Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
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Year : 2009  |  Volume : 4  |  Issue : 2  |  Page : 93-94
Author's reply

Department of Medicine, College of Medicine, King Saud University, P. O. Box 2925, Riyadh 11426, Saudi Arabia

Correspondence Address:
Ibrahim O Al-Orainey
Department of Medicine, College of Medicine, King Saud University, P. O. Box 2925, Riyadh 11426
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1817-1737.49420

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How to cite this article:
Al-Orainey IO. Author's reply. Ann Thorac Med 2009;4:93-4

How to cite this URL:
Al-Orainey IO. Author's reply. Ann Thorac Med [serial online] 2009 [cited 2023 Jan 27];4:93-4. Available from:


In his letter, Dr. Al-Hajoj [1] proposes a review of BCG vaccination policy in Saudi Arabia as it is causing "more confusion than protection" and he suggests stopping BCG vaccination altogether. This despite the fact that tuberculosis incidence in Saudi Arabia is rising, according to the Ministry of Health statistics.

BCG vaccination of infants was confirmed to have significant protective efficacy against disseminated childhood tuberculosis and tuberculous meningitis. A meta-analysis of 5 randomized control trials and 8 case-control studies showed an average protection of 80% among children vaccinated in infancy. [2] The impact of vaccination was demonstrated by the decline of tuberculosis among young adults in the UK after the introduction of vaccination. [3] In Sweden discontinuation of BCG vaccination was associated with a demonstrable increase in childhood tuberculosis. [4]

Currently, BCG vaccine is not given routinely in USA, Canada and parts of western Europe, because of the low disease incidence in these countries (<5 cases/100,000). In Saudi Arabia, the incidence of the disease remains moderate (about 40 cases/100,000), and there is a high influx of foreign workers (including housemaids) from countries with high prevalence of tuberculosis. In these circumstances, exposure of children to the disease is likely to be significant; and therefore, prevention of serious childhood tuberculosis should remain a priority. This emphasizes the need to continue with the current policy of compulsory BCG vaccination of infants in Saudi Arabia. A revision of this policy is justified when the disease incidence declines to low levels.

   References Top

1.Al-Hajoj S. Can we change the way we look at BCG vaccine? Ann Thorac Med 2009;4:92-3.  Back to cited text no. 1    Medknow Journal
2.Rodrigues LC, Diwan VK, Wheeler JG. Protective effect of BCG against tuberculous meningitis and miliary tuberculosis: A meta-analysis. Int J Epidemiol 1993;22:1154-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Sutherland I, Springett VH. Effectiveness of BCG vaccination England and Wales in 1983. Tubercle 1987;68:81-92.  Back to cited text no. 3  [PUBMED]  
4.Romanus V, Svensson A, Hallander HO. The impact of changing BCG coverage on tuberculosis incidence in Swedish-born children between 1969 and 1989. Tubercle Lung Dis 1992;73:150-61.  Back to cited text no. 4    


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