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Response: Policies must be agreed locally with school health services

Helen Thornton

Thank you for looking for clarification regarding administration of influenza vaccine at the same time as school BCG vaccine.

As stated in the article this was an unanticipated problem. At the time of the influenza campaign (1998-99), I contacted infection control and the school health services to ask why there was a problem. Their explanation was that the individual school nurse or doctor in attendance would ask the child if any other immunisations had been administered within the preceding three weeks. If any had and there was any suspicion that it could have been a live vaccine, the BCG would be deferred.

I do appreciate that influenza vaccines are now only available in inactivated form, but they have been available in a live form in the past. The responsibility for deciding whether or not a child may receive the school BCG lies with school health service and not the paediatric diabetes care team and is, therefore, beyond our control. 

Within the article ‘live’ was placed in inverted commas to indicate that it could be open to interpretation, and I apologise for any confusion that this may have caused. 

Locally, this issue of dual administration of the vaccines is subject to discussion because there are also practical difficulties surrounding site usage post-vaccination, as insulin should not be administered at the same site as BCG for three months, or until the BCG ulcer has healed.

In conclusion, influenza vaccines may be administered at the same time as school BCG vaccines if agreed locally.

Thank you for looking for clarification regarding administration of influenza vaccine at the same time as school BCG vaccine.

As stated in the article this was an unanticipated problem. At the time of the influenza campaign (1998-99), I contacted infection control and the school health services to ask why there was a problem. Their explanation was that the individual school nurse or doctor in attendance would ask the child if any other immunisations had been administered within the preceding three weeks. If any had and there was any suspicion that it could have been a live vaccine, the BCG would be deferred.

I do appreciate that influenza vaccines are now only available in inactivated form, but they have been available in a live form in the past. The responsibility for deciding whether or not a child may receive the school BCG lies with school health service and not the paediatric diabetes care team and is, therefore, beyond our control. 

Within the article ‘live’ was placed in inverted commas to indicate that it could be open to interpretation, and I apologise for any confusion that this may have caused. 

Locally, this issue of dual administration of the vaccines is subject to discussion because there are also practical difficulties surrounding site usage post-vaccination, as insulin should not be administered at the same site as BCG for three months, or until the BCG ulcer has healed.

In conclusion, influenza vaccines may be administered at the same time as school BCG vaccines if agreed locally.

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