TB Tests (Mantoux) and BCG Vaccines at CityDoc
Tuberculosis (TB) is an infectious bacterial infection, spread through inhaling tiny droplets from coughs or sneezes of an infected person. TB is caused by the bacteria Mycobacterium tuberculosis and remains one of the top infectious disease killers worldwide. TB is found in most countries of the world, but the highest incidences are in Africa and Asia. In 2014, 9.6 million people fell ill from TB and 1.5 million people died (WHO data). It is estimated that one third of the world’s population has Latent TB (have infection, but no symptoms of disease).
How do you catch TB?
TB is spread from person to person by coughing or sneezing and someone breathing in the droplets. Normally, prolonged contact with the infected person is required. TB can be transmitted by family members who live together and are in close contact.
Symptoms of TB
TB can affect any organ of the body and symptoms relate to the infected organ. However typical symptoms of TB include-:
- A persistent cough with phlegm that may include blood
- Chest pain
- Night sweats
- High temperature or fever
- Unintentional weight loss
- Poor appetite
- Tiredness and fatigue
Infants and children and anyone with a compromised immune system tend to get TB of other sites, especially TB meningitis (infection of the lining of the brain).
TB is a curable disease and also a preventable one. However, treatment requires a combination of medications taken for at least 6 months, whereas, prevention is much simpler with a single dose of BCG vaccine, which can be given from birth.
TB Vaccine – one lifetime dose
The BCG vaccine is a live vaccine, which means that it contains a weakened strain of actual TB bacteria, Mycobacterium bovis. The vaccine encourages the body to fight the TB bacteria without contracting TB, and therefore building immunity to the disease.
Who should have the BCG Vaccine?
The BCG vaccine can be given from birth and is particularly recommended to babies and young children to provide protection from childhood TB and TB meningitis. As well as adults who are at a high risk of infection.
- All infants born and living in areas of the UK with high incidence of TB
- Infants or children with a parent or grandparent from a country with high incidence of TB
- Certain groups of travellers to high incidence countries
- Anyone at risk of TB due to their occupation, such as healthcare workers
TB vaccination clinic
We will be running a Mantoux/BCG clinic in our Moorgate clinic for anyone who wishes to speak to a medical professional about living in or travelling to high risk TB areas, and those who are wanting a TB test (called Mantoux) or a BCG vaccine.
Our clinics will be open as follows-:
Normally – First Friday and Monday of each month at MOORGATE Clinic
CityDoc MOORGATE Clinic
16 City Road
London, EC1Y 2AA
CityDoc LONDON BRIDGE Clinic
52 Weston St,
Please call 0333 006 9976 to check Mantoux and BCG appointment times at the LONDON BRIDGE Clinic.
To be successful in receiving the TB test (Mantoux) or the BCG vaccine, you must have 2 of the following-:
- Living in or travelling to High-risk area – ie >40/100.00 for more than 3 months. (London is high risk area…)
- Grandparents / close family history of TB
- No previous BCG vaccination
- Occupational health risk
- 0-35 years of age
- Health status good
- Anyone under 6yrs of age is not routinely required to take the Mantoux skin test prior to BCG, unless risk factors of TB exposure are present for the child.
- No travel to high-risk country for a prolonged period of time
We are unable to provide TB tests or BCG vaccines if you have the following-:
- Allergic reaction to Mantoux test previously (discuss with our nurses), or have a medical reason as to why you shouldn’t have the test/vaccine
- Had live vaccine in last 4 weeks
- Are immunosuppressed – cannot have BCG vaccine
- Pregnancy – cannot have BCG vaccine
|Birth to 1 year||0.05mls single dose|
|Age of 1 and over||0.1mls single dose|
The vaccine is administered into the skin of the upper arm, normally the left side.
|BCG||NO BOOSTERS REQUIRED|
There is no need for further doses of the BCG vaccine- it should be given only once in a lifetime.
Exclusions to BCG vaccine
The BCG must not be given in the following situations:
- If you have already had the BCG vaccine
- If you have a past history of TB infection
- If you have a positive TB skin test (Mantoux test)
- If you have had a previous allergic reaction to any of ingredients in the vaccine (see FAQ section for ingredients)
- If you have a weakened immune system such as due to diseases like leukaemia, lymphoma, sever HIV infection or due to medications, such as oral steroids, cancer therapies and immunosuppressants.
- If you have a illness with a high fever (greater than 38.5 degrees Celsius) on the day of the vaccination.
The BCG vaccine should not be given during pregnancy, due to the risk of a live vaccine.
The BCG vaccine should not be given to breast feeding mothers.
Although there have been no harmful effects demonstrated when the vaccine has been given to breast feeding mothers, it is best that vaccination is avoided unless absolutely necessary.
Common Side Effects
NORMAL REACTION to the Vaccine
In the vast majority of those vaccinated, a blister forms at the injection site between 2 to 6 weeks later. The blister then becomes a open sore, which may leak fluid. The sore will eventually crust over and heal to leave a flat scar. This process may take months to occur.
- Localised side effects, such as pain, redness, bruising and swelling are common with the BCG vaccine.
- Uncommon side effects (occurring in 1 per 100-1 per 1000 individuals) include fever, headache, loss of appetite, irritability and enlarged lymph gland near the injection site (in the armpit or the neck). These are normally short-lived and get better by themselves.
- Rare side effects include allergic reaction to the vaccine and skin abscess.
Interaction with Other Vaccines
It is important that following BCG vaccination to the arm, no other vaccine is administered in that arm for 3 months.
The vaccine can be given at the same time or any time before or after the following vaccines:
- Chicken pox
- Diphtheria, Tetanus, Polio, Pertussis vaccine (part of childhood immunisation programme)
- Haemphilus Influenza Type B
- Meningitis B and Meningitis ACWY vaccines
- Oral Rotavirus vaccine
- Hepatitis B vaccine
- Any travel vaccines, such as Hepatitis A, Typhoid an Yellow Fever.
Frequently Asked Questions
1) Is the vaccine safe?
The BCG vaccine has been around for a long time and has been rigorously tested for safety. The vaccine does not contain any thiomersal (mercury derivative).
2) How effective is the BCG vaccine?
The BCG vaccine works best when it is given to young children, as they are more likely to get severe forms of TB and have active disease. The vaccine is around 70-80% effective against prevention of severe forms of TB such as TB Meningitis. It is less effective at preventing lung TB.
Vaccination is only recommended in individuals over 16 years of age if they are at high risk of encountering the infection. This is because there is limited data on how effective the vaccine is in individuals over 16 years of age and no data at all in those over 35 years of age.
3) Can the vaccine be administered in the leg or other areas of the body to avoid a visible scar.
The current guidance and advice from both The World Health Organisation and The Department of Health is that the BCG vaccine should only be administered in the arm as this reduces the risk of severe adverse reactions. The vaccine is usually given in the left upper arm, which has been shown to produce less reaction. The BCG scar is usually small and flat.
4) Can other vaccinations be given at the same time?
The BCG vaccine can be given at the same time or any time before or after routine childhood immunisations. There is no need to delay either the BCG vaccine or routine childhood vaccines. However, no other injection should be given in the BCG arm for 3 months. Other sites must be used.
5) Can the vaccine be given if the child is unwell?
The vaccine should not be given in the presence of a fever (above 38.5 degrees Celsius). If there are minor illnesses such as cold, cough or ear infections, but no fever, the vaccination can be given depending on how well the child is. This will be determined by the clinician in the consultation.
6) Is the vaccine infectious?
The TB bacteria in the vaccine is weakened and cannot be transmitted. Therefore, there is no risk in having your child vaccinated if there are family members who have weakened immune systems or are pregnant.
7) Is more than one dose of the BCG vaccine required?
The BCG vaccine is normally administered once only. There is no evidence that further doses provide any additional protection and indeed, can cause more adverse reactions.
8) Which BCG vaccine manufacturer do you use?
The BCG vaccine we use is the licensed vaccine, also used by the NHS, produced by AJVaccines.
9) Does my child need to have a test first before they can have the vaccine?
Children under 5 years of age do not have to be tested first and can have the vaccine directly. Children and adults from 5 years of age would need to have TB testing first to check for immunity or latent infection. This is because it is not advisable to have the BCG vaccine if you already have immunity as it can lead to serious adverse reactions and has no additional benefit on the immune response.
10) How long does the TB skin test last for?
The Mantoux test is valid for 3 months. If more than 3 months have elapsed, then the test would need to be repeated before the BCG vaccine can be given.
11) Can my child go to nursery/school afterwards?
Although the vaccine is live, it is not infectious and therefore, the advice is that children can go to nursery or school provided that they are well to do so. The clinician will advise you during the consultation of the expected reactions to the vaccine.
12) Can we travel after my child has the BCG vaccine?
You can travel after the vaccination provided your child is well following the vaccine. They are not infectious. If you are travelling to a country with a high incidence of TB, it is worth bearing in mind that full immunity to the vaccine can take up to 6 weeks to occur.
13) Can my child go swimming after vaccination?
The doctor will discuss what you can or cannot do following vaccination during the consultation. The current advice is that the injection site does not need to be protected from water. However, once the sore develops, it is best to use a non-adhesive waterproof dressing while swimming to protect the area from infection. You can bathe or shower as normal immediately after vaccination.
14) If my child does not have any reaction or scar, does that mean they are not immune?
Although the reaction and scar occurs in most vaccinated individuals, some do not have this reaction. This does not mean that they are not immune and further vaccination or TB testing is not required.
15) Can my child have the BCG vaccine if they are allergic to egg?
The BCG can be given to individuals with egg allergy, latex (rubber) allergy, as it does not contain these ingredients. For other allergies, please discuss with the doctor during the consultation, who will check the ingredients to ensure it is safe to administer. All our clinicians are trained in the management of severe allergic reactions on adults and children and have adrenaline on site.
16) Does the BCG vaccine contain animal products?
All the ingredients in the BCG vaccine dare of non-animal origin.
At CityDoc, we offer both the Mantoux test and the cutting edge, Quantiferon Gold TB test.
Available at CityDoc Moorgate & London Bridge (Monday-Friday). Telephone booking only.
Part of the protein from the TB bacterium is injected under the skin of the forearm. After 48-72 hours, the arm is checked to see if there has been a reaction. If there is latent (non active) TB, moderate redness and swelling is often seen at the site-a positive Mantoux test. If this reaction is more severe active TB is more likely. A mild reaction can also occur if you have had the BCG vaccination. Further investigation may be required either through Quantiferon Gold blood test and/or Chest X-ray in the case of positive Mantoux test results depending on the reaction and any symptoms.
Cost £80 includes consultation
Quantiferon Gold Test (Available at Moorgate & London Bridge)
This is a blood test, which determines if a person is infected with the tuberculosis bacteria by measuring the immune response to TB proteins in blood. It can be used instead of the Mantoux test or performed if the Mantoux test is positive. Unlike the Mantoux test, it is not affected by the BCG vaccination.
Cost £140 includes consultation