The practice of routinely vaccinating all children against tuberculosis may be reviewed in the light of an evaluation which suggests selective vaccination of high-risk groups might be a better use of resources.
The National Centre for Pharmaco economics (NCPE), which monitors the cost-effectiveness of drug treatments, says “due consideration” should be given to the practical elements of implementing a selective vaccination policy for the BCG vaccine.
High-risk groups
In a report evaluating current BCG vaccination strategies, the centre points out that TB control in countries such as Ireland, where the prevalence of the disease is low, requires efforts to tackle it in high-risk groups as well as to ensure that the health system is able to diagnose cases, regardless of group, as early as possible.
BCG (Bacille Calmette Guerin) has been used routinely in Ireland and worldwide since the 1950s.
However, since TB rates have declined, many other Western countries have abandoned mass vaccination on cost-effectiveness and other grounds.
The NCPE evaluation, which used a complex mathematical model to evaluate the two options, estimated that the State could save more than €560,000 a year over a 15-year time horizon by switching to selective vaccination.
However, the health gain would be reduced. The report points out that these estimates were subject to considerable uncertainty.
Childhood vaccination
In Ireland, BCG is given as part of the normal childhood vaccination schedule, and is also recommended for groups at higher risk of acquiring the disease, such as health workers.
The vaccine is made from a weakened form of a bacterium closely related to human TB. It makes the immune system produce antibodies, which makes people who receive it immune to TB.
The vaccine played a major role in ridding Ireland of the scourge of TB. In 1952, there were nearly 7,000 cases of the disease notified in Ireland.
A combination of better living conditions, antibiotics against TB and BCG vaccine dramatically reduced the number of cases. In 2011, 424 cases were reported.
Some experts say Ireland should follow the example of Nordic countries which have lower rates by focusing on a targeted programme of anti-TB measures, aimed at those most at risk – people in lower socio-economic areas, the homeless and migrants coming from countries with high TB rates.
