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Bacillus Calmette-Guerin (BCG) is the live attenuated vaccine form of Mycobacterium bovis used to prevent tuberculosis and other mycobacterial infections. The vaccine was developed by Calmette and Guerin and was first administered to human beings in 1921. BCG is the only vaccine against tuberculosis. It is the most widely administered vaccine and usually a part of the routine newborn immunization schedule. BCG vaccine also offers protection against non-tuberculous mycobacterial infections like leprosy and Buruli ulcer. This activity reviews the mode of action of the BCG vaccine and highlights the role of the interprofessional team in educating patients about tuberculosis prevention. Objectives: Describe the mode of action of the BCG vaccine. Review the indications for the BCG vaccine. Summarize the clinical relevance of the BCG vaccine. Outline the importance of improving care coordination among interprofessional team members to improve outcomes in patients receiving the BCG vaccine. Access free multiple choice questions on this topic.

Bacillus Calmette-Guérin (BCG) is the live attenuated vaccine form of Mycobacterium bovis used to prevent tuberculosis and other mycobacterial infections. The vaccine was developed by Calmette and Guérin and was first administered to human beings in 1921. BCG is the only vaccine against tuberculosis. It is the most widely administered vaccine and usually a part of the routine newborn immunization schedule.  BCG vaccine also offers protection against non-tuberculous mycobacterial infections like leprosy and Buruli ulcer. It is also used in the treatment of superficial carcinoma of the bladder. BCG vaccine is a fairly safe vaccine and it is not associated with severe complications. Prior to the mycobacterial infection, vaccine-induced or acquired naturally can protect against subsequent infection due to mycobacteria including tuberculosis.[1]  Prior infection with nontuberculous mycobacteria and Mycobacterium tuberculosis can confer natural protection against tuberculosis infection.[2][3] Protection against tuberculosis infection is usually due to the immune response to mycobacterial antigens. Prior contained latent infection with Mycobacterium tuberculosis can provide up to 80 percent protection against disease with subsequent exposure.[4] In patients with previous active disease, there is an increased risk of recurrence of active tuberculosis due to distinct strains in both HIV-uninfected and HIV-infected patients.[5][6][7][8][9][10] Bacille Calmette-Guérin (BCG) has been associated with a reduction in childhood mortality which is not attributable to tuberculosis.  Reduction in childhood mortality may be due to epigenetic reprogramming of the nucleotide-binding oligomerization domain (NOD2) receptor.[11][12][13][14] BCG vaccine can be given either intracutaneously or intradermally. Research is currently being conducted on respiratory administration since natural infection, and sensitization to Mycobacterium tuberculosis in humans tend to occur in the respiratory system.[15][16]

Injection site reaction is the most common complication. Injection site reaction includes granulomatous lesions, lymphadenopathy of regional lymph nodes, and nodules or ulcers at the vaccination site with or without draining sinus tracts or fistulae. Mycobacterium bovis is positive when wound culture is obtained. One of the adverse effects of BCG is suppurative lymphadenitis, children with primary immunodeficiencies have been shown to have a higher risk of widespread suppurative lymphadenitis and should be avoided.[27][28] Other complications include: Osteitis Osteomyelitis Disseminated infection may occur in the setting of immunosuppression including HIV infection.

BCG vaccination policy is determined by the regional prevalence of tuberculosis infection. Routine neonatal vaccination is recommended by the WHO in countries with moderate to the severe incidence of tuberculosis. Conversion of tuberculin skin test should not be used to determine the efficacy of the BCG vaccine among recipients.[34][35][42] Routine BCG vaccination is not generally recommended in the United States due to a low incidence of tuberculosis infection and also due to interference of immunization with the PPD test. BCG vaccination is not recommended for health care workers in low-risk areas. Vaccination is also contraindicated in immunosuppressed patients. BCG vaccination may be considered in situations where a high percentage of patients are infected with TB strains that are resistant to isoniazid and rifampin.[42] Vaccination can also be found in cases where the implementation of general infection precautions has failed and when transmission of multi-drug resistant strain of Mycobacterium tuberculosis is likely.[42] Nurses practitioners, physician assistants, and physicians that administer BCG should work together in an interprofessional team to assure the safe and effective administration, follow-up, and education of the patient. [Level 5]