Tuberculosis (TB) was a leading cause of death in the first half of the century in Singapore. With improved socio-economic conditions and established TB control measures, the incidence rate of TB has declined from 307 cases per 100,000 population in 1960 to 47 per 100,000 in 2000. The number of deaths from TB has also declined from 646 in 1960 to 97 in 2000.

Singapore has a comprehensive TB Control Programme, which includes early detection of TB cases, treatment of infectious TB cases, treatment of infected contacts and prevention through BCG vaccination. The TB Control Programme was further strengthened in April 1997 with the implementation of the Singapore TB Elimination Programme (STEP). With STEP, there has been a 15% decline in the incidence of TB between 1997 and 2000.

BCG vaccination is one of the strategies in the national TB Control Programme. Since 1957, BCG vaccination has been given to all newborns. In addition, a second BCG vaccination has been given to children at 12 years or 16 years depending on their reaction to the Mantoux skin test.

BCG vaccination at birth has been shown to be highly effective in preventing the serious forms of childhood TB such as TB meningitis and disseminated TB. However, despite numerous studies done worldwide over the years, there is no scientific evidence to show that repeated BCG vaccination is effective in protecting against TB. Based on the absence of evidence to support the effectiveness of repeated BCG vaccination, the World Health Organisation (WHO) no longer recommends repeated BCG vaccination.

Repeated BCG vaccination is not practised in many developed countries including Australia, United Kingdom and the United States of America. Hong Kong, which has an incidence of TB that is about five times that of Singapore’s, discontinued the practice of repeated BCG vaccination last year.

The Ministry of Health, together with the Ministry’s expert advisory committees, namely the International Advisory Panel to the STEP, the STEP Committee and the Expert Committee on Immunisation, have carefully reviewed the practice of a second BCG vaccination and have decided to discontinue the practice of a second BCG vaccination from 1 July 2001. However, all newborns will continue to receive BCG vaccination at birth. The Ministry has informed schools, parents and doctors of the decision to discontinue the practice of a second BCG vaccination.

The Ministry reassures all parents that discontinuing the practice of a second BCG vaccination does not pose a threat to the health of their children. The Ministry will continue its efforts to eliminate TB in Singapore.