Expats with children - question re BCG?

#1 May 2nd, 2008, 19:09
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  • 4gotoIndia is offline
#1
Hi there,
I wonder if any expats with children can help me out with a question about vaccination.
We're getting very unclear messages re whether our children (aged 5 and 18months) should have their BCG.
We had it in our teens, but it is no longer routinely given in the UK. (ONly to high-risk groups, I think).
I know that TB is common in India, but I also know that our children will have a good standard of living.
Any thoughts, anyone.
Thanks,
Mrs4
#2 May 2nd, 2008, 19:59
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  • Nick-H is offline
#2
I thought TB was on the increase world-wide, and that one was as likely to catch it on the streets of London as on the streets of Chennai.

Probably qualified medical advise is necessary on this one --- let us know what you learn!

I don't think standard of living would necessary be a protector. You will, one way or another, mix with almost all classes of people. Your own staff will be relatively poor, you will buy stuff in markets, generally be on the street, not to mention the fact that young children tend to be great disrespecters of social boundaries!

Added to which, I don't think the famous Tony Hancock song (Coughs and sneezes, spread diseases...) has ever been heard here --- and isn't TB spread in droplets from a cough?

My utterly unqualified opinion is it would be better to be protected on this one.

And I don't have any children, so perhaps I better shutup!
~
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#3 May 2nd, 2008, 21:37
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#3
As another non medic I have to say that you need to get proper medical advice - but I'd agree with Nick about the potential risks. Our daughter was a bit of a pin cushion before we left for India as she had all the vaccinations going.

There's a quaint Indian practice of blocking one nostril and clearing your lungs starting at your toes and hacking and retching until every molecule of mucus is expelled through your nose and onto the road. It's best performed in a busy public area where you can have an appreciative audience .

So the risk of TB is real here.
#4 May 3rd, 2008, 01:27
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#4
and ditto (don't worry Nick - having children is by no means a license to better knowledge - quite the opposite in fact at 3am in the morning when you fumbling with a bottle and trying to feed a baby). Like familyonthemove - our kids were all pin cushions as well (in fact mondays got renamed "happy meal monday" as it was the only way to get them into the doctors from about the 2nd week on - and it was 6 weeks worth of visits). Our older two already had their TB shots years ago - but our youngest had to go through it (I think like the UK, NZ does not do it any more as routine).

here's the thing. First off - as everyone has said - get good medical advice. This forum is full of information - but it's still a forum and no substitute for the real thing.

Secondly - I'm pretty sure diseases don't recognise political, ethnic, or social boundaries. I guess there will be research somewhere showing that some groups of people are at less risk than others - but I wonder whether the bacteria or viruses have read the same material.

thirdly - sitting in advance of the trip, quietly contemplating whether or not to have the vaccine, with the benefit of time and hindsight on your side, means you still have control of the situation (you can decide whether or not to get the vaccine). If you don't get the vaccine and someone gets sick - its no longer up to you. Then it becomes a case of finding the right treatment, the right doctors, in the right hospital, etc.

Of course there is no such thing as a 100 percent guaranteed vaccine - but not getting it means you are 100 percent, definitely not covered.

anyway - good luck.
"the last meal is history - its the next one that's important" - Garfield (the cat)
#5 May 10th, 2008, 17:13
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#5
I think BCG is one of the common vaccinations given to just about all expat children. Newcomers are easily recognised, you can spot the bump on their upper arm from the recent vaccination!
Our second child will be born here in India within weeks, and will get BCG vaccination directly after birth, just as the Indian children. This is also standard procedure I think for expat babies born here.
#6 May 28th, 2008, 11:20
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#6

BCG effectiveness?

We are moving with two toddlers to Mumbai from the US in June and have been researching vaccinations extensively. I am intrigued by some of the comments here. What I am hearing from our health advisors in the US is that BCG protects only against certain less common strains of TB and not the more common (and easily communicable) pulmonary forms. They choose to not give the BCG since it makes the widely used skin tests less useful. We are still researching this...
#7 May 28th, 2008, 12:50
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#7
i know the BCG vaccination is not 100% effective, but we were told it especially protects against the most dangerous strains of TB (I think they can cause a kind of meningitis). And yes, you cannot use the skin test any more, if TB is suspected you will need a chest x-ray.

I'm no medical expert, so for things like this I just rely on what doctors advice, and so far I've only heard them (both here in India as back home in the Netherlands) advise to have the BCG vaccination.
#8 May 29th, 2008, 05:17
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  • edwardseco is offline
#8
The only problem with it is that the simple TB test will subsequently report false positives. Since I come into contact with young people and did work for awhile in a high TB area I am tested frequently. I was told not to get the BCG because I would then have to be constantly chest X rayed! The doc didn't seem to have much faith in its efficacy either..
#9 May 29th, 2008, 12:01
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  • 70s-80s overlander is offline
#9

get BCG; later test with "QuantiFERON-TB" [gamma-interferon-based blood test]

As a medical student I received a BCG inoculation in 1968 -- forty years ago. Currently BCG's protection is "guaranteed" only for 10 years, BUT last year I was re-tested for TB with ONE-HALF of a child dose of tuberculin and popped a 22mm [0.87inch] induration -- which is huge [that is, my BCG sure was still active!].

In the US (and I believe in the UK) the new "test of choice" -- which can be used in the face of BCG -- is the "QuantiFERON-TB" [an Australian invention].

I'd get the BCG -- and for the kids, too.
#10 May 29th, 2008, 21:40
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#10

More on BCG and US policies

We spoke to our pediatrician about the BCG some more. There are some implications for your child if you are returning to the US.

The fact that the skin test comes out as a positive (even if false positive) automatically triggers a full treatment regimen for the child. They will put the child on months of Anti-biotics for exposure even if you explain the effects of the BCG. I am trying to figure out if refusing the possibly unnecessary treatment will hinder school admissions.

I need to look into the new test that Overlander mentioned as well.

Any other Americans wrangling with the same decision?
#11 May 29th, 2008, 22:16
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#11
Can that really be as crazy as it sounds, or I must be misunderstanding.
#12 May 30th, 2008, 03:23
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#12

More conflicting advice...

We're still getting conflicting stories.

The Masta (UK travel advisor service) advice is that BCG is recommended for anyone under the age of 16 who is living in India for more than 3 months. This is following the NHS and Dept of Health advice in the UK. (This has changed fairly recently - they used to advise anyone under the age of 35 to get it). I was referred to the Dept of Health 'GReen Book', which is available on the internet easily. Sure enough, this mentions the change in policy.

However, the Masta woman said that in the US and Australia they don't give the vaccine routinely.

The other advise we have received is from a relative who is a Belgian doctor who works for the Red Cross, and who is involved in vaccination programmes all over the world. He expressed suprise that we were considering giving BCG to our children. He said that WHO guidelines are that it should only be given to babies under the age of 12 months. The reasons for this are that firstly, it isn't v effective (esp against certain types of TB), and secondly the problem with not being able to test after having had the BCG. We found this on the WHO website:
<http://www.who.int/immunization_monitoring/diseases/tuberculosis/en/index.html>

So we're still unsure what to do.

(We don't have the same problem as you, kamadoll, on returning to the States...)
#13 May 30th, 2008, 09:37
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#13

in 2008, BCG does NOT imply repeat Chest X-rays or Antibiotics

As I noted above, in this new era, IF there is a question about TB infection -- or one needs the "proof" for some agency -- one just gets the above noted "QuantiFERON-TB" test.

You do NOT have to have a repeat Chest X-ray. You do NOT have to go on a course of antibiotics.

If you are still in doubt, ask your physician -- or public health department -- specifically about the "QuantiFERON-TB" test. http://www.quantiferon.com/

Please, ONLY talk to sources that have the up-to-date medical information.

Quote:
In July 2005, CDC convened a meeting of consultants and researchers with expertise in the field to review scientific evidence and clinical experience with QFT-G. On the basis of this review and discussion, CDC recommends that QFT-G may be used in all circumstances in which the TST is currently used, including contact investigations, evaluation of recent immigrants, and sequential-testing surveillance programs for infection control (e.g., those for health-care workers).
MMWR Recomm Rep. 2005 Dec 16;54(RR-15):49-55. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States.

see also: JAMA. 2005 Jun 8;293(22):2746-55. Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole-blood interferon gamma assay with tuberculin skin testing. [Pai, M, et al, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India] http://jama.ama-assn.org/cgi/content/full/293/22/2746 ; http://jama.ama-assn.org/cgi/reprint/293/22/2746.pdf

see also: J Infect. 2007 Mar;54(3):267-76. Comparison of a whole blood interferon-gamma assay with tuberculin skin testing for the detection of tuberculosis infection in hospitalized children in rural India. [Dogra, S, et al, Mahatma Gandhi Institute of Medical Sciences, Sevagram 442102, India]

[On Sevagram, see: http://www.indiamike.com/india/mahar...vagram-t39053/ ]
#14 Jun 2nd, 2008, 15:43
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#14
Here is the CDC advise, for anyone interested:

http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx

best,
4gotoindia

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