Assessment and Perspective of BCG -Vaccination Policy in Taiwan

Mei Yu Chiou^＊, Chien Bang Hsu, Yen Fang Huang, Chang Hsun Chen

2015 Vol.31 NO.5

Correspondence Author： Mei Yu Chiou

Abstract：

       BCG-vaccination is an evidence-based, tuberculosis (TB) control policy endorsed by many countries and World Health Organization (WHO). Especially in high TB-burden countries, it protects unspecified population. BCG-vaccination reduces disability and death caused by TB and accompany with low risk and different types of adverse reaction. There is a history of controversial concern over its efficacy and impact.
       This article describes Taiwan`s current policy of BCG-vaccination and active surveillance mechanism. Since 1977, Taiwan`s BCG vaccine was manufactured from Japanese Tokyo 172 strain. This strain was less virulent and caused less adverse events as revealed by published literature. The number of bacilli in single injection dose was 7.5x105, which was less than the dose in Japan. Follow recommendation of WHO, we complete BCG-vaccination in the infancy and choose intradermal injection. As a routine vaccination program, the TB incidence rate in the population younger than 5 years old was in accordance with other low-TB burden countries without routine BCG-vaccination. Moreover,  continuous training of BCG-vaccination skill was provided to maintain good quality of inoculation. In accordance, a BCG-vaccination active surveillance was established since 2007. The birth cohort of 2008-9 reveals the incidence of severe BCG-related adverse events was 55 cases per million population which was under the estimated range by WHO.
       The current TB status in Taiwan did not fit to the criteria to terminate BCG-vaccination as recommended by the International Union against Tuberculosis and Lung Disease (IUATLD). After weighing the mortality and long-term side effects caused by TB meningitis, the TB experts’ panel suggested to adopt recommendation of WHO and keep current BCG-vaccination policy as usual. In order to reduce the possible BCG-related harm, active surveillance mechanism was set up, strengthened providing comprehensive information and, follow up and personal care; furthermore, vaccine safety evaluation, health education and training, and to fast clarify the cause of adverse reaction. These would be the references for adjusting the policy of BCG-vaccination in the future.