My daughter is seven months old and still has a nasty red lump on her arm from her BCG vaccination which she had five months ago. Although it is unusual for babies to have a bad reaction for quite so long, it is not unheard of. Family and friends all remark on her sore arm as it still looks very painful. And, of course, they’re not used to seeing a BCG vaccination on a baby because most of them live outside London.
You may already realise that we in London are the only parents in the UK who are routinely asked to have their babies vaccinated against tuberculosis with the BCG vaccination. I remember having the BCG in high school: the ‘daisy’ test on the wrist and schoolboys attempting to punch each other on the arm after the vaccination was given. My husband still has a mark from a friend’s well-landed blow. But since 2005 vaccinating all young teenagers is no longer done. Instead only people at high risk are vaccinated and that includes all of us in London.
The BCG vaccination program started in 1953 and pretty much wiped out tuberculosis (or TB) in this country. TB was reduced from a high of 50,000 cases a year in the early 1950s, to a low of around 5,000 cases a year in the late 1980s. But the incidence of TB has been on the rise over the past ten years, mostly concentrated in London. In 2009, 41% of all cases occurred in London. This is because people come and go between the UK and countries where TB is still prevalent, bringing the disease back with them. The wonderful mix of people that is London brings with it a mix of diseases that globe trot as much as we do, and TB is one of them.
Tuberculosis was declared a global emergency by the World Health Organisation in 1993. It is the leading cause of death in the world among curable infectious diseases. TB is caused by a bacterium called Mycobacterium tuberculosis and it can be treated by a specific combination of antibiotics which must be taken for at least six months. But treatment is not equally available throughout the world and so it is that over 98% of deaths from TB occur in the developing world, particularly in sub-Saharan Africa and South Asia.
People die from TB because the damage it causes to the lungs can become so severe that a person cannot breathe properly. Symptoms include weight loss and coughing up blood. These are classic signs of ‘consumption’, as tuberculosis was commonly known, and they bring to mind many dramatic portrayals of the disease such as the plight of Mimi in La Bohème and Satine in Moulin Rouge. TB can also spread to other areas of the body such as the bones, joints and kidneys although it is not infectious in this form.
The resurgence of tuberculosis in the UK is concentrated in communities that have a connection with countries where TB is still prevalent. Research shows that TB is most likely to be contracted after prolonged exposure to someone with TB, not just a brief encounter. The disease can lie dormant for a number of years, showing no symptoms in the infected person, before becoming active. Because of this, vaccinations are recommended not only for babies born in London but also for babies born anywhere in the UK if one or more of their parents or grandparents were born in a country where TB is widespread. Babies are also vaccinated if someone in their family has had TB in the last five years. Vaccinations are also given to healthcare workers and those in other high risk occupations.
Recommendations about when to give your baby the BCG vaccination vary with region of London and prevalence of TB. In my area, we were advised to take our babies for vaccination as soon as possible within the first couple of months. In areas where the incidence of TB is at its worst, babies are vaccinated on the ward at birth.
Despite my daughter’s sore arm, I would still rather she had the vaccination than she had TB. Having babies vaccinated in high risk areas will prevent the rise of TB in Britain in the long term. So we in London should, as ever, keep up the vanguard. But be prepared for a few raised eyebrows when you go travelling.