Bacillus Calmette-Guérin (BCG) Vaccine in America and Overseas: A Narrative Review

Abstract

This narrative review examines the role of the Bacillus Calmette-Guérin (BCG) vaccine in global tuberculosis (TB) control efforts, with particular emphasis on the differences in vaccination policies between countries, such as the US, where routine BCG administration is not practiced. A significant complication of the BCG vaccine is false positive results in the tuberculin skin test (TST), often leading to misdiagnoses and unnecessary treatments. To address these issues, interferon-gamma release assays (IGRAs) have emerged as a more specific diagnostic tool that reduces false positives associated with prior BCG vaccination. However, despite advancements, public health challenges persist in accurately detecting latent and active TB, particularly in populations previously vaccinated with BCG. This review synthesizes existing literature to assess these challenges, emphasizing the need for updated policies and improved diagnostic tools for BCG-vaccinated populations in the US and globally. Recommendations include integrating IGRAs into routine practice and tailoring TB control strategies to mitigate the diagnostic complications of BCG.