London School of Hygiene & Tropical Medicine

An end to routine TB vaccination for schoolchildren will mean health resources can be more effectively targeted, a top expert said yesterday.

And Paul Fine, professor of communicable diseases epidemiology at the London School of Hygiene & Tropical Medicine, said that a new policy of using the BCG vaccine only on infants and adults in high-risk communities would bring Britain into line with much of the rest of the world.

Prof Fine said that the pattern of TB had changed enormously since the BCG vaccination programme against the disease began in the 1950s.

He added that the annual risk of infection in the UK had fallen from 20 per 1000 people in 1950 to less than 1 per 1000 today.

And the number of cases identified in people born in the UK had reached an all-time low in 2003.

Prof Fine said: "It is wise to re-examine processes which were introduced some time ago and examine the cost/benefit ratio. It's clear the BCG programme is no longer worth the cost and uses resources which could be shifted to tackle more pressing health problems."

He was speaking as his views were published in this week's edition of the prestigious British Medical Journal.

Prof Fine added: "The disease has become restricted to identifiable segments of the population, particularly immigrant communities, and that is where work should be concentrated."

He explained that Britain met the criteria set by the International Union Against Tuberculosis and Lung Disease for moving away from routine BCG vaccination in the mid-1990s.

But Prof Fine said that policy makers were reluctant to end the programme then because of fears that the increase in HIV infection and TB internationally might increase the risk of TB in the UK.

He added: "This feared increase hasn't happened and it's clear the risk of TB among immigrant populations declines over time after they have settled in the UK and that the imported disease hasn't led to increases in the disease among the indigenous population."

The new policy, which starts this autumn, means that BCG vaccination will be offered to infants in communities with an average incidence of TB of at least 40 per 100,000 and to unvaccinated people who come to the UK from countries where the incidence exceeds 40 per 100,000.

Prof Fine stressed: "BCG vaccination will continue to have an important role in protecting children in high risk populations from TB.

"Together with vigorous efforts to identify and treat TB cases and to offer treatment to people with latent infection, the new policy should allow more efficient control of the disease across the entire population of the UK."