Tuberculosis vaccination

and Sabine Schrör, medical journalist

Florian Tiefenböck studied human medicine at the LMU Munich. In March 2014, he joined as a student and has supported the editorial team with medical articles ever since. After receiving his medical license and practical work in internal medicine at the University Hospital Augsburg, he has been a permanent member of the team since December 2019 and, among other things, ensures the medical quality of the tools.

More posts by Florian Tiefenböck

Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

Until the end of the 20th century there was a tuberculosis vaccination. The Standing Vaccination Commission (STIKO) of the Robert Koch Institute (RKI) no longer recommends vaccination: On the one hand, complications have occurred time and again in the past. On the other hand, there are only a few cases of tuberculosis in Germany. Read everything you need to know about tuberculosis vaccination here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. A18A19A17A16A15

The tuberculosis vaccine

When vaccinating against tuberculosis, a weakened strain of the pathogen (mycobacteria) is used. So it is a live vaccination.

At the beginning of the 20th century, the French scientists Albert Camette and Camille Guérin bred Mycobacterium boviswhich occurs particularly in cattle. The pathogens multiplied on a special nutrient medium. This reduced the harmfulness of the tuberculosis pathogens. In 1921, the two researchers finally developed the tuberculosis vaccination from this. The vaccine was named BCG (Bacillus Calmette-Guérin) vaccine after its discoverers.

Application of the tuberculosis vaccination

The BCG vaccine is only injected into the skin (intracutaneous injection). Newborns and infants up to six weeks old can be vaccinated without any problems.

In children older than six weeks, however, the Mendel-Mantoux tuberculin test is carried out beforehand. A small dose of the tuberculosis protein tuberculin is injected into the skin. If there is no or very little reddened hardening on this skin area, the test is negative. Only then can these children be vaccinated.

The tuberculin test according to Mendel-Mantoux shows again whether the tuberculosis vaccination was carried out successfully. The test should be positive three weeks after the vaccination at the earliest. There is then a clear hardening and reddening at the puncture site of the skin. The tuberculin test is still positive years after a tuberculosis vaccination. Therefore, you should always inform the doctor about any vaccinations that have been carried out. On the other hand, if the test turns out negative, they will be vaccinated again.

Effectiveness of the tuberculosis vaccination

It is unfortunately not the case that a BCG vaccination always prevents tuberculosis diseases. It does not protect against infection or against the spread of the pathogen. The course of an infection is also only marginally affected in adults who have received the vaccination.

However, studies have shown that vaccination has great benefits in children. Here it protects about 80 percent, in particular against severe disease and tuberculosis diseases that spread over the whole body.

Apart from age-specific differences, the effectiveness of the BCG vaccine is sometimes quite different in different countries or regions of the world. A paper published in 1995 by the London School of Hygiene and Tropical Medicine compared the benefits of tuberculosis vaccination around the world. The vaccine was found to be most ineffective in regions of Africa, Latin America and Asia. The reasons are seen, on the one hand, in the various environmental situations such as city or country; on the other hand, the quality of the studies carried out at the respective locations, which were used for comparison, was very different.

Side effects of tuberculosis vaccination

Because this vaccination uses tuberculosis pathogens that are still alive (even if they are weakened), it can cause symptoms similar to TB. The most common side effects of the tuberculosis vaccination are extensive redness (erythema), induration, tissue damage and scarring. The tissue damage occurs mainly when the vaccine is not injected into the skin, but under the skin, i.e. subcutaneously.

Inflammation and swelling of the lymph nodes may also develop as a result of the vaccination. This so-called lymphadenitis can occur with 1 in 1000 BGC vaccinations.

In rare cases, there is an allergic inflammation of the eyes. Very serious complications such as inflammation of the bone marrow or meningitis as a result of the vaccination rarely occur.

Contraindications (contraindications)

Not everyone can be vaccinated against tuberculosis: Patients who are already suffering from TB or who have positive tuberculin tests may not be vaccinated. The vaccine contains live bacteria that would make an infection worse. For this reason, people with a weakened immune system, such as those with HIV, are not vaccinated against tuberculosis. The same applies to pregnant women and patients whose immune system is suppressed by drugs (e.g. after an organ transplant).

Current status of the tuberculosis vaccination

The BCG vaccine was introduced in Germany after World War II. One reason for the delay in use was, among other things, the Lübeck vaccination failure in 1930. Of the 208 vaccinated children, 77 died at that time - as a result of incorrect processing of the vaccine, the children contracted tuberculosis.

Since 1998 the tuberculosis vaccination is no longer recommended by the Standing Vaccination Commission (STIKO). In doing so, the experts are following a proposal by the World Health Organization (WHO). Accordingly, it is unnecessary to vaccinate against tuberculosis across the board if the risk of infection in the respective population group is below 0.1 percent. To illustrate: The 2018 RKI yearbook shows 5,429 cases of tuberculosis. This corresponds to around 6.5 cases per 100,000 inhabitants or an average new disease rate of around 0.0065 percent.

However, in countries where tuberculosis is particularly prevalent, the WHO still recommends vaccination against TB. The same applies if it cannot be avoided that children come into contact with resistant (resistant) pathogens, for example through a sick parent - regardless of the tuberculosis situation in the respective country. If there is contact with non-resistant bacterial strains, the WHO recommends a so-called chemoprophylaxis with isoniazid as a preventive measure. However, BCG vaccination is not recommended when traveling to countries with a high incidence of tuberculosis. However, you can then do a tuberculin test after your return.

New vaccine research

For several years, scientists around the world have been researching how to successfully contain tuberculosis infections with new vaccinations. For example, attempts are being made to increase the effectiveness of the previous BCG vaccine with another vaccine.

Another approach is to improve on the old BCG vaccine. The Max Planck Institute for Infection Biology developed the VPM 1002 vaccine and has been clinically tested with promise since 2008. It also contains the pathogen strain Mycobacterium bovis. However, the genetic make-up of these pathogens has been modified in such a way that they can be better recognized by the human immune system. Experts estimate that eight million deaths could be prevented by such an improved tuberculosis vaccination.

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