BCG Vaccine for Tuberculosis: Global Dosing Schedules and Efficacy
BCG (Bacillus Calmette-Guérin) is the only licensed TB vaccine. Schedules differ globally:
Dosing by Region
| Region/Policy | Schedule | Rationale |
|---|---|---|
| US (selective) | Single dose: high-risk infants/children only | Low TB incidence; interferes with TST interpretation |
| WHO (high burden) | Single dose: at birth or first contact | Maximize early protection against severe pediatric TB |
| Japan, Germany, others | 2–3 doses: birth, 6 mo, 12 mo (varies) | Historical practice; waning immunity concerns |
Efficacy Profile
- 70–80% effective against meningeal/miliary TB in children
- Variable (0–80%) against pulmonary TB in adults
- Protection wanes over 10–20 years
- No proven benefit for booster doses
US-Specific Notes
- Contraindicated in immunocompromised (HIV, immunosuppressive therapy)
- Causes false-positive TST/IGRA – use IGRA for LTBI diagnosis if BCG-vaccinated
- Not routinely available; consult TB control program
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