Finland switches rapidly from universal tuberculosis vaccination of all newborns to targeted risk group vaccination

May 23, 2006
The National Advisory Committee on Vaccination (NACV) recommends that BCG vaccination of all newborns against tuberculosis be stopped earlier than planned.

The incidence of tuberculosis in the Finnish population has decreased very rapidly, and childhood tuberculosis has become very rare. According to the NACV experts, the serious adverse effects of the current BCG vaccination programme, which are rare as such, have grown greater than the benefits. The NACV recommends that, instead of universal vaccination, vaccination be targeted solely at those risk groups, in which the incidence of tuberculosis is considerable and for whom the benefits of vaccination clearly outweigh the adverse effects. A child living in Finland belongs to a risk group, if any member of the family was born in a country with a high incidence of tuberculosis, or if a member of the family has been diagnosed with tuberculosis. Of the 57,000 babies born in Finland annually, 3,000 are estimated to belong to these risk groups for tuberculosis.

The NACV proposes that the switch from universal to targeted BCG vaccination be implemented as early as 1 September, 2006. The Finnish Ministry of Social Affairs and Health has started drafting the decree on revising the vaccination programme.

Tuberculosis in children is very rare in Finland
During the last decades, the incidence of tuberculosis in Finland has decreased to a very low level. Simultaneously, the risk of native-born Finns’ children born and living in Finland to contract tuberculosis has become very small. Similar developments have taken place somewhat earlier in many western industrialised countries, most of which have stopped universal BCG vaccinations as unnecessary. Up till now, Finland aimed at switching to targeted risk group BCG vaccinations from the beginning of 2008. Approximately five cases of tuberculosis occur in children in Finland annually. Of the children who have contracted tuberculosis in the last few years, 80% belong to those tuberculosis risk groups, for which the BCG vaccination will still be recommended.

Adverse effects of the BCG vaccine have increased
In 2002, Finland was compelled to replace the BCG vaccine manufactured by Evans Vaccines Ltd and used in the universal vaccination programme with a vaccine produced by Denmark’s Statens Serum Institut (SSI). –The change was made because Evans Vaccines discontinued the production of their vaccine. The SSI vaccine is the only BCG vaccine available in Europe. After the vaccine was changed, there was a rapid increase in the incidence of lymph node abscesses. The number of serious adverse effects from the BCG vaccine, reported to the Finnish National Public Health Institute, have lately increased to the extent that the harm from vaccination exceeds the benefits that can be achieved in a population, in which the incidence of tuberculosis is very low. The serious complications, caused by the attenuated, live BCG bacterium, consist of infections occurring at a distance from the vaccination site. They include osteitis, arthritis and generalised BCG infection. The rate observed and reported is 14 per 100,000 vaccinated children.

The NCAV, however, considers that the risk of children in the risk groups to contract tuberculosis is so high that for them the benefits from the BCG vaccine outweigh the adverse effects from the vaccine.

The National Advisory Committee on Vaccination was appointed by the Finnish National Public Health Institute. The Committee consists of Finnish experts, and gives recommendations in matters related to the general vaccination programme. Actual decisions on the vaccination programme are made by the Finnish Ministry of Social Affairs and Health.