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Let's face it. Doctors don't like giving vaccines. It's not something we're familiar with, but we're not sure if we've done it right after we've done it. The BCG vaccine is given to reduce the frequency of tuberculosis in at risk patients and it is often given in specialist pediatric clinics. So it is important that everyone knows how to administer it safely. I'm Doctor Matthew Sayers, a consultant pediatrician and I have administered a number of BCG vaccines in my training. In this video, I will share my tips and experience on how to safely and successfully administer the BCG vaccine and get that really satisfying Bleb. Thanks to all documents and guidelines in this video are available in the video description and also on the OA medical app. Tuberculosis is a really severe infection that has killed 100s of millions of people throughout history. It is caused by the bacteria, mycobacterium tuberculosis and it is generally caught through prolonged uh contact with someone who has active pulmonary TB. Most people do not develop symptoms but develop latent TB in which they are asymptomatic but then develop active disease in later life. During a period of immunocompromise, general symptoms of TB include fevers, weight loss and lethargy and symptoms of active pulmonary TB include chronic productive cough with blood streaked sputum. Thankfully, rates in the UK have massively reduced due to improvements in sanitation, vaccinations and treatment BCG vaccine was first introduced in the UK in 1953. And at that stage, it was given to 14 year olds which at that time was the school leaving age. Subsequently. In the 19 sixties, a neon whole vaccination program was introduced and this was for babies born to parents from high incidence countries. By 2005, the rates of tuberculosis had declined. So significantly in the UK that the adolescent vaccination program was scrapped. And the neonatal at risk program is now the only type that remains. The BCG vaccine is a live attenuated vaccine of the bacteria, mycobacteria bovis. Estimates of efficacy vary but UK meta analysis estimates a 70 to 80% efficacy in preventing severe tuberculosis disease. And it's particularly effective for TB meningitis protection is estimated to last between 15 to 60 years. So repeat vaccination is not recommended. Most babies require the BCG vaccine. Currently, the vaccine is given at around four weeks of age as this ensures that the baby's skid newborn screening result is confirmed before administration. The BCG vaccine is given to babies whose parents or grandparents um are from a high risk country or if the baby is going to reside in a high risk country. Do you mean by high risk. This is defined as atb rates of greater than or equal to 40 per 100,000 population. The World Health Organization collects and publishes this data. They used to have excel tables on their website. But these assists being discontinued, you can find the rates on a website. It's actually quite challenging to find this website. However, if you Google TB profile shiny apps, you will find the data. The BCC vaccination is contraindicated in babies born in households in which there is suspected or confirmed active tuberculosis. These babies should have a prebirth plan from infectious diseases. The BCG and other live vaccines are also contraindicated for the first six months of life in babies whose mothers have had the biologic medication and the TNF alpha antagonists. And there have been reports of babies dying from disseminated TB in these groups. TT vaccination is contraindicated for babies who are HIV positive and it should be defer until around 12 to 14 weeks in mothers that are HIV positive until the baby's negative HIV status can be confirmed. Finally, it is contraindicated in babies that have confirmed severe combined immunodeficiency syndrome or those babies in whom their skid screening status is not known. The baby is acutely unwell and has a fever defer the BCG vaccine until after they have settled. If there is eczema over the preferred injection site, discuss with a senior about an alternative injection site, firstly, prepare your equipment, you will need A BCG vial which needs reconstituted with water for injections. A 1 mL syringe and two needles, one to draw up the solution and one to inject these are generally all available within the BCG pack. Draw up the reconstituted BCG solution. Naught point naught five mils is the dose. Take great care not to accidentally draw up. Naught 0.5 mils insert the needle very superficially into the upper aspect of the left arm over the deltoid muscle. This is an intradermal injection. The needle should be just visible through the skin and a bleb should be seen in the skin. On injection of the BCG vaccine do not inject it intramuscularly as this can cause an abscess as it is a live vaccine, remove the needle and syringe and dispose of them in the cytotoxic purple, sharp spin normal progress of the skin. After a BCG vaccine is for the baby to develop an injuried area over the site. This len develops into a papule over 2 to 3 weeks and this papule may then ulcerate which heals over several months leaving a scar. Local lymph nodes can be enlarged up to one centimeter. The child can be bathed as normal after the vaccine but try to avoid tight ft clothing, try to leave it uncovered as much as possible. But if it is discharging significantly, a dry bandage can be put over it never use a plaster. Do not give another vaccine into the same arm as the BCG vaccine until three months after this. As this can otherwise cause regional lymphadenitis. Children can otherwise have their childhood vaccination program as normal. Remember that as in old vaccines, premature babies have their BCG vaccine at their chronological age, not at their corrected age. Very rarely. The BCG vaccine can have some complications and normally a small scar can develop but rarely a large keloid scar formation can occur. This is more common if the BCG is given too superiorly on the arm. A local hypersensitivity reaction can also occur as the BCG is a live vaccine. There is a small risk of introducing TB infection, particularly if there is immunocompromise or if the vaccine is inadvertently administered intramuscularly, super adenitis and abscess formation should be treated with warm water compress and ID advice do not start anti TB therapy or drainage without discussing first disseminated TB disease is extremely rare, seek urgent ID advice and on the appropriateness of starting M PTV agents. Thanks so much for watching. 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