier I think to cope with my little boy with a scarred arm (then, if he did get it anyway due to some incredibly bad luck, we can console ourselves that we did all we could).

So – to BCG?

I’m on the fence, but teetering wildly towards going for the vaccination. Apart from the scar and unpleasant wound, there don’t seem to be any serious side effects (incredibly rare anaphylactic shock which quite frankly he could get from ANYTHING!)

Every little boy needs a few scars anyway, right?

helmet

Well… not if this mum can help it!

3 thoughts on “To B(CG) or not to B(CG)

  1. Charlie

    I would worry too much about Pip getting a scar. I don’t have a scar from mine. I wasn’t in school when they gave them so I had to go and get it done before starting a job in a hotel. I didn’t scar at all – I put this down to not being punched in the arm by my school friends, its not just boys who do that.

    Take good care of the blister and he hopefully wont scar too bad. Although that is probably easier to do at 16 than it is with a baby.

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  2. Anna

    You wouldn’t remember this from school because we were never given it there (the area didn’t issue the vaccine even at that time). But of course you may have had it outside school? I had to get it at 19 years old before going to sub-Saharan Africa, where there are still high rates of TB – was never told is less effective after 16. No scar and I’d echo what Charlie days about not worrying about that side of things.

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  3. Jess

    Cath, We get the small pox vaccine in the states as a baby that leaves the indented scar on the arm. No TB vaccines. My family (the 3 of us) were exposed to TB for a length of time in Nepal. We were given gama goblin before exposure (it temporally boosts the immune system for TB exposure). We were all fine and clear. Unfortunately, Mr Jess was exposed later at the hospital he worked in and he did get it. He was treated, and cured. The two of us were tested and were negative. A side note, Mr Jess never felt sick, he just tested positive on one of the tests. After x rays a slight shadow was there and has never changed in over 20 years. Keep looking into this vaccine, not sure I would do it.

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