Tuberculosis vaccination
There is currently no effective vaccination to prevent infection or contracting tuberculosis. The BCG vaccination, which has been used worldwide for over 100 years, prevents severe forms of the disease in infants and young children. Due to the low infection rate in Germany and the possible risk of side effects, it has not been recommended in Germany since 1998. However, BCG remains one of the most frequently used vaccinations worldwide, especially in high-incidence countries.
What is the tuberculosis vaccination (BCG vaccination)?
The BCG vaccine (Bacillus Calmette-Guérin) is currently the only available vaccine against tuberculosis (TB) that has been used worldwide for over 100 years. The vaccine is a live vaccine and contains the attenuated BCG bacteria, which trigger an immune response in the body without causing the disease itself. In infants and young children, the vaccination can prevent severe and complicated courses of disease such as tuberculous meningitis (meningitis) or miliary tuberculosis. However, the vaccination does not provide sufficient protection against infection or contracting tuberculosis.
Is BCG vaccination recommended in Germany?
In Germany, the BCG vaccination is not recommended for children or adults and is also not recommended as a travel vaccination. The STIKO is thus following the advice of the World Health Organization (WHO) not to carry out a general tuberculosis vaccination in countries with a tuberculosis infection risk of less than 0.1 percent. There is currently no longer a vaccine approved in Germany. BCG is available internationally, but due to the lack of a vaccination recommendation, there is no entitlement to care in the event of possible vaccination damage.
The reasons for this are the consideration of the low risk of infection for tuberculosis in Germany and the possible side effects of the BCG vaccination. In addition, the vaccination does not provide sufficient protection against infection or the occurrence of tuberculosis and is therefore not very effective, particularly after early childhood. Instead, Germany relies on targeted measures such as early detection and treatment of tuberculosis in order to contain the disease.
Until the 1990s, BCG vaccination was also given to newborns and children in Germany. Since 1998, the BCG vaccination has no longer been recommended by the Standing Committee on Vaccination (STIKO) in Germany.
BCG vaccination worldwide
The BCG vaccination contains live but attenuated bacteria that do not cause illness. The vaccination triggers an immune reaction that signals the immune system to develop defense mechanisms. The vaccine protects young children well against the most severe forms of tuberculosis, such as meningitis or the spread of the pathogens via the blood into the entire body (miliary tuberculosis), in which the pathogens can also affect the central nervous system. However, protection against pulmonary tuberculosis, by far the most common form of tuberculosis, is low in children and adults. Vaccination protection does not last a lifetime either. The effectiveness of the vaccine has probably diminished over the decades due to the repeated need to breed the original BCG bacteria. Despite these limitations, BCG vaccination remains one of the most important preventive measures against the above-mentioned forms of tuberculosis in high-risk areas for newborns and small children.
Research and the future of TB vaccination
However, intensive research is being carried out into the development of a new and more effective vaccine. Some vaccines are currently in phase 2 and 3 trials, but none of these have yet been completed. However, the results of these studies are eagerly awaited over the next few years.
The vaccine strain M.bovis BCG is also used for the immunomodulatory treatment of superficial bladder cancer. For this purpose, the bacteria are introduced into the bladder (instillation). A rare side effect of this therapy is the spread of the bacteria from the bladder to other organs, which is called BCGitis. As the vaccine strain for instillation is present in a different concentration, it must not be used for vaccination.