Bacillus Calmette-Guerin (BCG) vaccine is a live attenuated vaccine. With declining incidence of Tuberculosis in Europe, the only countries that routinely administer BCG to all babies at birth are Ireland, Bosnia–Herzegovina, Portugal and Norway.
In the UK, BCG is given to selected groups and there has been a recent change nationally in the timing of BCG vaccination. The timing of BCG has been moved from birth to 4 weeks to facilitate a pilot into severe combined immunodeficiency screening in six areas of the UK (Manchester, Birmingham, Sheffield, Newcastle, London Great Ormond Street Hospital and London Southeast Thames).1
The British Society of Gastroenterology recommend that babies exposed to biologics in pregnancy should not receive live vaccines for the first year of life.2 In the UK, this means babies would not receive the rotavirus (oral dose at 8 and 12 weeks) and BCG vaccination should be delayed (given in selected group at 4 weeks). American guidelines differ somewhat, suggesting only babies exposed to biologics in third trimester need to avoid live vaccines for the first 6 months.3 There is increased use of biologics throughout pregnancy including the third trimester given the results of large registries, including the Pregnancy Inflammatory bowel disease And Neonatal Outcomes (PIANO) registry, which support the safety of antitumour necrosis factor medications and highlight the risks of active disease in pregnancy.4
This new policy may increase the risk of babies inappropriately receiving live vaccines. The later time schedule results in a disconnect between postnatal obstetric and midwifery services, and the community team responsible for the vaccination of infants.
Babies are identified centrally and vaccinators often do not have access to the mother’s medical notes or pregnancy notes, for example, BadgerNet electronic records. The increasing use of biosimilar medications results in a myriad of trade names for biologic medications making it difficult for vaccinators to recognise category the drug falls under. Increasingly, we are relying on maternal recollection and understanding of exactly what type of medication they have received and the implications for vaccination of their baby. When the service transitions to the community, this will be an even greater risk. Clear systems of communication are essential to avoid future errors.
We recommend the following:
Written information should be given to mother during pregnancy explicitly listing which vaccines baby cannot have and why. A copy of this written information should be sent to the patient's General Practitoner. BCG and rotavirus are the two live vaccines given in the first 6 months in the UK.
Alert in maternity records to highlight mother was on biologic medications in pregnancy.
At the neonatal physical examination, an alert is entered into the babies red book highlighting that the baby should not have live vaccines for at least the first 6 months.
Use of generic names of medications to avoid confusion, particular in the advent of biosimilars.
Acknowledgments
Thanks to Dr Tracey Johnston and Rachel Carter at Birmingham Women’s Hospital for their helpful comments.
Footnotes
Twitter: @rachelcooney7
Contributors: RC conceived and wrote the first draft of letter and MP revised it.
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
Ethics statements
Patient consent for publication
Not applicable.
Ethics approval
Not applicable.
References
- 1. BCG immunisation programme: changes from September 2021 letter - GOV.UK. Available: www.gov.uk
- 2. Selinger C, Steed H. Management of the pregnant patient with inflammatory bowel disease. British Society of Gastroenterology 2021. [Google Scholar]
- 3. Mahadevan U, Robinson C, Bernasko N, et al. Inflammatory bowel disease in pregnancy clinical care pathway: a report from the American gastroenterological association IBD parenthood project Working group. Gastroenterology 2019;156:1508–24. 10.1053/j.gastro.2018.12.022 [DOI] [PubMed] [Google Scholar]
- 4. Odufalu F-D, Long M, Lin K, et al. Exposure to corticosteroids in pregnancy is associated with adverse perinatal outcomes among infants of mothers with inflammatory bowel disease: results from the piano registry. Gut 2021. 10.1136/gutjnl-2021-325317. [Epub ahead of print: 22 Oct 2021]. [DOI] [PubMed] [Google Scholar]