BCG vaccination and the EPI

BCG vaccination for newborns has been compulsory by law in the RSA since 1973. From limited published information, it appears that coverage has now reached more than 80%. However, the effectiveness of the vaccinations in terms of disease prevention in the young is unknown. Small studies indicate protection of approximately 60% against all forms of tuberculosis in infants, but this figure is not generalisable. It is pointed out that the contribution of BCG vaccination to an overall decline of tuberculosis rates is minimal and should not be considered as a measurement of success of the EPI. The prevalence and risk of infection in southern African children is such that a policy of reduction or withdrawal of BCG vaccination from some sections of the community is not feasible. The current strategy of compulsory BCG vaccination at birth, followed by repeat vaccination 3 months later in children without evidence of reactivity at the vaccination site, as well as revaccination at school entry and school leaving, is both adequate and necessary. A standardised immunisation data recording format and full exchange of information at all decision-making levels between the EPI and the tuberculosis control programme is called for.