Q. What if the child develops fever?
A. BCG does not lead to fever. Hence search for another cause & treat accordingly.

Q. What are the complications of BCG?
A. In 1-2 % of vaccinees, local lymphadenitis can occur involving axillary lymph nodes or rarely supraclavicular gland, especially if injection is given very high over arm. In children with immune compromised state like AIDS, BCG can lead to progressive systemic disease.

Q. Can BCG be given over thigh from beauty point of view so that scar is hidden?
A. As we saw before, 1-2% of children develop local BCG lymphadenitis. If that happens following injection over thigh, it will involve superficial & deep inguinal lymph nodes, which can prove dangerous. Also, by convention BCG scars are looked for over the left arm & hence it is easier to recognize for the doctor when parents do not remember whether BCG was given in the past or not. Hence BCG should only be given over left arm & nowhere else.

Q. What should be done for BCG lymphadenitis?
A. Local lymphadenitis can occur due to superadded infection over BCG ulcer. One should try oral antibiotics & anti-inflammatory with good local hygiene (Soap & water). If the lymph node does not shrink or disappear, it is true BCG lymphdenitis. In these cases if the size of node is less than 10mm - 15mm, if it is firm, non-painful & not matted; no treatment is required & only observation is required. It will usually disappear on its own in the next few months time. If the glands are bigger than 15mm, soft, fluctuating with signs of inflammation or softening, painful and matted or if already an abscess has formed with or without discharge, treatment is definitely required. One can either remove the entire gland surgically or try a course of anti-tuberculous drugs in form of Isoniazid 5 mg/kg/day & Rifampicin 10mg/kg/day on empty stomach for a period of 3-6 months.

Q. What if BCG is not given at birth?
A. BCG should be given as early as possible in life, before child comes in contact with tuberculosis. It can be given up to 5 years of age. If it is given beyond 6 months it is preferable to do a prior Mantoux test to see if the patient is already sensitized to tuberculosis. If patient is already sensitized as shown by positive MT, BCG is not necessary. If prior MT is not done, at least check for accelerated reaction to BCG in first week after vaccination which may suggest presence of tuberculosis in the child.

Q. Why is BCG not recommended in USA?
A. In developed countries like USA, very few cases of tuberculosis occur. As BCG does not prevent primary complex or the adult type of tuberculosis no benefit will be derived by routine BCG vaccination in such countries. In fact BCG can interfere with interpretation of Mantoux test done subsequently. Hence BCG is not recommended in USA routinely. With the spread of HIV, incidence of tuberculosis is rising in USA. Under such circumstances they may have to reconsider about routine BCG vaccination.

Q. What if scar is not seen after BCG vaccination?
A. Formation of scar is neither necessary nor is the only indication of success of BCG vaccine. However it is the only simple & convenient way of determining success of BCG vaccine. It may take 3-6 months for the scar to form. If no scar is visible at all after 6 months one needs to do Mantoux test. If negative, one should give repeat BCG

Q. Can BCG be given with other vaccines?
A. BCG can be given with other vaccines. In fact, BCG is given along with zero dose of OPV & 1st Dose of Hepatitis B vaccine at birth. As measles can depress cell mediated immunity & as BCG induces cell mediated immunity BCG should not be given along with measles or MMR

Last created on 23-02-2001
Last updated on 01-11-2004

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