BCG vaccine

On this page you’ll find an overview of the BCG vaccine, including how it can protect against TB meningitis.

Tuberculosis (TB) is a very serious infectious disease that can cause TB meningitis.
The Bacillus Calmette–Guérin (BCG) vaccine provides protection against TB meningitis in children.
The World Health Organisation (WHO) recommends that all infants in countries with high TB rates get the BCG vaccine at or shortly after birth.
In several high-income countries, such as the UK, the BCG vaccine is only given to people at increased risk of coming into contact with TB.
Vaccination is the best way to prevent TB meningitis in children. With growing antibiotic resistance, it’s now more important than ever.

What is the BCG vaccine?

The Bacillus Calmette–Guérin (BCG) vaccine protects against the disease tuberculosis (TB), which is caused by the bacteria Mycobacterium tuberculosis. TB is an infection which usually causes disease in the lungs. But the bacteria can affect other parts of the body like the joints, kidneys and bones. It can also cause meningitis.

Read more about TB meningitis.

The BCG vaccine gives good protection against the TB meningitis in babies and young children. There are several versions of the BCG vaccine available. They’re made from a weakened strain of the bacterium Mycobacterium bovis.

The BCG vaccine doesn’t protect against TB that causes lung disease in adults. It also does not prevent the initial infection with the TB bacteria that cause disease. So it’s not effective at preventing the spread of the disease. Early detection of TB and quick treatment are key to stopping its spread.

The BCG vaccine is a live vaccine. It works by introducing a weakened form of the bacteria, known as an antigen, into the body. When you’re vaccinated, your immune system recognises the antigen and makes protective antibodies against it. These antibodies then circulate in the bloodstream. If you encounter the bacteria you’ve been vaccinated against, your antibodies can destroy them.

Who can get BCG vaccines?

The BCG vaccine is recommended for certain groups of people:

The World Health Organisation (WHO) recommends that all infants in countries with high TB rates get a single dose of the BCG vaccine at or shortly after birth.¹
In countries with low rates of TB, the WHO recommends the BCG vaccine for infants and children who are at higher risk of developing TB.
The vaccine is also recommended for children travelling to a country which has a high TB rate.

BCG vaccination policies and practices vary across countries. The BCG World Atlas is an online database. It provides information about BCG vaccination policies and practices in most countries around the world.

In several high-income countries, such as the UK, the BCG vaccine isn’t part of the routine vaccination schedules. But it is offered to children or adults who are at higher risk of TB, as follows.

Babies and children

It’s recommended that babies and children aged one to sixteen have the BCG vaccine if:

They live in an area with a high rate of TB.
They have a parent or grandparent born in a country with a high rate of TB.
They will be going to live or stay in a country with a high rate of TB.
They are close contacts of someone who has or had TB.

People at occupational risk of TB

BCG vaccination is recommended for those aged sixteen to 35 at risk of TB due to their work, including:

Healthcare workers with an increased risk of exposure to TB.
Laboratory staff who may come into contact with TB bacteria.
Vets and those who work with animals that are susceptible to TB, such as abattoir workers.
Those who work with people who may be more at risk of TB. This may include staff at facilities working with homeless people, refugees, asylum seekers, drug users and prisoners.

Travellers

The BCG vaccine is also recommended for any unvaccinated people under sixteen who will be living or working with friends, family or local people for over three months in a country with high TB rates.

Adults arriving from countries with high rates of TB

People returning from sub-Saharan Africa or high TB-risk countries may need the BCG vaccine.

Detailed information about who is offered the BCG vaccine in the UK is available from the NHS website.

Is the BCG vaccine safe?

Yes, the BCG vaccine is safe.

The BCG vaccine has been in use for over 100 years.² It has been given to millions of people worldwide and has an excellent safety record.

Before a vaccine is given to humans, scientists usually spend many years developing and testing it in the lab. A potential vaccine will only move to human trials if it appears to work safely. A vaccine must pass several phases of clinical trials in humans. They test its safety and effectiveness. Once licensed, a vaccine’s safety is then closely monitored during use. The WHO has also made recommendations to ensure the quality and safety of the BCG vaccines available.³

Like all vaccines, the BCG vaccine can cause side effects. The most common side effect of the BCG vaccine is a blister where the injection was given. This may appear as a raised bubble straight after the injection. It then turns into a blister or sore after two weeks. The area may become red and tender. The reaction usually heals within two to five months, leaving a small, flat scar. This is normal. If you’re worried or think the blister has become infected, see a healthcare provider.

Other common side effects of the BCG vaccine include:

Headache.
Swollen glands under the armpit on the side of your body where the injection was given. (this can develop 1 to 2 months after the vaccine is given)
High temperature (fever).

These symptoms are usually mild and go away on their own within a few days.

TB meningitis is a severe and life-threatening disease that can be fatal. So it’s important to get your children vaccinated if they are considered to be at risk.

Why is it important to take up the BCG vaccine?

TB is the leading cause of infectious death worldwide.⁴ It’s a serious infection that can cause TB meningitis.

TB meningitis is a life-threatening condition that is fatal without treatment. Up to half of survivors will have long-term after effects. These can include brain damage, epilepsy, paralysis and hearing loss.⁵

The vaccine saves lives. BCG vaccination has been estimated to prevent one case of TB meningitis for every 3,435 vaccinations given.⁶ It has saved over 10.9 million lives since the launch of the WHO's expanded immunisation programme in 1974.⁷

The United Nations Sustainable Development Goals (SDGs) include ending the tuberculosis epidemic by 2030. In 2015, the WHO Member States endorsed the End TB Strategy. It aims to reduce the number of TB deaths by 95% by 2035, compared to 2015 rates.⁸ BCG vaccination is key to achieving this.

For many years antibiotics have been used to treat TB. But the bacteria are finding new ways to resist antibiotics which makes the infection harder to treat. This is known as antimicrobial resistance. The WHO estimates that, in 2016, there were 600,000 new cases of TB with resistance to rifampicin, the most effective first-line drug to treat the disease. Of these, 490,000 had multidrug-resistant TB, where the bacteria were resistant to more than one type of antibiotic.⁹ Vaccination is key to preventing infections which are resistant to antibiotics and hard to treat.

Physical and emotional recovery from meningitis and its impact can be different for everyone. Support is available if meningitis has affected you or someone you know.

If you are in the UK or Ireland, the Meningitis Research Foundation Support Services team are ready to answer your questions.

If you are outside the UK and Ireland, our member network is the Confederation of Meningitis Organisations (CoMO). CoMO is dedicated to reducing the impact of meningitis globally, with members across the world. It is a great resource for finding support where you live.

Find a CoMO member in your country.

Frequently asked questions about the BCG vaccine

Why should people have the BCG vaccine?

People should have the BCG vaccine to protect themselves from severe forms of TB, including TB meningitis if they are identified to be at increased risk. TB meningitis is a serious, potentially life threatening disease. The disease can cause lifelong disability, and in some cases can be fatal. Vaccination is the best way to protect against TB meningitis.

How does the BCG vaccine work?

The BCG vaccine is a live vaccine. It works by introducing a weakened strain of tuberculosis bacteria into the body. This allows our immune system to recognise the bacteria and make protective antibodies against it. These antibodies then circulate in the bloodstream. If you come into contact with the bacteria you’ve been vaccinated against, the antibodies can destroy them before they can make you sick.

At what age should people have their BCG vaccine?

The BCG vaccine is typically given to babies soon after birth, usually by 28 days after birth. It can be given after 28 days, but is best given before the age of one.

The BCG vaccine may also be given to infants and children aged one to sixteen who have an increased risk of developing TB. BCG vaccination is rarely given to anyone over the age of sixteen and never over the age of 35, because it doesn't work very well in adults.

You only need to have the BCG vaccine once.

How effective is the BCG vaccine?

The BCG vaccine is 70-80% effective against the most severe forms of TB, such as TB meningitis. The vaccine doesn’t protect against TB that causes lung disease in adults. It also doesn't prevent initial infection with the TB bacteria that cause disease.

Can the BCG vaccine give you meningitis?

No, the BCG vaccine doesn’t cause meningitis. The BCG vaccine contains a weakened strain of TB bacteria that stimulates the immune system to produce protective antibodies. It doesn’t cause TB meningitis, but helps the body develop immunity against it.

The benefits of BCG vaccination in protecting against severe forms of TB, especially in high-risk populations, far outweigh the potential risks of side effects.

How do I find out what BCG vaccine is available in my country?

You can find out what BCG vaccine is available in your country by checking your country’s immunisation schedule here: WHO’s national immunisation schedule data portal.

The BCG Atlas is an interactive website that allows you to view information about a country's BCG vaccination policy.

The BCG vaccine is not part of the routine NHS vaccination schedule in the UK. But the vaccine may be given to children or adults who are at increased risk of TB.

Are there other vaccines that protect against TB?

Currently, the BCG vaccine is the only licensed vaccine available that protects against TB. The vaccine provides protection against TB meningitis in children.

Several new TB vaccine candidates are currently in clinical trials, aiming to provide better protection across all age groups. More information is available at Global Tuberculosis Programme.

Why is it important to continue the research and development of other TB vaccine candidates?

The BCG vaccine provides vital protection for infants from disease. But it does not always stop them from acquiring or carrying the bacteria without showing any symptoms. So the vaccine has a limited impact on the spread of the bacteria.

TB infection can reactivate in people who had harmlessly carried the bacteria. If illness, stress, or aging weakens the immune system, the bacteria can multiply. This can cause disease with symptoms like coughing, fever and weight loss.

Currently, BCG is the only available TB vaccine. But there’s hope that more effective vaccines that protect all age groups against all types of TB will be soon available.

References

Pooransingh, S., & Sakhamuri, S. (2020). Need for BCG Vaccination to Prevent TB in High-Incidence Countries and Populations. Emerging infectious diseases, 26(3), 624–625. https://doi.org/10.3201/eid2603.191232
Costello, V. H., raiciulescu, S., Santosham, M., Harrison, L., Aronson, N. E., & Aronson, N. E. (2023). 1721. BCG Vaccination Impact on Mortality: a 71 year Follow-up of a US BCG Controlled Trial. Open Forum Infectious Diseases, 10(Suppl 2), ofad500.1553. https://doi.org/10.1093/ofid/ofad500.1553
WHO. Recommendations to assure the quality, safety and efficacy of BCG vaccines, Annex 3, TRS No 979. Available from: https://www.who.int/publications/m/item/trs-979-annex-3-bcg-vax
Qu, M., Zhou, X., & Li, H. (2021). BCG vaccination strategies against tuberculosis: updates and perspectives. Human vaccines & immunotherapeutics, 17(12), 5284–5295. https://doi.org/10.1080/21645515.2021.2007711
Wang, MG., Luo, L., Zhang, Y. et al. Treatment outcomes of tuberculous meningitis in adults: a systematic review and meta-analysis. BMC Pulm Med 19, 200 (2019). https://doi.org/10.1186/s12890-019-0966-8
Roy, P., Vekemans, J., Clark, A., Sanderson, C., Harris, R. C., & White, R. G. (2019). Potential effect of age of BCG vaccination on global paediatric tuberculosis mortality: a modelling study. The Lancet. Global health, 7(12), e1655–e1663. https://doi.org/10.1016/S2214-109X(19)30444-9
Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C. W., Thompson, K. M., Badizadegan, K., Lambert, B., Ferrari, M. J., Jit, M., Fu, H., Silal, S. P., Hounsell, R. A., White, R. G., Mosser, J. F., Gaythorpe, K. A. M., Trotter, C. L., Lindstrand, A., O'Brien, K. L., … Bar-Zeev, N. (2024). Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet (London, England), 403(10441), 2307–2316. https://doi.org/10.1016/S0140-6736(24)00850-X
WHO. The end TB strategy, 2015. Available from: https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy
BCG vaccines: WHO position paper – February 2018. Available from: BCG vaccines: WHO position paper – February 2018 – Vaccins BCG: Note de synthèse de l’OMS – Février 2018

Author: Meningitis Research Foundation.
Reviewed by: Hajime Takeuchi, CoMO member.
Published: 7 April 2025.

Meningitis in your words: real-life stories

Meningitis affects millions of people, in all regions of the world. Through the bravery of sharing personal stories, we bring together people from every region of the world to support one another, so they are empowered to live a life beyond meningitis.

Sophia Speirs

Type - Meningococcal
Age group - Young adult (20-25)
Outcome - Recovery with after effects

"If only we had known there was a vaccine to help protect her."

Meningitis in your words

Percilla Ann Marie April-Hodge

Type - Pneumococcal
Age group - Adult
Outcome - Bereavement

"Percilla had a major headache. She thought it was a migraine."

Meningitis in your words

Earl Falconer

Type - Bacterial
Age group - 60+
Outcome - Recovery with after effects

"Meningitis has damaged my hearing – both ears are damaged in different ways."

Meningitis in your words