A hospital consultant has warned that the BCG vaccination, which the Southern Health Board proposes to reintroduce in Cork in response to the high incidence of TB in the area, may make the disease more difficult to detect.
Routine neonatal BCG was stopped in much of the greater Cork area in 1972, and it is the only area to have stopped BCG. The board has not yet ratified its reintroduction, but is expected to do so shortly following recommendations for standardisation of BCG vaccine from the board's TB review committee.
In addition to neonatal vaccinations, it has recommended vaccinations for children aged between 10 and 14, who have not previously been vaccinated, and others in high-risk groups.
However, board member Mr Cathal Bredin, a consultant respiratory physician at Cork University Hospital, is so firmly opposed to the reintroduction of routine neonatal vaccination that he "regrets greatly" the setting up of regional TB committees. No area in the Western world has reintroduced the controversial vaccine having once stopped it, he said.
In 1999, however, the National Immunisation Committee of the Royal College of Physicians of Ireland recommended neonatal vaccination along with the immunisation of 10/14-year-olds who had not been previously vaccinated.
New statistics about to be published by the National Disease Surveillance Centre will show the Southern Health Board has the highest rate in the country of confirmed cases of TB among the indigenous Irish population, with a rate of 7.8 per 100,000. Overall figures are 7.9 including immigrant population.
The vaccination may actually disguise the real incidence of TB and would prevent getting to the "reservoirs" of the disease, Mr Bredin said. Routine tests such as skin tests to diagnose infection are useless, forcing the use of X-rays. Control of the disease relies on early diagnosis and prompt contact tracing.
The vaccine is best in preventing a type of meningitis known as TB meningitis, a form of TB that no longer occurs in the region. "We are bringing it back for a disease we currently do not have," Mr Bredin said.
Dr Darina O'Flanagan, director of the National Disease Surveillance Centre, accepted BCG "is one of the most controversial vaccines" because it inhibits detection of the disease. "BCG is not the best vaccine we have ever invented. But the protection afforded by BCG is still better than the problems it brings," Dr O'Flanagan said. And she maintained that, while it did not guarantee immunisation, the benefits among children and young adults played a role in containing outbreaks.
Still, standardisation which included routine vaccination was the "best policy", Dr O'Flanagan said. It was very confusing for people to have different policies. She added: "The rates have come down where there has been a policy of vaccination."