Table 3

Specific immunodeficiencies in which BCG vaccination is contraindicated in infants and children

CategorySpecific immunodeficiencies in which is BCG contraindicated
Immunosuppression in mother

  • Mother on immunosuppressive biological agents in pregnancy, eg, TNF alpha inhibitors (delay BCG in infant for 6 months)1

Immunosuppression in baby

  • Corticosteroid use >2 mg/kg/day for more than 1 week or >1 mg/kg/day for more than 2 weeks (delay BCG in infant for 3 months)

  • Severe combined immunodeficiency (through its impact on affecting T cell immunodeficiency)

  • Disorders of phagocytosis, eg, chronic granulomatous disease

  • Mendelian susceptibility to mycobacterial diseases (MSMD) (eg, gamma interferon receptor deficiency, natural killer lymphocyte deficiency)

  • Infection-related conditions that can cause immunosuppression associated with T cell function, eg, HIV with severe immunosuppression

  • Other T cell disorders, eg, 22q deletion (Di George’s syndrome, with severe immunosuppression)

Host immune response

  • Confirmed anaphylaxis to vaccine component

Evidence for previous exposure to pathogen/antigen

  • Previous BCG vaccination

  • History of TB

  • An induration of 5 mm or more following Mantoux tuberculin skin testing

  • BCG is contraindicated in immune deficiencies associated with T cell function, phagocytosis and cytokine-mediated disorders such as chronic granulomatosis and MSMD. BCG is not contraindicated in pure B cell or antibody deficiencies. HIV infection and Di George’s syndrome are relative contraindications based on degree of immunosuppression.