Friday, 5 August 2016

TB, the BCG, and the RVD

This week, our Project Cataloguing Archivist Rebecca looks at the development of the BCG vaccination and its introduction to Edinburgh:

I’m sure many of you will have the distinctive scar on your arm from the BCG [Bacille Calmette-Guérin] vaccination, which protects against tuberculosis [TB]. The vaccination works by injecting one with a weakened form of tuberculosis, so that the body is able to recognise and defend against the bacteria if one comes in contact with the disease.

A BCG poster on display as part of a public health exhibition, c. 1952. [P/PL16]
It is named for the men who developed it, Albert Calmette and Camille Guérin; they began their work in Lille in 1900, and worked throughout the German occupation of the city during World War I to create a weakened form of tuberculosis bacteria which wouldn’t cause infection when injected into animals. In 1921 the vaccine was ready for testing on humans, and was first administered orally to an infant whose mother had died from tuberculosis; by 1924, 664 infants had been vaccinated with BCG, and in the next four years 114,000 infants were vaccinated without serious complications. The vaccine was taken up in various European countries, but British doctors remained sceptical of its effectiveness, and in the US there were some concerns over the safety of the vaccine.

These concerns came to a head with the Lübeck disaster in 1930, in which a scheme to vaccinate 250 newborn infants led to 73 deaths and 135 infections of tuberculosis after a contaminated vaccine was used; though the BCG itself was not the cause of the disaster, confidence in it dropped considerably. However, when tuberculosis became a major public health concern in the aftermath of World War II, which led to renewed vigour in attempts to find a cure. Trials of BCG carried out in the UK at this time showed that the vaccine was highly effective when given to children who had not previously been infected with tuberculosis, leading to its adoption in this country.
Case notes from the Royal Victoria Dispensary, 1950, [LHB41/CC/2/PR2] , showing: (L-R)
A record that the patient was vaccinated and subsequent positive Mantoux tests, a form consenting to vaccination, and a negative and a positive Mantoux test result.

From around 1950, the Royal Victoria Dispensary [RVD] gave BCG vaccinations to children and young adults who were in close contact with a tuberculosis sufferers. A Mantoux test was given to all attendees of the clinic in order to determine if they had already been exposed to TB bacteria. If a young patient had a negative response to the Mantoux test, indicating that hadn’t been infected already, they would be given the vaccination in order to protect them against catching the disease in the future.

The 1949-1950 Annual Report of the Royal Victoria Tuberculosis Trust shows the optimism that the success of the vaccine brought to the community, proclaiming that “[t]he tuberculosis BCG vaccine has been accepted as being of value in stimulating immunity, and its increasing use among those approaching puberty who have not already come successfully through a tuberculous infection will prevent much of the morbidity and mortality of that period of life.” In this spirit, from the mid-1950s the UK introduced the routine vaccinations of school children, which continued until its replacement with a more targeted programme of vaccination in 2005.

A girl receives a BCG vaccination, 1953 [LHB16/38/21]

LHB41/7/1 Annual Report, 1949-1950

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