Hiqa recommends selective neonatal vaccination against TB

The State’s health services watchdog has recommended a move from universal to selective BCG vaccination in conjunction with enhanced tuberculosis (TB) control measures.

A health technology assessment by the Health Information and Quality Authority (Hiqa) has been presented to Health Minister Leo Varadkar.

Hiqa has advised the minister that any change in strategy must be supported by a clear commitment to enhanced systematic and comprehensive TB control measures.

The assessment followed ongoing issues with the supply of the BCG vaccine earlier this year. A six-week consultation on the draft report took place between September and October.

The proposed change comes just eight years after the BCG was introduced as a universal treatment in Cork.

Since October 2007, have been newborns in Cork offered the vaccine. The change followed an outbreak of TB at two creches in the city. An adult carrier of the disease caused the outbreak that resulted in around 15 children being treated for TB, with preventative measures taken for a number of other children.

Universal BCG vaccination stopped in Cork in 1972 and after that the vaccine was only offered to newborns considered at risk of developing TB.

Hiqa’s director of health technology assessment, Dr Máirín Ryan, said the recommendation to switch to a policy of selective neonatal vaccination was based on best available evidence.

“Selective vaccination would focus resources on those who are at higher risk of contracting TB; one in eight newborns will continue to be eligible for the vaccine,” said Dr Ryan.

Newborns considered at risk are those born in, or whose parents are from, a country with a high risk of TB. Also considered at risk are infants in contact with patients with active respiratory TB and members of an at-risk group such as the Traveller community.

Dr Ryan said falling TB incidence has decreased the potential benefit of BCG vaccination for most children.

The number of TB cases in Ireland has dropped from over 600 in the early 1990s to under 400 since 2012 — there were 324 cases reported last year. Ireland is one of only two western European countries with a policy of universal neonatal vaccination. The other is Portugal.

A move from universal to selective vaccination would greatly reduce the number of vaccinated infants from about 61,000 to 8,000 per year and reduce the cost by over €1m.