Kenya's BCG vaccine crisis could spark surge in newborn TB cases

Jane Akinyi (right) holding her baby while a medic adminster a Bacillus Calmette-Guerin vaccine(BCG) vaccine at Forest Dispensary in Nakuru on January 28,2019.Most of the hospitals in the county are facing shortage of the vaccine. [Kipsang Joseph/Standard] A nationwide shortage of Bacillus Calmette-Guerin (BCG) vaccines is leaving Kenyan newborns vulnerable to Tuberculosis (TB), a disease with high prevalence, health experts have warned. The vaccine has been out of stock for over a month, with some counties facing limited supply, while others have completely run out. Prof Ruth Nduati, a paediatrician and researcher, stresses the critical role of the BCG vaccine in protecting newborns. She explains that BCG acts as an antigen, teaching the body's immune system to recognise and combat TB bacteria without causing infection. "BCG is a very important vaccine. An infant who is vaccinated develops immunity after three weeks, which helps prevent severe forms TB," says Prof Nduati. She stresses that while the BCG vaccine does not entirely prevent TB infection, it significantly reduces the risk of severe manifestations, such as miliary TB, which can affect multiple organs, including the lungs. TB in babies can also lead to TB meningitis, a life-threatening condition that impacts the brain and central nervous system. "TB meningitis has a high fatality rate, and even survivors often face severe consequences, including brain damage, cerebral palsy, stunted growth, and lifelong disabilities," Prof Nduati notes. "Pulmonary TB damages the lungs permanently, even if successfully treated, and this is particularly concerning for children whose lungs are still developing," she adds. Symptoms of TB in infants, include persistent cough, weight loss, enlarged lymph nodes, altered mentation when the brain is affected, weakness, and reduced alertness and activity levels. "BCG prevents babies from developing severe forms of the disease. Although it doesn't guarantee full immunity, vaccinated children are far less likely to experience these critical complications," Prof. Nduati explains. She highlights the increased risk of TB transmission from adults to children, especially in households with individuals living with HIV. Stephen Anguva, the National Coordinator of the Network of TB Champions Kenya, warns that if nothing is done, the country will see an increase in TB cases among infants, with some potentially dying. "Infants are so vulnerable, and their first immune defence is the BCG vaccine. If mothers expose their babies, they are likely to get TB," Anguva says, adding. Data from the Ministry of Health reveals that the proportion of TB in children under 15 years old was 13 per cent in 2024, a slight increase from 12 per cent in 2023. In 2023, at least 139,000 people developed TB in Kenya, of which 17,000 were children. "While most adults with TB do not have HIV, the disease is often more severe in HIV-positive individuals. National TB programmes must prioritise screening among people living with HIV and those with advanced disease and implement standard TB prevention programmes, including prophylaxis," advises Prof Nduati. She further warns that undiagnosed TB cases in communities pose a significant threat. "Someone with undiagnosed TB could be a mother, father, babysitter, or relative, unknowingly transmitting the bacteria to infants. TB bacteria can linger in the air for up to 18 hours after being expelled through a cough," she explains. To protect newborns, Prof Nduati advises limiting their exposure to large groups of people and suggests that mothers and caregivers wear masks, especially if there is a respiratory infection. She also cautions against infections brought home by school-going children. "For babies born during this period of BCG shortage, we should not be surprised to see a rise in TB cases, including severe forms of the disease. Infants have low immunity, making them particularly vulnerable," Prof Nduati says. "After contracting TB, it typically takes 10 to 14 days for severe symptoms to develop," she explains. Despite the impact of the disease, Anguva notes that diagnosing TB in babies is a major problem. StopTB Partnership's Coordinator in Kenya, Evaline Kibuchi, explains that diagnosis in infants requires the removal of sputum for testing, which can be uncomfortable for babies as it involves inserting pipes into their respiratory system. In babies, TB presents with weight loss, lack of appetite, and fever-symptoms that can easily be mistaken for other diseases, leading to misdiagnosis. Kibuchi criticises the government for the inconsistency in the supply of BCG vaccines, which prevent TB in children. The country faced a stock-out of the vaccine last year. Prof Nduati is calling for urgent measures to address the vaccine shortage and prevent further harm to vulnerable populations. "Whenever crises, such as these arise, we must quickly identify the root cause and implement systems to prevent recurrence. Learning from our mistakes is essential for better future outcomes," she says, adding, "The current shortage of BCG vaccines is alarming. This is a shame for our nation, as immunising children is a predictable annual need that must be adequately planned for and budgeted." Permanent Secretary for Medical Services, Harry Kimtai stated that the National Treasury has allocated Sh500 million for the procurement of the vaccine, with logistics already coordinated with United Nations Children's Fund (Unicef). Meanwhile, civil society organisations have lamented the low budgetary allocation for immunisation, linking it to such disruptions. James Kamau, a health economist and the Chief Executive Officer for the Kenya Treatment Access Movement, attributes the vaccine shortage to the government's failure to allocate sufficient funds.

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