BCG Vaccination Guidelines

Pre-Vaccination Assessment

The Centers for Disease Control and Prevention recommends BCG vaccination for persons who have a reaction of less than 5mm induration after skin testing with 5 tuberculin units of PPD tuberculin, indicating a low risk of previous tuberculosis infection 1
BCG is contraindicated in immunocompromised persons, including those with HIV infection, as it can increase the risk of adverse reactions, according to the Centers for Disease Control and Prevention 2, 3
The Centers for Disease Control and Prevention does not recommend BCG vaccination during pregnancy due to the potential risks to the fetus 1

The BCG vaccine vial, specifically the Tice strain, is the only licensed BCG vaccine in the United States, as recommended by the Centers for Disease Control and Prevention 1
Sterile gauze or cotton balls are required for skin preparation and post-vaccination care, as recommended by the Centers for Disease Control and Prevention 4
Gloves and other personal protective equipment are necessary to prevent exposure to the vaccine and potential biohazards, according to the Centers for Disease Control and Prevention 4

The Centers for Disease Control and Prevention recommends using appropriate hand hygiene methods before starting the vaccination procedure to prevent contamination 4
The BCG vaccine vial should be removed from refrigeration and checked for label and expiration date before use, as recommended by the Centers for Disease Control and Prevention 4
The freeze-dried vaccine should be reconstituted according to the manufacturer's instructions, as recommended by the Centers for Disease Control and Prevention 1

The skin preparation site should be cleaned with an alcohol or acetone swab using a circular motion from center to outside, as recommended by the Centers for Disease Control and Prevention 4
The site should be allowed to dry thoroughly before administering the vaccine, according to the Centers for Disease Control and Prevention 4

Draining lesions resulting from vaccination should be kept clean and bandaged, as recommended by the Centers for Disease Control and Prevention 1

Normal reactions to BCG vaccination include the formation of a bluish-red pustule within 2-3 weeks after vaccination, which eventually ulcerates and forms a lesion, as described by the Centers for Disease Control and Prevention 1
The lesion typically heals within 3 months after vaccination, leaving a permanent scar at the puncture site, according to the Centers for Disease Control and Prevention 1
A tuberculin skin test should be performed 3 months after BCG administration to document tuberculin reactivity, as recommended by the Centers for Disease Control and Prevention 1

BCG vaccination is rarely indicated in the United States and should only be considered in specific situations, such as high-risk individuals, as recommended by the Centers for Disease Control and Prevention 5, 6
Physicians considering BCG vaccination for their patients should consult with TB control programs in their area, according to the Centers for Disease Control and Prevention 5