6 YEARS EXPERIENCE WITH THE DISCONTINUATION OF BCG VACCINATION .1. RISK OF TUBERCULOSIS INFECTION AND DISEASE

BCG vaccination programmes were introduced into Czechoslovakia 40 year s ago under a quite different epidemiological situation than that of t oday. Compulsory mass BCG vaccination of infants born in a selected ar ea was discountinued in 1986, except for those having a high risk of c ontracting tuberculosis or those whose parents expressly asked for it. The aim of this study was to ascertain the risk of tuberculosis infec tion and breakdown rate from infection to disease in 165 854 newborns following a period of 6 years. The average risk of infection in childr en aged 0-6 years was low (0.046%). No identifiable factors increasing the risk of infection were found. Primary tuberculosis was diagnosed in 31 children (7/100 000 persons/year); this corresponds to a 15.5% b reakdown rate from infection to disease. The majority of patients were symptom-free with minimal disease and detected in the course of regul ar check-ups. These findings indicate that the change from mass BCG va ccination to selective vaccination of high risk newborns can be recomm ended. Nevertheless social and economic aspects which involve migratio n, living conditions and the attitudes of the population, as well as o f medical staff, to vaccination should also be taken into consideratio n.