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Health technology assessment of a selective BCG vaccination programme: Draft for public consultation

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Foreward

Following a request from the Minister for Health, the Health Information and Quality Authority agreed to undertake a health technology assessment of selective neonatal BCG vaccination. The assessment was completed and submitted as advice to the Minister for Health for consideration.

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Purpose

The purpose of this HTA was to determine the impact of changing from a universal to a selective national neonatal BCG vaccination programme.

Background

Tuberculosis (TB) remains a major health challenge, with an estimated 9.6 million new cases globally in 2014. As with most other Western European states, the incidence of TB in Ireland is low. In line with global trends, TB incidence in Ireland has been in decline over the last 25 years, with over 95% of cases occurring in adults. In 2014, there were eight cases of TB in children aged less than 16 years. The BCG vaccine provides protection against TB. Universal BCG vaccination of newborns was first introduced in Ireland in the 1950s. Due to declines in TB incidence, many European countries have ceased universal vaccination, mostly switching to selective vaccination of children at higher risk of contracting TB. At present in Western Europe, only Ireland and Portugal have universal vaccination programmes despite neither being considered a high TB incidence country.

Methodology

This assessment examined the clinical and cost-effectiveness of selective BCG vaccination of children at high risk of contracting TB, as well as the wider implications of making changes to elements of TB control in Ireland.