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Tuberculosis: Vaccination

Volume 481: debated on Thursday 23 October 2008

To ask the Secretary of State for Health which countries are classified as possessing a level of tuberculosis infection sufficient to justify the treatment of their nationals as a high risk group under the new guidelines for the national BCG vaccination programme. (228988)

The Bacillus Calmette-Guerin (BCG) vaccination programme offers the BCG vaccine to those at greatest risk of exposure. These are:

all infants (aged 0 to 12 months) living in areas of the UK where the annual incidence of tuberculosis (TB) is 40 in 100,000 or greater;

all infants (aged 0 to 12 months) with a parent or grandparent who was born in a country where the annual incidence of TB is 40 in 100,000 or greater;

previously unvaccinated children aged one to five years with a parent or grandparent who was born in a country where the annual incidence of TB is 40 in 100,000 or greater. These children should be identified at suitable opportunities, and can normally be vaccinated without tuberculin testing;

previously unvaccinated, tuberculin-negative children aged from six to under 16 years of age with a parent or grandparent who was born in a country where the annual incidence of TB is 40 in 100,000 or greater. These children should be identified at suitable opportunities, tuberculin tested and vaccinated if negative;

previously unvaccinated tuberculin-negative contacts of cases of respiratory TB; and

previously unvaccinated, tuberculin-negative new entrants under 16 years of age who were born in or who have lived for a prolonged period (at least three months) in a country with an annual TB incidence of 40 in 100,000 or greater.

BCG may be required for previously unvaccinated, tuberculin negative individuals according to the destination and nature of travel. BCG vaccine is recommended for those under 16 years of age who are going to live or work with local people for more than three months in a country where the annual incidence of TB is 40 in 100,000 or greater.

The following countries have an annual incidence of TB equal to or greater than 40 in 100,000 people.

Afghanistan

Algeria

Angola

Armenia

Azerbaijan

Bahrain

Bangladesh

Belarus

Belize

Benin

Bhutan

Bolivia

Bosnia and Herzegovina

Botswana

Brazil

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cambodia

Cameroon

Cape Verde

Central African Republic

Chad

China

China, Hong Kong SAR

China, Macao SAR

Colombia

Comoros

Congo

Cote d'Ivoire

Croatia

Djibouti

Dominican Republic

DPR Korea

DR Congo

Ecuador

El Salvador

Equatorial Guinea

Eritrea

Ethiopia

Gabon

Gambia

Georgia

Ghana

Guatemala

Guinea

Guinea-Bissau

Guyana

Haiti

Honduras

India

Indonesia

Iraq

Kazakhstan

Kenya

Kiribati

Kyrgyzstan

Lao PDR

Latvia

Lesotho

Liberia

Lithuania

Madagascar

Malawi

Malaysia

Maldives

Mali

Marshall Islands

Mauritania

Micronesia

Mongolia

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Nicaragua

Niger

Nigeria

Niue

Northern Mariana Islands

Pakistan

Palau

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Qatar

Rep. of Korea

Republic of Moldova

Romania

Russian Federation

Rwanda

Sao Tome & Principe

Saudi Arabia

Senegal

Sierra Leone

Solomon Islands

Somalia

South Africa

Sri Lanka

Sudan

Suriname

Swaziland

Tajikistan

Thailand

Timor-Leste

Togo

Tokelau

Turkmenistan

Tuvalu

Uganda

Ukraine

UR Tanzania

Uzbekistan

Vanuatu

Venezuela

Viet Nam

Wallis and Futuna

Yemen

Zambia

Zimbabwe

Source:

World Health Organization. Global Tuberculosis Control: Surveillance, Planning, Financing. WHO Report 2008. Geneva, WHO/HTM/TB/2008.393. www.who.int/tb/publications/global_report/

To ask the Secretary of State for Health what the rate of tuberculosis infection was among children under 11 years of age in each of the last five years. (228989)

The available information is in the following table.

Number of cases aged 0-10 years

Rate of TB per 100,000 population

2002

263

4.10

2003

209

3.30

2004

277

4.44

2005

292

4.61

2006

246

3.93

Notes: 1. The data provided are for England only. 2. They are for children aged 0-10 years inclusive. 3. Validated data for 2007 are not yet available. Source: Health Protection Agency Enhanced Tuberculosis Surveillance (ETS) system. Mid-year population estimates were compiled from Office of National Statistics (ONS) data.

To ask the Secretary of State for Health what estimate he has made of (a) the number of children who will be vaccinated under the revised guidelines for the national BCG vaccination programme and (b) the cost of the revised programme. (228990)

There were nearly 220,000 Bacillus Calmette-Guerin vaccinations in 2007-08 (NHS Immunisation Statistics, England 2007-08).

The cost of administering the programme is included in primary care trusts' overall budget and cannot be separated out.

To ask the Secretary of State for Health what the reasons are for moving to a policy of selective rather than universal vaccination of children against tuberculosis. (229725)

The Department moved to a selective policy following advice from the Joint Committee on Vaccination and Immunisation (JCVI).

Having reviewed all available scientific and epidemiological evidence, the JCVI recommended from September 2005 that a targeted approach to vaccination should be introduced to replace the national schools Bacillus Calmette-Guerin (BCG) programme.

The key reasons behind this decision were:

the primary role of the BCG vaccination is to protect individuals at high risk of exposure to tuberculosis (TB);

since the introduction of the schools based BGC programme the epidemiology of TB has changed from a disease of the general population in the 1950s to one of predominately high-risk groups;

targeted BCG vaccination means that the majority of children at high risk of TB exposure will now be vaccinated earlier in life than under the previous policy;

the BCG is most effective at preventing severe forms of TB in infants and young children; and

protection decreases with time but repeated vaccination does not appear to offer any additional protection.