An Overview of BCG Vaccination Policies in Europe

Background: Despite progress made in the last few decades in tackling tuberculosis (TB), it remains an important cause of morbidity and mortality worldwide. Bacillus Calmette-Guerin (BCG) is the only licensed vaccine available for TB. However, vaccination policies have varied widely between countries and over the years.

Objective: Characterise current BCG vaccination policies in the European Region.

Methods: Data on vaccination practices were extracted from BCG World Atlas (available at http://www.bcgatlas.org/). Additional information regarding TB burden was obtained from the World Health Organization official database (available at https://worldhealthorg.shinyapps.io/tb_profiles/). Countries were categorised according to the World Bank classification of income.

Results: Recent information on national BCG recommendations was available from 52 of the 54 European Region countries included in the study. In 26 countries universal BCG vaccination of newborns is still implemented with coverage levels in 2019 ranging from 84 to 99% (mean coverage 95,4%). Mean estimated incidence of TB cases in this group of countries, in 2019, was 41,0 (per 100000 population). Revaccination is recommended in six of the countries where BCG is administered universally at birth.

In another 26 countries, all classified as high income, BCG is not currently universally recommended. The majority of these countries have shifted in the last decades from universal vaccination to targeting high-risk groups. Mean estimated incidence of TB cases in this group of countries, in 2019, was 6,8 (per 100000 population) but varied from 2,9 in Israel to 19 in Portugal (per 100000 population).

Conclusion: The decrease in the incidence of TB has contributed to a gradual change in policy with more countries progressively deciding on targeted vaccination of high-risk children instead of a universal approach. However, assessing risks and benefits is essential as BCG vaccination can help prevent severe cases of tuberculosis in children, particularly in high incidence settings.