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BCG and tuberculosis
  1. M J Bannon
  1. Northwick Park and St Mark’s NHS Trust, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK
  1. Dr Bannon.

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Tuberculosis (TB) has represented a significant threat to children’s health since antiquity. Far from being eradicated, conclusive evidence exists to suggest the presence of a global pandemic. It has been estimated that by the end of this decade 15 million children will have developed the disease worldwide, with five million deaths.1 Various factors account for the resurgence of TB and these include the presence of pre-existing HIV infection,2 3 migration of populations from areas with a relatively high prevalence of TB to developed countries,4adverse social conditions,5 development of multidrug resistant strains of Mycobacterium tuberculosis,6 inadequate medical management of individual cases,7 and ineffective public health surveillance programmes.8 Some industrialised countries have experienced a sustained decline in the incidence of childhood TB whereas others have observed that the rate of decline has either slowed or has even reversed.9 In England and Wales the rate of notification for childhood TB declined from 7/100 000 in 1978 to 3.1/100 000 in 1988.10 However, the number of notifications has steadily increased since then. This rise has been partly attributed to immigration of children and their families from the Indian subcontinent and increasing levels of deprivation.11 The rate of notification for UK children of the Indian subcontinent and African-Caribbean ethnic origin continues to be significantly higher than for white children.12 The precise impact of HIV infection and the development of multidrug resistance on the epidemiology of childhood TB in the UK has yet to be fully determined.

Key messages

  • BCG is a safe and effective vaccine for the prevention of childhood TB in the UK

  • Percutaneous BCG administration may be an acceptable alternative to the intradermal method for infants, but requires further evaluation

  • Districts with a high prevalence of TB should consider universal BCG immunisation …

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