Since 2005, NHS England’s TB strategy changed away from universal vaccination using the tried and trusted BCG vaccine towards one of targeted risk and vaccination based upon triggering factors. Risk factors to be considered across the UK (not across parts of London) are regional rates of TB infection, time spent abroad in high incidence areas and family background. TB is a global disease killing two million people annually. Data has been compiled in the UK since 1913, with 117,139 recorded cases, with a reducing trend across the century to 5,193 cases in 2017 (2,210 in London). Multiple antibiotics taken for a period of up to 9 months is the general treatment, however new drug-resistant strains are now commonplace requiring extended use of second-line antibiotics for up to 30 months.
The risk-based approach has led to continued universality of TB vaccination across 22 out of 32 London boroughs in areas where the incidence of TB exceeds 40 per 100,000 (average UK incidence is 9). London Borough of Newham in 2013 had an incidence rate of 122.1 cases per 100,000, by far the highest in the country. This compares with Peru at 116 cases per 100,000, Algeria at 70 per 100,000 and the global highest, Lesotho, at 665 per 100,000.
This universality extends to out of area children born at hospitals within the London boroughs affected.
Whilst the BCG vaccine offers 80% protection against infection, recent cases of TB, in unusual places in the UK which would have been considered ‘low risk’, have highlighted the ongoing worrying prevalence of the disease, long since considered to have been consigned to the mid 1900’s. Margaret Pegler from Llwynhendy, Carmarthenshire died in September 2018 leading to 29 confirmed local cases and urgent screening for 700 residents.
Craig Mackinlay MP is calling for Kent-wide TB vaccinations for children and considers that nationwide vaccinations should be rolled out as part of the usual baby and child immunisation strategy for the UK. He said:
“I have had a number of constituents alarmed at the fact that the BCG vaccination was no longer routinely available for their children. I tabled a written Parliamentary question in October 2017 to clarify the position and received the response from the Health Minister signposting the new risk-based approach being employed by NHS England.”
“The realities of life for new-born children in Kent is that their lives are more likely to see them travelling globally and certainly interacting closely with London life through work or visits. Ease of travel means interactions with people from across the world on a more regular basis. It seems incoherent to me that universal vaccination is considered the right thing to do in much of London, but not the right thing to do for children just a few miles away in Kent.”
“The BCG vaccine is a low cost, low-risk vaccine that has been used routinely in the UK since 1953, invented in 1921. At a cost of just £3 per vaccination I want to see routine universal TB vaccinations as the new norm for children in Kent and see the current strategy as weak and potentially hazardous.”