BCG (Tuberkulosis)

Pregnancy: CONTRAINDICATED — live vaccine.

BCG is a live attenuated vaccine and is contraindicated during pregnancy.

• No adequate human pregnancy studies. Theoretical risk of fetal BCG infection.

• Defer vaccination until after delivery.

• Neonatal BCG (given at birth in endemic countries) is safe for the neonate — this does not apply to the mother.

Breastfeeding: Likely safe but limited data.

BCG vaccination of breastfeeding mothers is generally avoided (live vaccine precaution). However, neonatal BCG is routinely administered to breastfed infants at birth. If BCG vaccination of the mother is indicated, breastfeeding need not be discontinued.

Pediatric use: Primary target population.

• WHO recommends BCG at birth (or as soon as possible) in countries with high TB incidence.

• Dose: 0.05 mL intradermal (neonates), 0.1 mL intradermal (infants >1 month and children).

• Expected local reaction: papule at 2–3 weeks, ulceration, scar over 2–3 months — this is normal.

• Contraindicated in infants with known or suspected immunodeficiency (HIV-positive with symptomatic disease, SCID).

• HIV-exposed infants who are asymptomatic: WHO recommends BCG vaccination (benefit outweighs risk in high TB burden settings).

• Revaccination is not recommended by WHO (no evidence of additional benefit).

Geriatric use: Not routinely recommended.

• BCG is not recommended for adults or elderly individuals in most developed countries due to variable efficacy against pulmonary TB and potential for adverse reactions (BCG-osis in immunocompromised individuals).

• Strictly contraindicated in immunosuppressed elderly patients.

• Tuberculin skin test (TST) may be positive after prior BCG — use IGRA for TB screening.