60 years of vaccination against tuberculosis. Outcomes

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

Almost the entire population of the Russian Federation is infected with mycobacterium tuberculosis, but only 0.07% gets sick. Does vaccination help? Today I will talk about the effectiveness and safety of vaccination against tuberculosis, and why the live BCG vaccine is used for this.

Even before the start of mandatory BCG vaccination, according to the Institute of Tuberculosis in 1955, the infection rate of the population of the USSR was:

- preschool age - 20%

- teenagers 15 - 18 years old - 60%

- over 21 years old - 98%

Moreover, the development of tuberculosis was observed only in 0.2% of those infected.

Taking into account the epidemiological situation, it was decided on the compulsory vaccination of newborn children. Vaccination is performed with a live weakened strain of BCG, since killed mycobacteria are not able to evoke immunological memory. "Weakening" of mycobacterium is carried out by its repeated reproduction on nutrient media, as a result of which the pathogenicity is reduced. After intradermal injection, mycobacterium with blood spreads throughout the body, forming foci of chronic infection in the peripheral lymph nodes, thereby maintaining tense immunity from 2 to 7 years. This is the main difference between BCG vaccination and other live vaccines, which are able to form immunological memory without the formation of living enclaves in the body.

The effectiveness of BCG. The use of this vaccine, both in the Russian Federation and around the world, did not prevent the spread of infection, which is repeatedly reflected in the official position of WHO. Does not prevent BCG vaccination and the development of tuberculosis, with the exception of brain tuberculosis in children. Therefore, WHO recommends compulsory BCG vaccination of newborns in countries where brain tuberculosis in children under 5 years of age is recorded more often than 1 case per 10 million population (p. 14). So, in Russia, brain tuberculosis in children is recorded 4 times less often than the specified threshold - only 5 cases per 142 million country (p. 103). Nevertheless, the Ministry of Health of the Russian Federation does not cancel the mandatory BCG vaccination. But on the other hand, parents have the right to refuse it, especially since WHO recommends it!

Most developed countries in Europe have abolished universal vaccination. In Germany, since 1998, the mandatory vaccination of newborns has been abandoned because "there is no reliable evidence of efficacy and the likelihood of side effects is high." In Finland, BCG was abandoned in 2006 due to outbreaks of complications. The United States and the Netherlands have never used BCG in large quantities. This is what the map of Europe looks like, where in developed countries compulsory vaccination is not carried out (Germany, France, Austria, Switzerland, Netherlands, Norway, Czech Republic, etc.):

The aforementioned countries have achieved a favorable epidemiological situation by exerting efforts for early detection and effective treatment, as well as increasing social standards and hygiene. Russia, applying compulsory vaccination, finds itself in the company of the poorest countries in Europe - Belarus, Ukraine, Azerbaijan, Bulgaria, Romania, Moldova, etc. effective. It is generally accepted that the incidence of tuberculosis depends on socio-economic indicators. Visually, it is easy to assess by looking at this map of the World:

Morbidity and mortality from tuberculosis declined long before the invention of the vaccine. Tuberculosis began to disappear from England as early as the 1850s, when the chaotic growth of cities came to an end. Public health laws provided the foundation for improved sanitation, new building standards, and slum liquidation. The streets were widened, sewers and ventilation were isolated, and the dead were buried outside the cities. Even after the invention of the vaccine, countries that never used BCG in their vaccination programs (for example, the United States) experienced the same rate of decline in deaths from tuberculosis as in countries with mandatory vaccination (link).

Thus, if a child lives in a prosperous family and in modern housing, receives adequate nutrition and is socially secured, BCG vaccination can be safely abandoned, since the risk of post-vaccination complications will be much higher than its effectiveness.

Complications of BCG vaccination. The high risk of BCG was first confirmed back in the 1960s, when WHO conducted the largest vaccine trial on 375,000 people in India with an analysis of the consequences for 7.5 years. As a result, the incidence was higher in the vaccinated group.

In 2011, 437 cases of post-vaccination complications were registered in Russia, 91 of them were severe. It seems a little, but this exceeds the incidence of tuberculosis in children by 30%! I'll chew it and put it in my mouth: the BCG vaccine provokes tuberculosis more often than the disease occurs naturally! And it was not rabid anti-vaccination agents who came up with it - it is written in the official Analytical Report of the Ministry of Health (p. 112). For example, 60% of cases of severe osteoarticular localization of tuberculosis in children are associated with the activation of the BCG vaccine strain (p. 102), which is observed on average in 5 newborns out of 100,000 vaccinated. This once again suggests that the mycobacteria of the vaccine penetrate into all tissues of the body, including bones.

Thus, the complications of BCG vaccination are the activation of the virulence of the vaccine strain in the body of the vaccinated, which is observed more often than tuberculosis itself. Such a child will have to receive treatment with a complex of antibiotics for months. After that, he will be registered at the tuberculosis dispensary for years.

Conclusions:

1. We are all infected with mycobacterium tuberculosis, but the development and outcome of the disease depends on the socio-economic situation and on the level of TB care.

2. The BCG vaccine was developed 100 years ago and during this time it has not prevented the spread of infection and the incidence of tuberculosis.

3. BCG vaccine is more likely to cause complications than tuberculosis itself.

4. Tuberculosis specialists recommend that affluent families give up BCG.

I hope this information will help parents make an informed decision about vaccinating their children. In the next posts, read about vaccination against other diseases - we will analyze the entire national vaccination calendar.