Introduction
Bacillus Calmette Guérin BCG Vaccine is the foremost and first vaccine in the immunization schedule that is given to a newborn baby within 2 weeks of birth to provide immunity against tuberculosis (TB).
Definition
The BCG vaccine (Bacillus Calmette–Guérin) is a live attenuated vaccine primarily used to protect against tuberculosis (TB). It was developed from a strain of Mycobacterium bovis and named after its creators, Albert Calmette and Camille Guérin.
Purposes
- To prevent TB.
- To help the immune system make antibodies for fighting against the Mycobacterium tuberculosis antigen.
Indications
- Newborn baby on days 0-15 days after birth.
- Child born from an HIV-positive mother.
- Contact with a patient with TB.
Key Facts About the BCG Vaccine
| Aspect | Details |
|---|---|
| Origin | Developed from Mycobacterium bovis by Calmette & Guérin in 1921 |
| Main Use | Prevents severe TB in children; limited effect on adult pulmonary TB |
| Administration | Intradermal injection, usually in the deltoid region |
| Efficacy | Varies by geography; protection may last up to 20 years |
| Common Side Effects | Local ulceration, scarring, mild swelling or redness |
| Serious Risks | Rare; includes disseminated BCG infection in immunocompromised patients |
| Impact on TB Testing | Can cause false-positive tuberculin skin tests (TST); IGRA preferred |
| Other Uses | Sometimes used in bladder cancer therapy and for Buruli ulcer |
Route and Site of Injection
It is given intradermally in the arm, over the distal aspect of the deltoid muscle onto the humerus which is approximately one-third down the upper arm. The needle is inserted at a 10°-15° angle parallel with the skin surface. The skin is stretched between the thumb and the forefinger. A raised, blanched bleb indicates that the injection is administered at the correct site. The vaccination usually leaves a small scar.
Special Consideration
- Delayed vaccination may be considered in infants born to HIV-positive mothers until HIV status is confirmed.
- Healthcare workers should be counselled on risks and benefits before vaccination.
| Consideration | Details |
|---|---|
| Timing of Administration | Ideally given within the first 15 days of life. Delayed vaccination may be considered for infants born to HIV-positive mothers until HIV status is confirmed. |
| Route and Site | Administered intradermally over the deltoid region of the upper arm. A raised, blanched bleb confirms correct technique. |
| Contraindications | Not recommended for immunocompromised individuals (e.g., HIV-positive, leukemia, on immunosuppressive therapy) due to risk of disseminated BCG infection. |
| Impact on TB Testing | Can cause false-positive results in tuberculin skin tests (TST); interferon-gamma release assays (IGRA) are preferred for TB screening post-vaccination. |
| Counseling for Healthcare Workers | Those working in high-risk TB environments should be counseled on the risks and benefits before receiving the vaccine. |
| Other Uses | Occasionally used in bladder cancer therapy and for Buruli ulcer treatment. |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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