TB Vaccination

[Pandora II]

My health visitor came to see me and Daisy yesterday and gave me the ''Red Book'' with the immunisation schedules etc, she then asked about the BCG vaccine for Tuberculosis and I had Daisy''s name put on the request form as it takes a couple of months to book.

There are high rates of TB in London and so most babies in inner cities here in the UK are offered the immunisation. There''s also a question mark over my status as I have antibodies and yet I have never had the immunisation - or at least there is no record of it in my medical notes and I have no scar. I''d have thought that my father might have given me the vaccination and forgotten to put it in my notes, but my sister tested negative and had the vaccination when she was 11 (they used to vaccinate all 11 year olds in the UK). I used to work with bovine TB and it was picked up by Occupational Health just before I began the job - their verdict in the end was that I had been exposed, possibly had a very mild case of it and was now completely clear but testing positive for the antibodies.

I am VERY pro vaccinations, but my concern here is a bit of a strange one...

The likelyhood of Daisy contracting TB is extremely low and the fact that I am breastfeeding her will apparently give her a lot of my natural immunity to the disease. The vaccination is quite an unpleasant one - it forms a blister at the site which they turns into a spot that gradually disappears (can take 6 months to do so) leaving a scar. They also mustn''t have any other vaccinations in the same limb for at least 3 months as it can cause the glands to swell up.

I remember from school that the BCG scars were pretty big even years later.

If I look at my smallpox vaccination mark, it was tiny when I was a child, but as I grew so it grew and now I have a pretty large mark where it was. I would prefer Daisy not to end up with some enormous great scar on her upper arm when she is older and so I''m tempted to have her vaccinated later on. I also hate the thought of giving her a vaccination that I know will be unpleasant for some time afterwards - she will definitely be having all the other, MMR etc on schedule.

Is this completely crazy of me to have these thoughts? I know that TB used to kill thousands (I used to work with the stuff) and that I am fortunate to have the option of vaccination when many people in the world do not. If we were planning to move abroad or spend a lot of time in countries with high rates of TB I would of course have her vaccinated straight away, but here in London the chances are very low and there isn''t any argument along the lines of herd immunity as most people in the country aren''t vaccinated at all.

Her name is down to have the vaccination asap, but I was told I could change my mind and have it done later on if I preferred.

So, those of you with children, would you have it done now or wait till school age or teens?

 

[Lorelei]

I had to have it Pan and the scar on my arm is still noticeable.

 

[swimmer]

Pandora,
That scar is how you can tell who is American and who isn''t. My scar is a bit darker than the rest of my arm and Americans ask "what happened" when those of us not born in the US all have it. Its like all scars, a life souvenir. How can Americans all be vaccinated for TB and yet not have the scar? TB is becoming more and more of an issue in urban areas, the drug resistant strains percolating in Russian jails are just terrifying link. But you know all about that and the other risks of not getting vaccinated.

 

[Lorelei]

I seem to recall when I was at school in the seventies, they tested us all to see who reacted first, those that did got the jab.

 

[LtlFirecracker]

I can''t speak for other countries, but we don''t give it in the US. From what I have been told it is not the most effective immunization and it makes the PPD positive. Therefore, when I get someone from an endemic area who has a pos PPD, I end up treating them regardless of weather or not they had the immunization in the past. For someone with a positive PPD and no clinical signs, that would be 9 mo of INH.

 

[Pandora II]

Swimmer, this is one reason that I''m really torn - where I live it''s very likely that there will be up to 40 different nationalities at any primary school, many of them from Eastern Europe or Africa, so there''s definitely a possibility of her coming into contact with it. However there are only 7000 cases a year in the UK, most in recent immigrants (before the BCG there were 50,000 cases a year) so the risk is relatively small.

Ltl - ditto in Italy, hence I''ve been down the whole Rifampicin plus all the other meds route as they decided to treat possible TB despite my having tested positive since I was 11. Total PITA...

Lorelei - they were still doing it well into the 90''s. You and Swimmer know what I mean by the scar - it''s an impressive one for a vaccination, and it taking up to 6 months to totally heal is not fun for a tiny baby.

 

[cara]

TB vaccine is not routinely administered in the US. Its a balance of effectiveness of vaccine, side effects of vaccine, likelihood of exposure, and the severity and treatability of illness if contracted. The vaccine is not that effective - something like 70% but don't hold me to it - and it is treatable usually though the drug course is not pleasant and there are some antibiotic resistant strains nowadays. The vaccine is routinely administered in coutries with higher latent TB infection rates... So the key is figuring out how likely exposure/infection is for your child and balancing that against the cosmetic, (in)effectiveness, and other downsides of the vaccine.

I will tell you my story about the downsides of vaccination. A person in my work group at school visited his home country, contracted TB. Was diagnosed at the school health clinic and given a multimonth course of drugs to treat it. Took the drugs for a while until he was feeling better and then stopped. Developed a raging case of active TB in which he was coughing up stuff and potentially infection. Initially lied or mislead the doctors about the fact that he had stopped taking the drugs, so the doctors assumed that he had a drug-resistant strain (until they later ran the tests on the strain and he confessed.) The county health officials were called, the school administrators were worried about a potential panic and forbid us from emailing each other about his condition, etc. People he worked closely with were tested for TB infection. Everyone that was from a country that vaccinates (Russia, Korea, China, etc.) tested positive for TB. And because you can not tell the difference between a positive test because you were once vaccinated and have developed immunity, and a positive test because you were once vaccinated but did not develop immunity (as the vaccine is not perfectly effective) and were later exposed and now are infected, they treated everyone as if they were infected. County health officials were involved, and after one case of noncompliance with a communicable disease, everyone that tested positive for TB was monitored and required to take nasty drugs for X months, during which one is not supposed to drink alcohol and there are other unfortunate side effects. The unvaccinated Americans all tested negative and were allowed to skip the nasty drugs. So. Not saying you should go one way or the other on this one, but its not a perfectly clear cut case, and I am generally pretty pro-vaccine. But you know this already, LOL, so I guess I haven't added much on the decisiveness end of this discussion!