Why is BCG not recommended in USA?
In developed countries like USA, very few cases of tuberculosis occur. As BCG does not prevent primary TB or the adult type of tuberculosis no benefit will be derived by routine BCG vaccination in such countries. Hence BCG is not recommended in USA routinely.

What is the normal reaction to BCG vaccine?
Immediately after the BCG vaccine there is a small swelling at the injection site, which persists for 6-8 hours. After that the swelling disappears & the injection site looks normal. After 6-8 weeks a swelling reappears, which looks, like a mosquito bite. It grows in size & forms a nodule, which breaks open & discharges some fluid & forms an ulcer. The ulcer heals by forming a scar. The whole process takes 2-5 weeks. Some times this process of ulceration & healing recurs 2-3 times. Ultimately the typical puckered scar is formed which remains for lifetime.
If ulceration occurs within 7 days of injection, one must report to the doctor, as it may be a sign of tuberculosis in the child.

What local care should we take at injection site?
Injection site should not be pressed or rubbed. It should not be fomented. Nothing needs to be applied locally. Infact, bath with soap and water should suffice even when it has ulcerated.

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

Can BCG be given over thigh from beauty point of view so that scar is hidden?
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.

What if scar is not seen after BCG vaccination?
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

Can BCG be given with other vaccines?
BCG can be given with other vaccines except Measles and MMR. In fact, BCG is given along with zero dose of OPV & 1st Dose of Hepatitis B vaccine at birth. BCG should not be given along with measles or MMR

What are the complications of BCG?
In 1-2 % of vaccinees, local gland can get swollen. Consult your doctor if it remains the same.