17908 Bacillus Calmette Guerin Bcg Treatment

Overview

BCG stands for Bacillus Calmette-Guérin. It is a vaccine — a jab given to help the body fight off tuberculosis, or TB for short. TB is a serious infection that usually affects the lungs but can harm other parts of the body too. The BCG vaccine is made from a weakened form of a germ that is very closely related to the TB germ. Because the germ is weakened, it cannot cause TB in a healthy person, but it teaches the body's defence system (the immune system) to recognise and fight the real TB germ. BCG is also used in a completely different way: as a liquid put into the bladder to treat some early bladder cancers. That use is explained in the treatment section.

TB is uncommon in the UK but very common in many other parts of the world. The BCG vaccine is given to millions of babies around the world every year, so it is a very well-known and widely used vaccine.

BCG is offered to people whose chance of meeting TB is higher than average. In the UK this includes babies born in an area where TB is common, babies with a parent or grandparent born in such an area, and children living with someone who has had TB. It can also be offered to people under 16 living in an area with high TB rates, to people travelling to a high-risk country for three months or more, and to healthcare workers, laboratory staff and people in close contact with TB. BCG is not usually given to adults over 35, because the protection it gives at that age is less certain.

Symptoms

Common symptoms

• A small raised spot or blister at the injection site, usually appearing 2 to 3 weeks after the jab.
• The blister may ooze a little clear fluid, then form a crust and slowly heal over several weeks.
• A tiny round scar is left behind in most people — this is a normal and expected sign.
• A slightly swollen, tender gland (lymph node) under the arm on the side that was injected.
• Mild soreness or itching around the site for a few days.

Symptoms in children

• Babies may be a little grouchy, sleep more, or feed slightly less for a day or two after the jab.
• A small swollen gland under the arm is fairly common in babies and usually settles on its own.
• The sore can look quite noticeable for a few weeks — this is normal and does not mean anything is wrong.
• Children can go to nursery or school as usual, as long as the sore is kept clean and covered if it is weeping.

Symptoms in older adults

• BCG is not usually given to older adults, but adults who have it for travel or work reasons get the same kind of sore.
• The spot may take a little longer to heal in older skin.
• Tell the clinician beforehand if you have a weakened immune system, for example from certain illnesses or treatments, as BCG may not be suitable.

Causes

Main causes

• BCG is a vaccine, not an illness, so it does not have a 'cause' in the usual sense. It is given to prevent TB.
• TB spreads through the air when a person with TB in the lungs coughs or sneezes, and someone else breathes in the germs.
• BCG is offered to people who are more likely than average to breathe in TB germs at some point in their lives.

Risk factors

• Being born, or having a parent or grandparent born, in a country where TB is common.
• Living in close contact with someone who has TB.
• Living in crowded or poor-quality housing, or being homeless.
• Having a weakened immune system, for example from HIV or from certain medical treatments.
• Working in healthcare, a laboratory, or another setting where TB is more likely to be met.
• Planning to live or work for several months in a country where TB is common.

When to see a doctor

See a doctor urgently if:

• You or your child has a high temperature and seems very unwell after the jab.
• The injection site becomes very red, hot, swollen or leaks pus.
• A gland under the arm becomes large and painful.
• The sore is getting bigger instead of healing, or is still open after about six weeks.
• Anyone develops a cough with blood, chest pain, or unexplained weight loss and night sweats.

Book a routine appointment if:

• You are unsure whether you or your child needs the BCG vaccine.
• You are planning a long trip to a country where TB is common.
• You want the scar or the healing spot checked.
• You need a written record of your BCG for work, study or travel.

Diagnosis

BCG is not a treatment for an illness you already have, so there is nothing to 'diagnose'. Instead, before the vaccine is given, a clinician checks whether you or your child might already have been infected with TB. This matters because the vaccine works best in people who have not yet met the TB germ. The check is quick and is usually done at the same clinic.

Tests that may be done

• A skin test (sometimes called a Mantoux test): a tiny amount of test liquid is injected just under the skin of the forearm and the spot is looked at two to three days later.
• A blood test that looks for signs of TB infection.
• Sometimes a chest X-ray, if TB in the lungs is a possibility.
• A review of your health, medicines and travel history to make sure the vaccine is safe and suitable for you.

What to expect at your appointment

The appointment is short. You may need to come back a couple of days later so the skin test can be checked. If the tests suggest you have already been infected with TB, you will not be given BCG. Instead you will be referred to a TB clinic for a full check and, if needed, treatment. This is a normal and sensible safety step, not a reason to worry.

Treatment

BCG is itself a way of preventing serious illness rather than a treatment for a condition you already have. When used as a vaccine, it is a single injection given just under the skin, usually in the upper left arm, by a trained nurse or doctor. A small raised spot appears, then a blister, then a scab, and finally a small scar over roughly six to twelve weeks. When BCG is used to treat early bladder cancer, a liquid containing the weakened germ is passed into the bladder through a thin, soft tube and held there for a short time. This is done in a hospital or specialist clinic as a course of treatments over several weeks, and it is supervised by a specialist team.

Self-care at home

• Keep the injection site clean and dry, and pat it dry gently after washing rather than rubbing.
• Do not scratch, squeeze or burst the blister — let it heal on its own.
• If the spot is weeping, cover it loosely with a clean dry dressing and wash your hands after touching it.
• Do not share towels, creams or ointments with anyone else.
• Wear loose clothing over the arm so the spot is not rubbed.
• If the area is sore, ask your pharmacist which mild painkiller is suitable for you or your child.
• Note the date of the jab and keep any record card safe for school, work or travel paperwork.

Medical treatments

Most people need no medical treatment at all after BCG. If the injection site becomes infected, or a gland under the arm becomes swollen and painful, your clinician will assess it and may offer appropriate treatment. Rarely, a more serious reaction needs urgent medical care. For people receiving BCG into the bladder as a cancer treatment, the specialist team will explain possible side effects and how they will be managed. Always tell any clinician treating you that you have had BCG recently.

When is surgery considered?

Surgery is not part of BCG vaccination. Some people whose bladder cancer is treated with BCG may later need surgery as part of their cancer care, but this is decided by their specialist team and is separate from the BCG itself.

Living with this condition

Life carries on as normal after BCG. The spot is small and most people forget about it within a few days. If it is weeping, keep it covered with a clean dressing, especially if you are around anyone with a weakened immune system. Tell your health visitor, GP or nurse the date it was given, and make a note of it for your own records.

Lifestyle tips

• No change to your usual routine is needed — you can go to work, school, nursery or childcare as normal.
• Wash your hands after changing a dressing on the spot.
• Keep the arm clean and avoid perfumed creams or lotions near the site.
• Do not let anyone else use your towel or flannel while the spot is open.
• If you have a weakened immune system, or live with someone who does, mention this to your clinician when you have BCG.

Diet and exercise

There is no special diet to follow and no need to avoid exercise. Normal eating, drinking and activity are all fine. A baby can feed as usual straight after the jab.

Mental health and emotional wellbeing

It is very common for parents to feel anxious about a weeping sore or about TB risk, and for adults to feel uneasy about a new scar. These feelings usually settle once the spot heals and you can see it is behaving as expected. If worry is affecting your sleep, mood or daily life, do talk to your GP, health visitor or practice nurse — support is available and you do not have to cope alone. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away.

Prevention

BCG reduces the chance of catching TB, and it is particularly good at protecting young children from the most severe forms such as TB meningitis. It does not give full protection, so it still matters to avoid close contact with someone who has untreated TB in the lungs and to get any lasting cough checked.

Vaccines

BCG is the main vaccine used against TB worldwide. It is usually given once, and a small scar is a sign that it has taken. If no scar appears, your clinician may recommend a repeat dose. BCG is not given to people who already have TB infection, and it is not usually offered to adults over 35.

Screening programmes

TB screening is offered to people who have been in close contact with someone with TB, to some people newly arriving from countries where TB is common, and to healthcare workers. Screening can include a skin test, a blood test and a chest X-ray. Finding TB early means it can be treated before it causes harm.

Complications

If left untreated

• If TB itself is left untreated, it can damage the lungs and spread to other organs such as the spine, kidneys or brain.
• TB meningitis is a life-threatening infection of the lining around the brain, and BCG protects young children against it.
• Possible problems from the BCG site include a larger-than-usual sore, a wound infection, a thick raised scar, or a swollen gland under the arm.
• Very rarely, people with a severely weakened immune system can develop an infection from the weakened germ in the vaccine. This is why clinicians ask about your health before giving BCG.

Long-term outlook

For most people BCG causes nothing more than a small sore that heals into a tiny scar, and life goes back to normal quickly. It gives good protection to young children against the most dangerous forms of TB, and TB itself can be cured with treatment. If you have any worries about the spot or about TB risk, your GP or health visitor can help.

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