Tuberculosis in Malta and the school BCG vaccination programme

Abstract

Background: Malta has one of the lowest incidence rates of tuberculosis in Europe and a comprehensive free-of-charge health care system. Objective: To investigate whether Malta satisfies the criteria recommended by the International Union Against Tuberculosis and Lung Disease (IUATLD) in order to consider the discontinuation of the present school BCG vaccination programme. Method: Review of World Health Organization (WHO), and IUATLD guidelines for BCG use and discontinuation. Examination of surveillance data pertaining to tuberculosis in Malta, for the years 1979 to 2008. Findings: Malta has a long-standing, well-developed surveillance, treatment and follow-up programme for tuberculosis. The average annual notification rate of smear positive pulmonary tuberculosis was about 2 per 100,000 person-years since 1990. This is well below rates recommended by the IUATLD for the discontinuation of routine BCG vaccination programs. Conclusion: Malta satisfies established international criteria for discontinuation of the school BCG vaccination programme and therefore the programme should be reconsidered.