This week, Hope received her BCG (Bacillus Calmette–Guérin) vaccination.

Regarded as a hallmark of modern medicine, the vaccination is administered each year to over 100 million babies across the world, to protect against tuberculosis (TB).

The BCG shot is controversial among foreign parents in Japan due to its 18-needle “stamp” method of insertion.

BCG in Japan – what’s the big deal?

A brief search on any online forum for foreign parents will return countless column inches on the multi-puncture BCG vaccination and its resultant scar.

Foreign parents generally fall into one of two camps:

Camp I, Pro-BCG: Receive the vaccine and accept the risk of long-term / lifetime scarring

Exhibit A, below.

This camp would argue that ‘cosmetic reasons’ should not prevent children from having a vaccination that’s shown to have about 70% efficacy for babies. Indeed, since almost 100% of children have the same “made in Japan” scar, it’s a non-concern for families staying in the country long-term.

As with all routine immunisations in Japan, your baby up to the age of 1 can receive the BCG for free at a number of hospitals across your ward, using vouchers sent by the local public health office.

Doctors at nearby Nisseki and Sanno hospitals told us that the only possible place for Hope to have the 18-stamp vaccine was on her upper arm. Receiving the vaccine anywhere else on her body would not be covered by Japanese National Health Insurance vouchers.

Camp II, Anti-BGC: Don’t receive the vaccine and worry about your baby contracting TB

According to the World Health Organization, the number of cases of TB in Japan has been decreasing since 2000. At the same time, Tokyo Metropolitan Government data shows that in 2014, over 2500 new cases were discovered – and 216 people died from TB – in the capital alone.

And in the aftermath of the 3/11 disasters, interruption in treatment for one individual meant that the disease spread through an emergency shelter in the Tohoku region.

Cases of TB in under-14s are exceptionally rare in Japan – but not unknown. Some friends had been told by doctors in Tokyo that their babies did not need to have the vaccine if they were moving back to the UK or the US within a year or so.

But could we, as permanent residents of Japan, really justify not having it done?

Our dilemma

Having followed Japan’s public health schedule for all other vaccinations, we were torn.

In all honesty we did not want our wee pale-skinned angel to bear a scar in a prominent location, which could become an unwelcome talking point if we were to move countries at some point down the line.

We had also learned that children who receive the BCG vaccine may test positive for TB for a number of years after immunisation; this could be of relevance if Hope had to take a medical test to get into a particular college or profession, for example.

However, of most concern was that one-third of the world’s cases of TB (about 4.9 million people) are found in South-East Asia. Since we are fairly frequent travelers throughout the region, it’s likely that our daughter could visit a country where TB is still a real threat.

So, we decided to explore some middle ground: receive the vaccination as a one-hole shot in her arm (in the UK) or have the 18-hole shot on a a less visible part of our daughter’s body (in Japan).

BCG vaccination in the UK

TB has been almost eradicated in the UK, meaning that the BCG vaccine is no longer readily available. Only ‘high-risk’ babies are immunised on the NHS:

• Those born in areas where TB rates are higher than in the rest of the country, including some parts of inner London;
• Those who have a parent or grandparent who was born in a country where there is a high rate of TB.

When we were back in England in May, we inquired about the possibility of receiving a vaccination for Hope. However, NHS doctors in the area my brother lives (Epsom, Surrey) were unable to order and / or administer the BCG, and even after having called three different private clinics, we had no success (one clinic had a waiting list of three years!).

What our family decided

After countless conversations over the past seven months – at our dinner table, with my mama-tomo (mum friends) in Japan, and friends and family back in the UK – we finally had Hope receive the 18-needle vaccination in Japan, on the sole of her foot (her bum was also an option!).

For this, we visited the Tokyo Medical & Surgical Center (TMSC) and saw Dr Sumiyoshi, a Japan- and US-trained physician who was happy to bend the BCG rules. Dr Seez at the TMSC could also offer this service; other doctors in the practice would not.

Dr Sumiyoshi explained that having a shot in the upper arm muscle maximises the efficacy (“enhances the immunogenicity”) and reduces possible local adverse effects of the vaccine. He went on to say that having a shot on the bottom of the foot might be less successful, as “the efficacy has so far not been proven”.

Having weighed up the pros and cons, we went ahead with the procedure. I sang ‘Old McDonald Had a Farm’ and ‘5 Little Monkeys’ while Hope was injected quickly with two 9-needle stamps. Hardly a tear was shed (by mother or baby)!

In total, the consultation and vaccination cost us JPY10,800 (GBP73.60); we paid the fee in full.

Drawing to a close months of discussion, we are happy that our little cherub is up to date with her shots, and is on good form.

Phew.

If you managed to read this far . . . What would you have done / what did you do, in our shoes? Can you understand the viewpoints of both Camp I and Camp II? I’d love to hear!

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More reading

WHO Tuberculosis Country profiles HERE

WHO Tuberculosis Country Profiles JAPAN HERE

Historical Review of BCG vaccine in Japan HERE

Special Circumstances on Tuberculosis and BCG in Japan HERE

Problems with BCG Vaccination Program in Current Tuberculosis Control HERE

Tokyo reveals rare outbreak of tuberculosis, plays down ongoing risk HERE

BCG Vaccine Wikipedia HERE

Variation in yield of needle scars with multipuncture BCG vaccination HERE