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BCG Scar Recognition
BCG Scar Recognition
Please read through the following module. Further information can be obtained via the reference
sites at the end of the module. Complete the quiz once you have read through the module.
2.
Know how the vaccine is administered and the process of scar formation.
3.
Know how to identify BCG scars and the process for checking scars
4.
Know how to distinguish between BCG scars and small pox scars
Background Information
What is TB?
Tuberculosis (TB) is caused by the bacterium, Mycobacteria tuberculosis, which is mainly transmitted
via respiratory droplets i.e. through coughing, sneezing. It is the second greatest killer due to a single
infectious agent worldwide (after HIV). The WHO estimates that one third of the worlds population
have latent TB (infection without symptoms). The highest rates of infection are found in South and
South East Asia and Sub Saharan Africa.
In the UK, the highest risk of TB is in people born in countries with high incidence.
In adults, TB of the lung is the commonest (and most infectious) form, but TB can affect any organ of
the body.
BCG Vaccine
Bacillus Calmette-Guerin (BCG) contains a live, attenuated strain of Mycobacterium bovis, which
provides cross immunity to Mycobacterium tuberculosis and Mycobacterium leprae (causes leprosy
in humans). The vaccine has been in existence since 1921 and was introduced into the WHO
Expanded Programme on Immunisation in 1974, leading to global coverage of over 80% in endemic
countries.
The vaccine was introduced in the UK in 1953 when school children were routinely vaccinated.
However, as the incidence of TB declined in the indigenous population, the vaccine was removed
from the childhood immunisation programme. It is now only administered to babies born to parents
from high prevalence countries.
The effectiveness of the vaccine varies in different studies. However, meta-analysis shows that the
vaccine is 70-80% effective against the most severe forms of TB such as TB meningitis, which tends
to occur in children. It is less effective against the respiratory form of the disease. Protection is
thought to be between 10 to15 years; data after this time is limited and it is thought protection is
likely to wane.
Screening for or evidence of TB immunity is required for all health care workers due to the increased
risk of exposure.
Evidence of BCG vaccination includes the following
Scar Check
Ask the client if they have a BCG scar and follow the procedure outlined below.
Position- should be left upper arm, either centrally or the posterior lateral or anterior
medial aspect of the arm. Less commonly, the scar might be located in the right upper arm and rarely
thigh or forearm.
Appearance-usually circular in shape, but can be oval or even linear. The scar is
o
typically raised.
Palpate the scar to feel the central raised area, either central region or uniformly.
If the client is unsure if they have a BCG scar, then:
Check both upper arms and then the thigh for characteristic features as above.
Vaccine administered percutaneously (some countries such as Japan prefer this route),
therefore characteristic scar not formed.
Non standard administration site used (i.e. site other than upper arm and typically the left
arm).
When there is an unclear vaccination history and no characteristic scar, further BCG vaccination
must not be administered as this increases the risk of adverse reactions. In these individuals, they
should be referred first for Mantoux testing or Quantiferon Gold Testing.
that is dipped into the vaccine solution. When removed, the needle retains a droplet of the vaccine.
The needle is used to prick the skin a number of times in a few seconds. The pricking is not deep,
but it will cause a sore spot and one or two droplets of blood to form. This method givens the scar
its typical appearance with a central depression and lines radiating out (similar to a bicycle wheel).
The differences between the scars of the small pox vaccine and the TB vaccine can be seen in Figure
2 and 3. The small pox vaccine is no longer routinely administered following the eradication of small
pox in 1979.
Your Name*
Clinic Location*
Date Of Birth*
DD
MM
YYYY
1) The WHO recommends that the BCG vaccine should be administered in the left upper
arm:*
o
True
False
2) To confirm whether a BCG vaccination as been given, the following information is required
(tick all that apply)*
True
False
True
False
True
False
5B.*
True
False
5C.*
True
False
5D.*
True
False
5E.*
True
False
6A) Identify the correct BCG and Smallpox scars on the following
pictures:
Top Scar*
Bottom Scar*
6B
6C
Top Scar*
Bottom Scar*
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