Global shortages of BCG vaccine and tuberculous meningitis in children

The WHO estimates that 1 million children younger than 15 years developed tuberculosis globally in 2016, 58 000 of whom live in South Africa.1 Vaccination with bacille Calmette-Guerín (BCG) has been an integral part of childhood immunisation programmes in countries with a high burden of tuberculosis for several decades. BCG traditionally has been considered to have limited efficacy in preventing tuberculosis disease in adults. However, BCG has consistently been shown to protect young children against miliary tuberculosis and tuberculous meningitis2,3—a devastating disease with high morbidity and mortality.