BCG vaccine comes as a dry powder. Before you can use it you must reconstitute it with diluent (see Module 7).
Remember about BCG immunization: before you use any vaccine or diluent check:
• whether the label is still attached to the vial; if it is not, dispose of the vial;
• whether it is the right vaccine or diluent;
• whether the expiry date of the vaccine or diluent has passed; if it has, dispose of the vial;
• whether the vaccine vial monitor (if one is present on the vial) has changed colour; if it has, dispose of the vial.
1.1 Position the child
BCG vaccine is usually injected on the outer part of the left upper arm. Inject the vaccine in the same place for each child to make it easy to find the BCG scar subsequently.
Ask the parent to free the child's arm from its clothing, to seat the child on her or his lap, and to hold the child firmly.
1.2 Inject the BCG vaccine
The dose of BCG vaccine is only 0.05 ml. To measure and inject such a small dose accurately you must use a special BCG syringe (0.1 ml), and a special BCG needle (10 mm, 26 gauge) (reusable).
Figure 8-A: BCG syringe and needle
1) Load the syringe with BCG vaccine.
Do NOT shake the BCG vaccine ampoule. Shaking can damage the vaccine.
2) Hold the child's arm with your left hand so that:
- your left hand is under the arm;
- your thumb and fingers reach around the arm and stretch the skin tight.
3) Hold the syringe in your right hand, with the bevel of the needle facing up towards you.
4) Lay the syringe and needle almost flat along the child's arm.
Figure 8-B: Position of syringe and needle
5) Insert the tip of the needle just under the skin - insert only the bevel and a little bit more.
6) Keep the needle FLAT along the arm, so that it goes into the top layer of skin only. Keep the bevel facing UP.
Figure 8-C: BCG needle position
7) Do NOT push too far and do NOT point down or the needle will go under the skin. If BCG is injected under the skin an abscess or enlarged glands may result.
8) To hold the needle in position, put your left thumb on the lower end of the syringe near the needle, but DO NOT touch the needle.
9) Hold the plunger end of the syringe between the index and middle fingers of your right hand. Press the plunger in with your right thumb.
Figure 8-D: Injecting BCG
10) Inject the vaccine and remove the needle.
If you have injected BCG correctly you will see a clear, flat-topped swelling on the skin, like a mosquito bite. The swollen skin may look pale with small pits.
When an intradermal injection is given correctly the plunger is hard to push.
If the vaccine goes in easily you may be injecting too deeply. In this event, proceed as follows:
- Stop injecting immediately, correct the position of the needle, and give the remainder of the dose but no more.
- If the whole dose has already gone under the skin, count the child as being injected. Do NOT repeat the dose.
- Ask the parent to return with the child if any side-effects, such as abscesses or enlarged glands, appear