Poland among last countries in Europe still recommending universal BCG vaccination

BCG vaccines are the most used vaccines with more than 4 billion children vaccinated each year. The BCG vaccines are effective in protecting against the disseminated forms of tuberculosis, including meningitis, related with high case-fatality among children.

BCG vaccination is mandatory in Poland and is given to newborns within 24 h after birth or later, before discharge from the hospital. In babies which were not vaccinated at birth, vaccination should be administered as soon as possible, but no later than before 15 years of age. BCG vaccinations are mandatory to all children residing in Poland longer than 3 months. Vaccination coverage reaches the level of 93-95%. Although the number of notified tuberculosis cases is decreasing, WHO epidemiological criteria for tuberculosis control are still not met. Therefore, Poland cannot resign from universal BCG immunization of newborns. Additionally, Poland borders with high-risk countries such as Bielorussia, Ukraine and Russian Federation, and receives an increasing number of visitors from developing countries that were not vaccinated.

Bacillus Calmette-Geurin (BCG) vaccine was developed in 1921 in Pasteur Institute through Mycobacterium bovis bacterial strains passaging (growing new microbiological cultures made by transferring some or all cells from a previous culture to fresh growth medium, until obtaining a strain with desired properties). Then it was given to many vaccines manufacturers in the world. In Poland, BCG vaccine has been used for universal immunization since 1951. Since 1955 BCG vaccine is produced nationally with M. bovis BCG Moreau as an active substance (Biomed, Lublin). Until now, the locally-produced vaccine is the only one used for immunizing children.

The typical adverse events following BCG vaccination (AEFI) are changes in the injection site, peripheral lymph nodes, generalized dissemination, osteitis, keloid, lupus, nodular erythema. The locally-produced vaccine including the Brazilian substrain M. bovis BCG Moreau is less reactogenic than vaccines including other BCG strains. The frequency of AEFI after BCG was estimated as 2/10,000 doses during 1994-2000 and 6/10,000 doses during 2001-2010. Half of them were local reactions at the injection site and the other half – changes in peripheral lymph nodes.