Bacillus of Calmette

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Bacillus of Calmette Guerin (BCG) Vaccine SSI

• Mabel Simms
• Dec 2006

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BCG

• Infection spread from someone whose
• lungs/throat are infected coughing
• Up
• Droplets can stay in air for some time
• ?Inhale bacteria

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BCG

• History
• Great killer in 19th Century
• 1/3 of worlds population is infected with TB
• 2,000,000 deaths annually

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BCG

• Reduced due to
• Vaccination
• Pasteurisation
• General improvement in social conditions
• Expanded programme on immunization
• BCG to all newborns in developing
• countries

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BCG

• Who are at increased risk?
• Population from
• Eastern Europe
• Central Asia
• HIV infected individuals

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BCG

• In England Wales ? by 25 over last 10 years
  still rising (DH 2004)
• Around 350 people in England die from TB every
  year!
• Increased in inner cities of UK by 12 from
  1988-1992 (Shaw 1995)

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BCG

• Reasons for increasing trend
• World wide travel
• Mutation
• Altered immune system (HIV)
• Most infected people will never have symptoms
  (Dye 1999)

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BCG Vaccine

• Live vaccine!
• Not to be administered to anyone with impaired
  immunity

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BCG Vaccine

• Constituents
• Weakened strain of tuberculosis bacteria
• Freeze-dried powder
• Contains myobacterium bovis BCG- Danish strain
  1331

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BCG Vaccine

• Storage
• 2-8 0C
• Dose
• Infants aged under 3 months0.05mls
• Route intra-dermal, in deltoid insertion region
  of upper arm
• difficulties encountered!

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BCG Vaccine

• Adverse reactions uncommon
• prolonged ulceration
• subcutaneous abscess formation
• Why?
• Faulty injection technique

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BCG Vaccine

• Preparation
• Rubber stopper must not be contaminated with
  antiseptic detergent!
• If alcohol used to swab rubber stopper
• Must be allowed to evaporate

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BCG Vaccine

• Mix vaccine powder with solvent- diluted Sauton
  SSI
• Use syringe with a long needle to transfer
  solvent to dry vaccine
• Invert vial a few times
• DO NOT SHAKE!!

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BCG Vaccine

• Solution should appear homogenous,
• slightly opaque colourless
• Gently swirl vial before drawing up for each
  administration
• Use by 4 hours after reconstitution

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BCG Vaccine

• Advise to parents
• Leave injection site exposed- no plaster
• Do not wash area for 24 hours
• Always on LEFT ARM!

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BCG Vaccine

• Blister appears in approx. 2 weeks
• Lasts for about 6-8 weeks
• Fever - calpol

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BCG Vaccine

• Contraindications
• Immunosuppressed
• HIV
• NNU
• ? Eczema