Missed BCG jabs, leaves newborns at risk of deadly TB

Jane Akinyi (right) holding her baby while a medic adminster a Bacillus Calmette–Guérin vaccine (BCG) vaccine at Forest Dispensary in Nakuru on January 28, 2019. [File, Standard]

Failure to vaccinate newborns with the Bacillus Calmette-Guérin (BCG) vaccine puts them at serious risk of developing tuberculosis (TB), health experts have warned.

The BCG jab, administered shortly after birth, is a vital part of Kenya’s Expanded Programme on Immunisation (EPI). It protects infants from severe forms of TB, including TB meningitis and miliary TB, which can lead to death or lifelong disability.

Earlier this year, reported stock-outs disrupted the vaccine’s availability in some public health facilities, leaving thousands of newborns unprotected. Health professionals are now urging parents whose babies may have missed the vaccine to immediately visit the nearest health centre to catch up.

“The vaccine is very important in protecting children against TB. Children have lower immunity, and TB is a contagious disease that can kill them very quickly,” says Edith Anjere, Immunisation Coordinator in Vihiga County.

Kenya remains classified as a high TB burden country. Ensuring full immunisation coverage is essential to protect newborns and other vulnerable groups. Anjere confirms that vaccine stocks have since stabilised nationwide and urges parents to ensure their babies are vaccinated as soon as possible. “Parents and caregivers should ensure that every child born in a health facility receives the BCG vaccine before being discharged,” she says.

Anjere also emphasises the need to follow the national schedule, beginning with the BCG and oral polio vaccines at birth, followed by other routine immunisations to ensure a healthy start in life.

Vihiga County has recorded the highest rate of fully immunised children in Kenya, 96 per cent, well above the national average of 80 per cent, according to Ministry of Health data.

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Professor Ruth Nduati, a paediatrician and researcher, underscores the critical role of the BCG vaccine in protecting infants. “BCG acts as an antigen, training the immune system to recognise and fight TB bacteria without causing infection,” she explains.

Vaccinated infants typically develop immunity within three weeks. While BCG does not completely prevent TB infection, it significantly reduces the risk of severe forms such as TB meningitis and miliary TB. TB meningitis, in particular, has a high fatality rate and can lead to brain damage, cerebral palsy, stunted growth, or lifelong disability in survivors. “Pulmonary TB also causes permanent lung damage, which is especially concerning for young children whose lungs are still developing,” Prof Nduati adds.

Symptoms of TB in babies include persistent cough, weight loss, swollen lymph nodes, fatigue, and neurological changes if the brain is affected. These symptoms can easily be misdiagnosed, especially in infants.

“Although BCG doesn’t provide full immunity, it dramatically lowers the chances of serious complications,” says Prof Nduati. She warns that infants in households with adults living with HIV are especially at risk, as they may be unknowingly exposed to active TB infections.

Ministry of Health data reveals that TB cases in children under 15 accounted for 13 per cent of total TB cases in 2024, up from 12 per cent in 2023. In 2023 alone, 139,000 people developed TB in Kenya, including 17,000 children.

“While most adults with TB do not have HIV, the disease tends to be more severe in HIV-positive individuals. “National TB programmes must prioritise screening in people living with HIV and roll out standard TB prevention strategies, including prophylactic treatment,” Prof Nduati explains.

Undiagnosed TB in communities remains a serious threat. “The person spreading TB could be a parent, babysitter, or relative. TB bacteria can linger in the air for up to 18 hours after being expelled by someone coughing,” she cautions.

To protect newborns, Prof Nduati advises parents to avoid exposing infants to large gatherings. She also recommends that mothers and caregivers wear masks, particularly if they show signs of respiratory illness. School-going siblings can also carry infections home, so caution is advised.

With vaccine shortages earlier this year, Prof Nduati warns that more TB cases among children could emerge in the coming months. “We should not be surprised to see a rise in severe TB cases due to earlier BCG stock-outs,” she says. “Infants have low immunity and are extremely vulnerable.”

Stephen Anguva, National Coordinator of the Network of TB Champions Kenya, agrees. He stresses that recurring BCG vaccine stock-outs contribute to rising TB infections in infants, some of which can be fatal. “Infants are extremely vulnerable. Their first line of defence is the BCG vaccine. Without it, they’re at risk,” he says.

Anguva adds that once exposed, it typically takes 10 to 14 days for infants to show severe symptoms.

Despite the seriousness of TB in children, diagnosis remains difficult. Evaline Kibuchi, Kenya Coordinator of the Stop TB Partnership, explains that confirming TB in babies requires extracting sputum from deep in the lungs—a procedure that is uncomfortable and difficult to perform. “In babies, TB symptoms such as weight loss, poor appetite, and fever are often mistaken for other illnesses, leading to delays or misdiagnosis,” she says.

Kibuchi criticises the government’s failure to maintain a consistent vaccine supply. “We’ve experienced BCG stock-outs this year and last year. This should never happen,” she says.

Prof Nduati is calling for better planning and budgeting to avoid future shortages. “Stock-outs of vaccines are avoidable. Immunising children is a predictable, annual need. When crises like this arise, we must investigate the root causes and act fast to prevent repeat occurrences. We cannot afford to fail our children again,” she says.