High-Yield MSRA Blog: BCG Vaccine, UK Vaccination Schedule, and Vaccine Types

💉 BCG (Tuberculosis) Vaccine

✅ Who Can Have BCG:

• Individuals at high risk of TB (e.g., from or in contact with high-incidence countries)

• Healthcare workers at occupational risk

• Asplenic or hyposplenic individuals (they can receive live vaccines including BCG)

❌ Who Should Not Have BCG:

• Previous BCG vaccination

• Positive tuberculin skin test (Mantoux)

• Past history of TB infection

• Severe allergic reaction to a BCG component

• Septic skin lesions at the injection site

• Infants born to mothers on immunosuppressants (defer until full evaluation)

• Known or suspected SCID

• Immunosuppressed individuals (HIV, chemotherapy, blood cancers, immunosuppressive drugs)

• Pregnant women (defer until postpartum)

• People over age 16, unless at very high risk (efficacy is limited in adults)

⚡ Exam Triggers (MSRA):

• Positive Mantoux → do not give BCG

• Asplenic patient → can receive all vaccines including BCG

• Pregnant or immunocompromised → avoid all live vaccines including BCG

🎓 UK Childhood Immunisation Schedule (2025)

Age	Vaccines Given
8 weeks	6-in-1 (DTaP/IPV/Hib/HepB), MenB (1), Rotavirus (1)
12 weeks	6-in-1 (2), PCV (1), MenB (2), Rotavirus (2)
16 weeks	6-in-1 (3)
1 year	Hib/MenC, PCV booster, MMR (1), MenB booster
18 months	6-in-1 (4), MMR (2) [for those born ≥ July 2024]
2–15 years	Annual nasal flu (LAIV) each autumn/winter
3y 4m	Pre-school booster: 4-in-1 (DTaP/IPV), MMR (2) [for those born ≤ June 2024]
12–13 years	HPV vaccine (2 doses)

⚡ Exam Pearls:

• LAIV (Live Attenuated Influenza Vaccine): Nasal spray, annual, contraindicated in severe asthma, immunosuppression, or aspirin use

• MMR timing differs depending on birth cohort (check for July 2024 cutoff)

• MenB moved earlier to 12 weeks in updated schedule

🧪 Vaccine Types & High-Yield Characteristics

Type	Examples	Key Points
Live Attenuated	MMR, BCG, Yellow Fever, Nasal Flu, Oral Typhoid	Strong immunity, contraindicated in immunocompromised or pregnancy
Inactivated	Rabies, Hep A, IPV, JE (IXIARO)	Safe in immunocompromised, but may need boosters
Toxoid	Tetanus, Diphtheria, Pertussis toxoid	Targets bacterial toxins; used in combination vaccines
Subunit (Recombinant)	HPV, Hep B, MenB	Contains fragments, safe, needs adjuvants and multiple doses
Conjugate	Hib, MenC, PCV, MenACWY	Polysaccharide + protein, especially effective in infants/young children

🔎 Special Notes on Travel Vaccines

🌏 Whole Killed (Inactivated) Travel Vaccines (Used in UK):

• Rabies vaccine

• Japanese Encephalitis vaccine (IXIARO)

Both are safe in pregnancy and immunosuppressed patients.

⚠ Live Travel Vaccines:

• Yellow Fever vaccine

• Oral Typhoid vaccine

• Contraindicated in pregnancy and immunosuppression

📝 Summary Table: Live vs Inactivated Vaccines

Live Vaccines	Inactivated / Safe in Immunocompromised
MMR, BCG, Oral Typhoid, LAIV, Yellow Fever	Rabies, IPV, Hep A, JE, Hep B, HPV, Tetanus, Diphtheria, PCV

✨ Final Takeaway for MSRA

• BCG: Only for high-risk TB individuals → avoid in immunocompromised/pregnancy

• UK Schedule: Memorise age-specific vaccines; know cohort cutoffs (MMR, MenB)

• Vaccine Types: Know which are live, which are killed, and contraindications

📚 References

• https://www.cdc.gov/tb/hcp/vaccines/index.html

• https://www.nhs.uk/vaccinations/bcg-vaccine-for-tuberculosis-tb/

• https://www.nhs.uk/vaccinations/nhs-vaccinations-and-when-to-have-them/