Contents

20 Tuberculosis

20.5 Recommended immunisation schedule

20.5.1 Tuberculin skin testing (Mantoux) before BCG vaccination

Tuberculin skin testing is not needed if BCG is given before age 6 months unless a history of contact with a known or possible case of TB is obtained. Although the tuberculin skin test is usually positive in the year following BCG vaccination, at least 50 percent of children will be negative beyond that time, so tuberculin skin testing still has utility for diagnosing TB infection.

20.5.2 BCG eligibility criteriaTop

TB is more common in non-Māori and non-European people in New Zealand. However, all pregnant women should have a discussion with their lead maternity carer about the risk of TB for their baby.

A list of high-incidence countries and their TB rates is available in the Ministry of Health resource BCG Vaccine: Information for Health Professionals (code HE2204), available at www.healthed.govt.nz or the local authorised health education resource provider or public health unit.

Neonatal BCG is recommended and funded for infants at increased risk of TB, defined as those who:
  • will be living in a house or family/whānau with a person with either current TB or a history of TB
  • have one or both parents or household members or carers, who within the last five years lived for a period of six months or longer in countries with a TB rate ≥40 per 100,000
  • ​during their first five years will be living for three months or longer in a country with a TB rate ≥40 per 100,000.

As a general indication, the following global areas have TB rates ≥40 per 100,000:

Neonates at risk should be identified antenatally by lead maternity care providers and antenatal referral made to the neonatal BCG service. Midwives, GPs, practice nurses and obstetricians can also identify and refer neonates at risk. Immunisation is desirable before infants leave hospital. If this does not happen, immunisation should be arranged through the local medical officer of health.

Children who have missed vaccination at birth may be vaccinated at any time up to age 5 years. If the child is 6 months or older they should have a pre-vaccination tuberculin skin test to detect whether they have already been infected.

Infants born before 34 weeks’ gestation should have their BCG vaccination delayed until 34 weeks’ post-conceptual age.19 Babies born after this or with low birthweight appear to produce an adequate response, based on tuberculin skin test responses.20–22

If the baby has not been vaccinated before leaving hospital, and if there is a history of current TB in a relative who has had contact with the baby, do not vaccinate immediately. Withhold vaccination, conduct tuberculin skin testing, seek paediatric advice and vaccinate only after the possibility of infection in the baby has been excluded. Vaccination may not protect the baby who is incubating disease, and will prevent the tuberculin test from assisting with the diagnosis of disease.

A parent’s/guardian’s request in itself should not be accepted as an indication for immunisation. Parents/guardians seeking vaccination of children who do not meet the above criteria should be referred to the local medical officer of health to discuss the risks and benefits of immunisation before a final decision is made.

The National Immunisation Register (NIR) collects information on neonatal BCG immunisation, unless the individual or their parent/guardian has opted off the NIR (see section 2.8). The BCG vaccinator usually enters the immunisation data onto a form, which is sent to the DHB NIR Administrator to enter onto the NIR.

20.5.3 Other high-risk individuals or groupsTop

Repeat BCG vaccination is not recommended.

Funded BCG may be offered to the following at-risk people if they are tuberculin skin test- or interferon gamma release assay (IGRA) negative:
  • contacts of active TB cases aged under 5 years (note that a contact exposed to TB in the preceding three months will need two negative tuberculin skin tests, 8 to 12 weeks apart, before vaccination)
  • immigrants aged under 5 years from countries with a rate ≥40 per 100,000
  • health care workers and laboratory staff, depending on their risk of exposure (refer to the Guidelines for Tuberculosis Control in New Zealand 2010,1 or the current edition)
  • ​people exposed to animals that are likely to be infected.

The local medical officer of health may recommend vaccination programmes for specific populations with a high risk of TB, depending on local epidemiology. Staff and residents of rest homes, prisons and other closed populations may be recommended for vaccination from time to time, depending on local epidemiology and in consultation with the medical officer of health.

Vaccination for overseas travel (even prolonged travel in areas with a TB rate ≥40 per 100,000) should be discouraged. An exception to this is a child aged under five years travelling for prolonged residence in an area with a TB rate ≥40 per 100,000. In these circumstances vaccination should be considered.