Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

Working with the people of Auckland, Waitemata and Counties Manukau

Auckland Regional Public Health Service

BCG ProgrammeKathy Smith

Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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BCG Vaccination

• Does not significantly impact on disease incidence

• Is effective in protecting young children against severe forms of disease – TB meningitis, miliary TB

• One dose only – revaccination is not recommended

• Ideally given in neonatal period – only given to children under 5 years of age in NZ

Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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BCG Vaccine• Live attenuated vaccine (M. bovis)• Administered by gazetted BCG vaccinators• Can be given simultaneously with any other

vaccines (incl live vaccines) – but into a separate site, using a separate syringe

• Intradermal injection – left upper arm (deltoid insertion)

• Further immunisations must not be given into that arm for 3 months after BCG – due to risk of local lymphadenitis

Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Neonatal BCG eligibility Criteria(see page 523-524 of Immunisation Handbook 2017)

• BCG should be offered to infants who are at increased risk of TB:

• Living in house or family/Whanau with a person with either current or a past history of TB

• Have one or both parents or household members or carers, who within the last five years lived for a period of six months or longer in countries with a rate >40 per 100,000

• During their first five years will be living for three months or longer in a country with a rate > 40 per 1000,000 and are likely to be exposed to those with TB.

• https://www.healthed.govt.nz/resource/bcg-vaccine-information-health-professionals

Neonatal BCG eligibility Criteria(see page 523-524 of Immunisation Handbook 2017)

Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Contraindications To BCG

• Cancer• Corticosteroids/other immune suppressives• Baby with known HIV infection • Suspected HIV infection (mother has HIV)• Other immune compromising conditions• High fever• Positive Mantoux test/contact of a case (beware also

of mothers who are contacts – they could be a case themselves)

• Generalised septic skin conditions

Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Normal BCG Reaction and After Care

• Infant remains well and afebrile• Localised reaction only• After 1-6 weeks a red, raised lump/sore may

appear• May discharge for 2 to 3 months• Will leave a small scar• Keep clean and dry – dry dressing – gauze• Don’t use band aids or sticking plaster

Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Adverse reactions to BCG - parent must contact Public Health nurse

• Ulcer at injection site > 10mm diameter• Abscess at injection site • A sore developing in the first 2 days after the

injection• Weeping from injection site > 2 to 3 months• Regional (axillary) lymphadenopathy• 1 in a million: disseminated BCG reaction

(usually in immune compromised)

Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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ARPHS BCG Programme

• BCG vaccinators at community clinics• No in hospital programme as yet.• LMC to either fill in neonatal assessment form

and fax/email to ARPHS or direct parents to ARPHS BCG webpage.

• http://www.arphs.govt.nz/• Appointments given as soon after birth as

possible

Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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Auckland Regional Public Health Service Rātonga Hauora ā Iwi o Tamaki Makaurau

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How to book a BCG www.arphs.govt.nz/bcg

or 0800 FOR BCG

(0800 367 224)