Chloe Ramirez
Tuberculosis is an ongoing pandemic caused by the bacteria Mycobacterium tuberculosis, which usually attacks the lungs but can affect any part of the body. The Bacillus Calmette-Guérin (BCG) vaccine is the only licensed vaccine for tuberculosis and has been used in Mexico since 1951. While the BCG vaccine has shown significant effectiveness in several populations, its protective effect across different age groups has been inconsistent. In Mexico, the BCG vaccine is part of the national vaccine program and is required for school attendance. However, it is not a mandatory vaccination, and coverage rates have been decreasing in recent years, with an increase in new tuberculosis cases.
| Characteristics | Values |
|---|---|
| Country | Mexico |
| Vaccine Name | Bacillus Calmette and Guérin (BCG) |
| Vaccine Use | Primarily used against tuberculosis (TB) |
| Vaccine Coverage | Coverage is 90% or higher, except for the 2017-2020 period |
| Vaccine Efficacy | 44-99% protection against neonate pulmonary TB, 85-90% against severe TB, 73% against TB meningitis, and 77% against miliary TB |
| Incidence of Tuberculosis | In 2022, the incidence rate of tuberculosis in Mexico was the highest in the period analyzed |
| Required Vaccine | It is a required vaccine for school attendance |
| Population at Risk | Hispanic or Latino persons are at a higher risk of TB |
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What You'll Learn
Tuberculosis vaccine coverage in Mexico
Tuberculosis is an ongoing pandemic caused by the bacteria Mycobacterium tuberculosis, which usually attacks the lungs but can affect any part of the body. Anyone can get tuberculosis, but it is known to disproportionately affect certain groups, including Hispanic or Latino persons. In 2023, TB disease was reported among 3,546 Hispanic or Latino persons in the United States, accounting for 36.8% of all people reported with TB nationally.
The Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB). It is the only vaccine licensed against tuberculosis and was first used in humans in 1921. The World Health Organization (WHO) recommends that any BCG vaccine used in immunization programs should comply with their standards. The WHO also recommends that the BCG vaccine only be given to babies born in countries where tuberculosis is common. In countries where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated.
The BCG vaccine was first applied in Mexico in 1951, and an overall vaccination program for children above 5 years old was executed in 1991 under the name "Universal Vaccination Program". This program achieved a ≥90% vaccination coverage rate. However, in recent years, coverage has decreased, with one source stating that coverage was lower than 90% during the 2017-2020 period. Another source states that in 2022, around % of the population in Mexico was vaccinated against tuberculosis. According to some, the vaccine is not required in Mexico, and not everyone is offered it. However, others claim that it is a required vaccine for school attendance.
The variable efficacy of the BCG vaccine has been observed in different clinical trials, with trials in the UK showing a 60 to 80% protective effect, while trials conducted elsewhere have shown no protective effect. A 1994 systematic review found that the BCG vaccine reduces the risk of getting tuberculosis by about 50%. The duration of protection offered by the BCG vaccine is also variable, with some studies showing protection waning to 59% after 15 years and disappearing after 20 years, while others have found evidence of protection even 60 years after immunization. The variable efficacy of the BCG vaccine may be due to factors such as genetic differences in populations, changes in the environment, exposure to other bacterial infections, and conditions in the laboratory where the vaccine is grown.
Several new TB vaccine candidates are currently under development, and some have reached advanced clinical trials. These new vaccines are designed to be used as booster vaccinations after neonatal BCG vaccination.
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Effectiveness of the BCG vaccine
The Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB). It was first used in Mexico in 1951, and since 1991, the country has had a "Universal Vaccination Program" that envisions vaccinating children above 5 years old. However, BCG vaccine coverage has decreased in recent years, with coverage lower than 90% during the 2017-2020 period.
The effectiveness of the BCG vaccine varies depending on the population and the region. In countries where tuberculosis is common, the World Health Organization (WHO) recommends that all healthy babies receive a dose as soon after birth as possible. In areas where tuberculosis is not prevalent, only children at high risk are typically immunized. The BCG vaccine has shown significant effectiveness in several populations, with protection rates ranging from 44-99% against neonate pulmonary tuberculosis, 85-90% against severe TB, 73% against TB meningitis, and 77% against miliary TB. A 2014 meta-analysis found that the BCG vaccine reduced infections by 19-27% and reduced progression to active tuberculosis by 71%.
The duration of protection offered by the BCG vaccine is not entirely clear. While some studies have shown that protection wanes over time, others have found evidence of long-term protection lasting several decades. The protective effect of the BCG vaccine also seems to be greater in preventing severe forms of tuberculosis, such as miliary tuberculosis and tuberculosis meningitis, than in preventing pulmonary tuberculosis.
While the BCG vaccine is an important tool in the fight against tuberculosis, it is not sufficient on its own. New TB vaccine candidates are currently under development, and improving vaccination campaigns and coverage is necessary to protect the population effectively.
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Tuberculosis rates in Mexico
Tuberculosis is an ongoing pandemic and remains a public health problem in Mexico. The Bacillus Calmette–Guérin (BCG) vaccine is the only licensed vaccine against tuberculosis. The World Health Organization (WHO) recommends the BCG vaccine for countries where tuberculosis is endemic, and Mexico has been using the BCG vaccine since 1951.
In Mexico, tuberculosis cases have decreased by 2% annually from 1990 to 2010. However, the country has seen a decrease in BCG coverage in recent years, with coverage falling below 90% between 2017 and 2020, and dropping to 21% in 2020. This low coverage has occurred concomitantly with new cases of tuberculosis. The variable efficacy of the BCG vaccine has been observed in different clinical trials, and its effectiveness depends on various factors, including geography, genetic differences in populations, and environmental changes.
The protective effect of the BCG vaccine also varies depending on the form of tuberculosis. For example, it has been observed to provide 44-99% protection against neonatal pulmonary tuberculosis, 85-90% against severe TB, 73% against TB meningitis, and 77% against miliary TB.
In Mexico, the BCG vaccine is part of the national vaccine program, and it is required for children to receive it before attending school. However, it is not a mandatory vaccination for the general population, and not everyone in Mexico receives the vaccine.
Tuberculosis is linked to poor nutrition and poverty, and preventive treatment is recommended for those with latent TB infection, as they are at risk of developing TB disease.
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The BCG vaccine's variable efficacy
Mexico has been administering the Bacillus Calmette–Guérin (BCG) vaccine since 1951, with a Universal Vaccination Program for children over five years old being established in 1991. However, in recent years, there has been a decrease in vaccination coverage, with an increase in tuberculosis cases. While the BCG vaccine is effective against tuberculosis, its protective effect varies across different age groups and forms of TB. This variability in efficacy has been observed in clinical trials and is influenced by various factors.
The protective effect of the BCG vaccine ranges from 44% to 99% against neonate pulmonary tuberculosis, 85% to 90% against severe TB, 73% against TB meningitis, and 77% against miliary TB. However, its efficacy against pulmonary tuberculosis, especially in adults, is variable and appears to be lower in tropical and subtropical regions. Trials in the UK consistently demonstrate a 60% to 80% protective effect, while trials conducted in other regions have shown no protective effect, with efficacy decreasing as one moves closer to the equator.
The variable efficacy of the BCG vaccine is attributed to several factors, including geography, genetic differences in populations and BCG strains, exposure to other bacterial infections, and environmental changes. The Birmingham BCG trial in the UK examined children with family origins from the Indian subcontinent, where vaccine efficacy was previously found to be zero. The trial contradicted the genetic variation hypothesis by demonstrating a 64% protective effect, similar to other UK trials.
The duration of protection offered by the BCG vaccine is also inconsistent, with studies showing waning protection over time. While some studies indicate protection decreasing to 59% after 15 years and disappearing after 20 years, others have found evidence of protection even 60 years after immunisation, albeit with slightly reduced efficacy. The protective effect of the BCG vaccine also seems to wane faster in participants with negative tuberculin skin tests compared to those with positive tests.
In summary, while the BCG vaccine is effective against tuberculosis, its variable efficacy across different populations, age groups, and forms of TB highlights the need for improved vaccination strategies and the development of new vaccines with greater efficacy, especially against adult pulmonary tuberculosis.
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The BCG vaccine and school attendance in Mexico
The Bacillus Calmette–Guérin (BCG) vaccine is the only vaccine licensed against tuberculosis, a disease that affects the lungs and other parts of the body. While the BCG vaccine has shown significant effectiveness in several populations, its protective effects have not been consistent across all age groups and forms of TB. In Mexico, the BCG vaccine was first introduced in 1951, and a national vaccination program for children above five years old was implemented in 1991 under the "Universal Vaccination Program".
However, in recent years, Mexico has seen a decrease in BCG vaccine coverage, with an increase in new tuberculosis cases. Between 2017 and 2020, vaccine coverage fell below 90%, and as low as 21% in 2020, resulting in a considerable number of individuals left unprotected. This trend is concerning, given the re-emergence of tuberculosis as a public health problem in the country.
To address this issue, Mexico has implemented the Expanded Program on Immunizations, aiming to increase vaccination coverage and protect the population. While the BCG vaccine is not mandatory for all individuals in Mexico, it is required for children to attend school. This requirement ensures that a significant portion of the population is vaccinated and helps control the spread of tuberculosis among school-aged children.
The effectiveness of the BCG vaccine varies across different regions and populations, with trials in the UK showing a 60 to 80% protective effect, while other trials have shown no protective effect. Several factors contribute to this variability, including genetic differences in populations, environmental changes, exposure to other bacterial infections, and laboratory conditions for the vaccine's growth. Despite the variable efficacy, the BCG vaccine remains an important tool in the fight against tuberculosis, especially in countries like Mexico, where the incidence of tuberculosis is high.
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Frequently asked questions
No, the tuberculosis vaccine is not mandatory in Mexico. However, it is recommended that infants receive a dose right after birth, especially in countries where tuberculosis is common.
No, not all infants in Mexico receive the tuberculosis vaccine. Coverage is variable and has decreased in recent years.
In 2022, the incidence rate of tuberculosis in Mexico was the highest in the period analysed, with an overall increasing trend.
Tuberculosis is known to affect Hispanic and Latino persons at higher rates than other groups. Therefore, it can be assumed that the incidence of tuberculosis in Mexico may be higher compared to some other countries.
