BCG vaccination is recommended for babies and adults at risk of catching tuberculosis (TB).
Babies who should have the BCG vaccine
The BCG vaccination is recommended for all babies up to one year old who:
- are born in areas where the rates of TB are high
- have one or more parents or grandparents who were born in countries with a high incidence of TB
Older children and adults who should have the BCG vaccine
The BCG vaccination is recommended for all older children and adults at risk of TB including:
- older children with an increased risk of TB who were not vaccinated against TB when they were babies
- anyone under 16 who has come from an area where TB is widespread
- anyone under 16 who has been in close contact with someone who has pulmonary TB (TB infection of the lung)
Workers who should have the BCG vaccine
BCG vaccination is recommended for people under the age of 35 who are at risk of TB through their jobs including:
- laboratory staff who are in contact with blood, urine and tissue samples
- veterinary staff and other animal workers, such as abattoir workers, who work with animals, such as cattle or monkeys, that are susceptible to TB
- prison staff who work directly with prisoners
- staff of care homes for the elderly
- staff of hostels for homeless people
- staff who work in facilities for refugees and asylum seekers
- healthcare workers with an increased risk of exposure to TB
Travellers who should have the BCG vaccine
The BCG vaccine is also recommended for people under 16 years of age who are going to live and work with local people for more than three months in an area with high rates of TB.
Parts of the world that have high rates of TB include:
- Africa – particularly sub-Saharan Africa (all the African countries south of the Sahara desert) and west Africa, including Nigeria and South Africa
- southeast Asia – including India, Pakistan, Indonesia and Bangladesh
- South America
- the western Pacific region (to the west of the Pacific Ocean) – including Vietnam and Cambodia
Read more about travel vaccinations.
How is the BCG injection given?
BCG vaccination is given as an injection into the upper arm. If it's advised that your baby has the BCG vaccine, the jab is usually offered soon after birth or while your baby is still in hospital.
How to tell if you're already immune to TB
Before you have the BCG vaccination, you should be tested to see if you've been exposed to TB before. A test, called the tuberculin skin test, or Mantoux test, should be carried out before BCG vaccination if someone is:
- six years or over
- a baby or child under six with a history of residence or a prolonged stay (more than three months) in a country with an annual TB incidence of 40 per 100,000 or more
- those who have had close contact with a person with known TB
- those who have a family history of TB within the last five years
The Mantoux test assesses your sensitivity to a substance called tuberculin purified protein derivative (PPD) when it's injected into your skin.
If your skin is sensitive to PPD tuberculin a hard red bump will develop at the site of the injection, usually within 48 to 72 hours of having the test.
If you develop this reaction (a positive test result) it shows that your immune system recognises TB because of previous exposure and you should not be vaccinated as you already have some immunity to TB. In this case, the BCG vaccine would have no clinical benefit and may cause unpleasant side effects.
If the test is negative, you can go ahead and have the BCG vaccine.
If you have a strongly positive Mantoux result, you should be referred to a TB specialist team for further assessment.
Who should not have the BCG vaccination?
The BCG vaccine is not recommended for:
- people who have already had a BCG vaccination
- people with a past history of TB
- people with a positive tuberculin skin test (Mantoux)
- people who have had a previous anaphylactic reaction (severe allergic reaction) to any of the substances used in the vaccine
- newborn babies in a household where a case of TB is suspected or confirmed
- people who have a septic skin condition at the site where the injection will be given
- people who have received another live vaccine less than three weeks earlier
- people with a weakened immune system, either as a result of a health condition such as HIV, treatments such as chemotherapy or medicines that suppress the immune system such as steroid tablets
- people who have cancer of the white blood cells, bone marrow or lymph nodes, such as leukaemia or lymphoma
- people who are seriously unwell (vaccination should be delayed until they recover)
- pregnant women
BCG vaccinations are not usually offered to people over the age of 16 because the vaccine doesn't work well in those over 16 and there's virtually no evidence showing that it is effective in those aged over 35.
However, some people over 16 and under 35 whose work puts them at occupational risk of TB may still be offered the vaccine.
Read the answers to the frequently asked questions about BCG.