BCG vaccine

The BCG vaccine or Bacille Calmette-Guérin (BCG) vaccine is an attenuated live vaccine against tuberculosis. The vaccine is administered into the skin (intracutaneously). The vaccine contains the bacterium Bacillus Calmette-Guérin. It is important to note that the vaccine does not protect against infection or the spread of the germs. The course of the disease is also only minimally affected by the vaccination. The only benefit of the vaccine is to prevent serious complications in children. These include miliary tuberculosis and tuberculous meningitis. Here the vaccine provides very reliable protection. Since the 2000s, however, vaccination has only been carried out in exceptional cases because the number of cases continues to fall and the complications of the vaccination outweigh the benefits.

Today, the BCG vaccine is used to treat various types of bladder cancer. It is also used to prevent the cancer from recurring.

The BCG vaccine works by activating several immune cells (macrophages, natural killer cells, etc.) and stimulating them to multiply. It also leads to the formation of an immunological memory, which means that certain immune cells "remember" the pathogen and the immune response can be triggered more quickly in the event of a second or further infection. The vaccine contains weakened (attenuated) bacteria that only have a low infection potential.

The BCG vaccine is a vaccination and is therefore only administered by healthcare professionals. However, the vaccine is not administered like any other, but is applied as a liquid to the upper arm and small pricks/wounds are scratched into the skin with a needle. This is similar to a prick test, which is also known as an allergy test. This can lead to minor bleeding, redness and pain.

It is important that the bacteria can remain in the wound for a while and can therefore be transmitted by contact, which in the worst case can lead to infection. For this reason, the wound should be covered with clothing or wound dressings for at least 24 hours.

Before the actual vaccination, a skin test is carried out to ensure that the person does not already have tuberculosis. A skin test is also carried out again after the vaccination to ensure that the vaccination has worked. The skin test should be negative BEFORE the vaccination and positive AFTER the vaccination. If the test is still negative after vaccination, you may need to be vaccinated again.

For the treatment of bladder cancer, the vaccine is injected into the bladder by medical professionals using a catheter. However, the medication should remain in the bladder for 2 hours, which means that you should not drink any fluids or empty your bladder for 2 hours before and after the installation.

After immunization with the BCG vaccine, there may be normal vaccination reactions with a slight fever, flu-like symptoms and general discomfort.

However, there is also a risk of getting a BCG infection. You can tell the difference by the fact that a vaccination reaction usually only occurs after 24-48 hours.

However, if you suspect that you have a BCG infection, seek medical help IMMEDIATELY, as there is an acute danger to life!

Unfortunately, in individual cases you may only develop a so-called "delayed BCG infection" years later. Here too there is an acute danger to life and you should seek medical help IMMEDIATELY.

The following side effects may occur:

Very common:

• Nausea
• inflammation of the bladder
• Frequent urination with pain
• malaise
• Inflammatory reactions of the prostate

Frequent:

• Fever above 38.5°C
• muscle pain
• diarrhea
• Urinary incontinence

Occasional:

• Lack of blood cells
• Anemia
• Reiter's syndrome
• Pneumonia
• Liver inflammation
• Skin abscesses
• Skin rash
• Inflammation of the joints with pain
• Urinary tract infections
• Blood in the urine
• Abnormally small bladder
• urinary retention
• Inflammation of the testicles or epididymis
• low blood pressure (hypotension)

Rarely:

• Vascular infections
• Kidney abscess

Very rare:

• BCG infections of implants
• Inflammation of the cervical lymph nodes
• allergic reactions
• Inflammation inside the eye
• conjunctivitis
• Inflammation of the middle membrane of the eye
• vascular fistulas
• vomiting
• intestinal fistulas
• peritonitis
• Infection of bone and bone marrow
• psoas abscess
• Infection of the glans penis
• Swelling in the arms and legs

Frequency unknown:

• Discomfort in the genital area
• painful sexual intercourse
• kidney failure
• Inflammation of kidney tissue, cavities, pelvis
• No sperm or low sperm concentration in the seminal fluid

Interactions may occur if the following medicines are taken at the same time:

• Tuberculostatics (e.g. ethambutol, streptomycin, p-aminosalicylic acid, isoniazid, rifampicin)
• Antibiotics (fluoroquinolones, doxycycline or gentamicin)
• Antiseptics
• lubricants

BCG vaccine must NOT be used in the following cases:

• if you are allergic to Bacillus Calmette-Guérin
• if you have a weakened immune system or if you suffer from an immune deficiency
• if you have active tuberculosis
• during radiotherapy of the bladder
• if you had surgery through the urethra 2-3 weeks ago
• if you have had a bladder perforation
• blood in the urine
• acute urinary tract infection

As it cannot be ruled out that bacteria can be transmitted via sexual contact after the BCG vaccination, a condom should be worn for one week during sexual intercourse.

The BCG vaccine should only be used from the age of 18.

The BCG vaccine should NOT be administered during pregnancy and breastfeeding!

Two Frenchmen, the microbiologist Albert Calmette and the veterinary surgeon Camille Guérin, conducted research on tuberculosis cultures between 1908 and 1919. They found that a culture medium based on glycerine, bile and potato produced less virulence. They modified their research to carry out repeated cultivations in order to produce an attenuated vaccine. In animal experiments, however, the infection could not be stopped. They continued their research until the vaccine was approved in 1928. Due to the many opponents of the vaccine, it was not used until after the Second World War and was one of the safest vaccines in the world.

Unfortunately, there was also the Lübeck vaccination disaster, where 77 children died because of a contaminated vaccine. The laboratory used to manufacture the vaccine was unfortunately unsuitable for production. In addition, the vaccine was not tested on animals. The guilty party was sentenced to prison.