TB or not TB, that is the unoriginal title joke...
February 16, 2012 7:08 AM Subscribe
Should I, as an adult, be given the BCG vaccination...?
In Europe (I think it's different in the USA) all children are (were?) given the BCG vaccine to ward off TB.
For reasons that I don't recall, I never had that shot. It wasn't that I didn't need it - my mother decided that I wouldn't have it. I personally believe in vaccines and think that everyone should be vaccinated against TB.
Should I, as an averagely (un)healthy 35 year old male, approach my doctor about getting the BCG shot?
While I respect the rights of anyone to come to their own conclusions about vaccinations, I'm not after a debate about if vaccines are a good idea. I believe in them. I'm wanting to know if vaccine believers think it's a good idea as an adult. Ta.
In Europe (I think it's different in the USA) all children are (were?) given the BCG vaccine to ward off TB.
For reasons that I don't recall, I never had that shot. It wasn't that I didn't need it - my mother decided that I wouldn't have it. I personally believe in vaccines and think that everyone should be vaccinated against TB.
Should I, as an averagely (un)healthy 35 year old male, approach my doctor about getting the BCG shot?
While I respect the rights of anyone to come to their own conclusions about vaccinations, I'm not after a debate about if vaccines are a good idea. I believe in them. I'm wanting to know if vaccine believers think it's a good idea as an adult. Ta.
Best answer: Where do you live? Must not be in the US. :)
In the US, there was a decision not to use BCG because TB was/is seen as a rarer disease, and because it's not as protective against pulmonary TB. So, to diagnose TB in the US and other non-vaccinating countries, you have a skin test and look for a reaction. If you have had BCG as a child, you will have that reaction regardless, and so you have to have a chest x-ray to diagnose pulmonary TB.
At this point, I don't think that it would not offer much benefit to you. Ask your doctor, though--maybe there is something I'm missing that would make it worthwhile. (IANAMD, but IAADVM. Cows get TB!)
posted by marmot at 7:21 AM on February 16, 2012
In the US, there was a decision not to use BCG because TB was/is seen as a rarer disease, and because it's not as protective against pulmonary TB. So, to diagnose TB in the US and other non-vaccinating countries, you have a skin test and look for a reaction. If you have had BCG as a child, you will have that reaction regardless, and so you have to have a chest x-ray to diagnose pulmonary TB.
At this point, I don't think that it would not offer much benefit to you. Ask your doctor, though--maybe there is something I'm missing that would make it worthwhile. (IANAMD, but IAADVM. Cows get TB!)
posted by marmot at 7:21 AM on February 16, 2012
Best answer: In the UK, the BCG vaccination isn't normally given to children unless they live in certain areas (in London, currently) where TB is more common. When I was a kid, BCG vaccination was the norm, although I missed out on it for one reason or another.
Unless you're regularly coming into contact with people who have TB, it's probably not worth the trouble. As muddgirl said, it not all that effective against the form of TB most often seen in adults.
posted by le morte de bea arthur at 7:26 AM on February 16, 2012
Unless you're regularly coming into contact with people who have TB, it's probably not worth the trouble. As muddgirl said, it not all that effective against the form of TB most often seen in adults.
posted by le morte de bea arthur at 7:26 AM on February 16, 2012
Best answer: I am not a doctor, but I work on tuberculosis.
You do not need the BCG vaccine. It is only effective in children. It will not protect against adult TB. BCG is now only given to children in very particular low-resource settings, depending on TB rates, types of TB, etc.
Also, marmot is not quite correct on the chest X-ray. For people who received BCG as a child, they will always test positive in PPD tests - that's the skin test where they measure the bubble. Both BCG-vaxed people and people with latent TB infection (LTBI - it's not infectious, and it's just chilling in your body and not making you sick) will test positive on PPD, actually, which means PPD is not that great of a marker. However, if someone with BCG fits the TB algorithm - in most countries, coughing for three weeks, fever, night sweats, weight loss - they will get a sputum microscopy test; they'll cough into a cup and then lab techs will examine it. Chest x-rays are so outmoded that my department won't let even a picture appear in a powerpoint; they represent an old diagnostic method that is very inaccurate.
Also, you will probably not get TB if you are a healthy, well-nourished adult in a non-high-burden TB country. In the US, most people who get TB are immigrants from high-burden countries, prisoners, and the homeless. ("Congregate settings" - ie prisons, homeless shelters - are places TB loves to hang out. Multi-drug resistant TB even made an appearance at Occupy Atlanta's headquarters at a homeless shelter.) TB is a disease of poverty, and it would be very, very surprising to me if any health care professional recommended you get the vaccine.
posted by quadrilaterals at 7:36 AM on February 16, 2012 [6 favorites]
You do not need the BCG vaccine. It is only effective in children. It will not protect against adult TB. BCG is now only given to children in very particular low-resource settings, depending on TB rates, types of TB, etc.
Also, marmot is not quite correct on the chest X-ray. For people who received BCG as a child, they will always test positive in PPD tests - that's the skin test where they measure the bubble. Both BCG-vaxed people and people with latent TB infection (LTBI - it's not infectious, and it's just chilling in your body and not making you sick) will test positive on PPD, actually, which means PPD is not that great of a marker. However, if someone with BCG fits the TB algorithm - in most countries, coughing for three weeks, fever, night sweats, weight loss - they will get a sputum microscopy test; they'll cough into a cup and then lab techs will examine it. Chest x-rays are so outmoded that my department won't let even a picture appear in a powerpoint; they represent an old diagnostic method that is very inaccurate.
Also, you will probably not get TB if you are a healthy, well-nourished adult in a non-high-burden TB country. In the US, most people who get TB are immigrants from high-burden countries, prisoners, and the homeless. ("Congregate settings" - ie prisons, homeless shelters - are places TB loves to hang out. Multi-drug resistant TB even made an appearance at Occupy Atlanta's headquarters at a homeless shelter.) TB is a disease of poverty, and it would be very, very surprising to me if any health care professional recommended you get the vaccine.
posted by quadrilaterals at 7:36 AM on February 16, 2012 [6 favorites]
Oh, also, BCG isn't effective like other vaccines. I get DTP boosters, etc, but BCG just doesn't work that well. It won't protect you from TB in the long-run. But you still probably won't get TB, and even if you do, it is almost always very treatable. (Just don't go getting arrested and being thrown in prison in a former Soviet Republic.)
posted by quadrilaterals at 7:39 AM on February 16, 2012
posted by quadrilaterals at 7:39 AM on February 16, 2012
Response by poster: Well, I think that answered that one. Ta!
And yes, for completeness - I'm in the UK and old enough that when I was of BCGing age (9?) everyone in my year was injected despite the fact we lived in a low risk area.
I'll stop pondering this one and just be grateful I never got the injection scar. :)
posted by sodium lights the horizon at 7:56 AM on February 16, 2012
And yes, for completeness - I'm in the UK and old enough that when I was of BCGing age (9?) everyone in my year was injected despite the fact we lived in a low risk area.
I'll stop pondering this one and just be grateful I never got the injection scar. :)
posted by sodium lights the horizon at 7:56 AM on February 16, 2012
I don't know whether this is just the NHS being slow to catch up, but they still insist that employees that have patient contact have had the BCG vaccination If you don't have paperwork then they insist on seeing a scar otherwise they'll vaccinate again.
I know the BCG vaccination isn't very effective, but then lots of other vaccinations aren't either. I think the Hep B vaccination only makes 80% of people immune (and again, the NHS wants to see blood tests proving I'm actually immune, not just have had the vaccines).
posted by kadia_a at 9:40 AM on February 16, 2012
I know the BCG vaccination isn't very effective, but then lots of other vaccinations aren't either. I think the Hep B vaccination only makes 80% of people immune (and again, the NHS wants to see blood tests proving I'm actually immune, not just have had the vaccines).
posted by kadia_a at 9:40 AM on February 16, 2012
This thread is closed to new comments.
posted by muddgirl at 7:18 AM on February 16, 2012