I am 13 years old and live in London. I have heard many different rumors and stories about the BCG vaccination. We were going to have it, but the government has run out of enough to give to schools. I'll probably go to my doctor to have it done. Does it hurt? Please be truthful. I am not strong. I can take normal injections, but I've heard the BCG is bigger and all that. Is it possible for me to be put asleep to get the shot? What would it be like with general anesthetic? I'm desperate to know and very nervous.

Ricky

The BCG (Bacille Calmette-Guerin) vaccine is given in an effort to prevent tuberculosis (TB). As I have discussed in this column in the past, what most people think of when they talk about TB is a chronic lung infection, the most common form of active (symptomatic) TB. The BCG vaccine is a strain of Mycobacterium bovis, a bacterium very similar to Mycobacterium tuberculosis, the bacterium that causes TB. The BCG vaccine is, perhaps, up to 50 percent effective in preventing active TB. Its greatest benefit, however, is in preventing serious forms of TB in children, such as tuberculous meningitis (infection of the membranes covering the brain and spinal cord) and disseminated tuberculosis (widespread infection). Some studies found the BCG vaccine more than 80 percent effective in preventing these forms of TB in children, which are significant causes of death in many countries.

The BCG vaccine is relatively safe, particularly in people who are otherwise healthy. If it is given to someone with a serious immune disorder, however, it can cause actual disease similar to tuberculosis itself. Its most common complications occur at or near the site of injection, including blistering and lymph node swelling. There also may be some pain, though usually not much more than that seen with other vaccines. The vaccination can leave a small permanent scar, much like a smallpox vaccine scar. However, these side effects are considered to be minor, considering the vaccine's potential benefits. BCG is thus given in countries where the risk of TB is high. In the United States, the vaccine is currently only recommended in special circumstances, such as when a child or a health care worker is continually or frequently exposed to people with the infection, particularly people with resistant strains of the TB bacterium.

As far as the size of the shot is concerned, I do not think it is much to worry about. It should involve a small needle delivering a small amount of the vaccine. The shot itself hurts about the same as any shot, and you certainly do not want to be put asleep for it. General anesthesia is not to be taken lightly, and doctors would never give it to avoid the minor pain associated with a vaccine injection.