TB vaccine may only be given to ‘at-risk’ children

The vaccination against TB could become a selective jab and not one given to all babies under proposed changes by the Health Information and Quality Authority (Hiqa).

The health watchdog has started a public consultation on proposed changes to the BCG vaccination programme that would see the number of infants getting the vaccine fall from around 61,000 to 8,000 per year as only those most at risk would get the shot.

Hiqa has evaluated changes to the national infant BCG vaccination programme proposed by the National Immunisation and National TB Advisory Committees.

The Department of Health had asked Hiqa to examine the clinical and cost effectiveness of the planned changes, as well as organisational and ethical issues.

According to Hiqa, the high-risk population for TB comprises children born to parents from a high TB-incidence country and Traveller children. These two groups constitute about 13.4% of births annually.

High-risk infants were estimated to have a risk of contracting TB three times higher than that of the general population. A BCG vaccine shortage earlier this year raised concern that thousands of babies have not been immunised against TB.

However, Hiqa is considering whether the vaccine programme is still beneficial, given the low number of cases in Ireland.

The number of cases of TB has dropped each year from more than 600 in the early 1990s to under 400 since 2012. There were 324 cases reported last year.

According to the Health Service Executive, there were were no cases in young children last year.

Ireland is one of only two western European countries with a policy of universal vaccination against TB. The other country is Portugal.

Hiqa’s director of health technology assessments, Máirín Ryan, said the public was being given an opportunity to review the authority’s advice and give their feedback.

“In the context of a fall in TB incidence and diminished risk of acquiring TB, there has been a shift in the balance between the benefits and risk of offering vaccination to all infants. Selective vaccination will continue to protect those at higher risk while avoiding unnecessary side effects in those with a limited capacity to benefit from vaccination,” said Dr Ryan.

She said most infants who received the vaccine had minor side effects while one in 1,200 experienced side effects that required a medical follow up.

There is only one licensed manufacturer of the BCG (Bacillus Calmette-Guérin) vaccine in the EU. The HSE ran out of the vaccine at the end of April.

The vaccine manufacturer has told the HSE that the vaccine will not be delivered to Ireland until next month, at the earliest. The BCG vaccine has been used routinely in Ireland and worldwide since the 1950s. In 1952 there were almost 7,000 cases of the disease in Ireland.

The public consultation period will end on October 21, after which Hiqa will publish the findings of the assessment and advise the minister for health.