Advice for midwives, general practitioners, practice nurses, health providers and Public Health Units
Changes in tuberculosis legislation
The Health (Protection) Amendment Act 2016 repealed the Tuberculosis Act 1948 and the Tuberculosis Regulations 1951. From 4 January 2017:
- tuberculosis is notifiable under the Health Act 1956 instead of the Tuberculosis Act 1948
- the requirements under the Tuberculosis Regulations 1951 to gazette approved BCG vaccinators no longer apply
- all new BCG vaccinators are required to become authorised vaccinators under clauses 44A(1) and 44A(2) of the Medicines Regulations 1984 and then seek endorsement as a BCG vaccinator from their local Medical Officer of Health
- all existing gazetted BCG vaccinators were given an initial national BCG vaccinator endorsement by the Ministry of Health for a two-year period until 4 January 2019, after which they are required to seek regional BCG vaccinator endorsement from their local Medical Officer of Health.
Access to BCG vaccine
From 2015 to 2018 there was a global shortage of Bacillus Calmette-Guérin (BCG) vaccine which affected New Zealand and many other countries. Vaccine supplies are now available but continue to be limited.
BCG vaccine is only available through local District Health Board (DHB) BCG vaccination programmes, to babies and children aged 0-5 that meet the following eligibility criteria (as per the PHARMAC Schedule):
- they will be living in a house or family/whānau with a person with either current TB or a history of TB
- they have one or both parents or household members or carers who, within the last 5 years, lived for a period of 6 months or longer in countries with a TB rate ≥ 40 per 100,000 (see current list)
- during their first 5 years they will be living for 3 months or longer in a country with a TB rate ≥ 40 per 100,000.
Babies under 6 months of age that meet the above eligibility criteria are considered highest priority and midwives should screen babies for referral to local DHB BCG vaccination clinics.
Children aged between 6 months and 5 years may need to have a tuberculin skin test in the first instance to detect whether they have already been infected with TB.
Parents or caregivers of older children who met the eligibility criteria over the period the vaccine was unavailable may request BCG vaccination for such children, for assessment on a case-by-case basis.
Ordering BCG vaccine
The vaccine is available for order through ProPharma by authorised DHB BCG vaccination clinics only. The vaccine comes in a box of 10 vials each containing 10 doses, so please minimise wastage by planning vaccination clinics accordingly.
New BCG vaccinators
To be endorsed as a new BCG vaccinator, individuals must apply to their local Medical Officer of Health and provide documented evidence that they:
- are a current authorised vaccinator (see Appendix 4 of the Immunisation Handbook for more details on authorised vaccinators)
- have successfully completed a Ministry of Health-approved BCG vaccination training course (see below for details)
- have completed, under clinical supervision (by a currently approved BCG clinical assessor - see below for details), a minimum of five BCG vaccinations, and have been assessed as competent by the clinical supervisor
- have been nominated by their employer for endorsement as a BCG vaccinator.
It is the BCG vaccinator’s professional responsibility to ensure they apply for the appropriate regional endorsement(s).
BCG endorsement is valid for up to two years from the completion of the BCG vaccinator training.
Tuberculosis, Mantoux Skin Testing and BCG Vaccinator Update Online Course
The Ministry-approved online course Tuberculosis, Mantoux Skin Testing and BCG Vaccinator Update is available through the Immunisation Advisory Centre (IMAC) as a requirement for BCG endorsement or to update your knowledge in this area. The course is 8 hours and is also followed by a clinical assessment component if you are not currently a BCG-endorsed vaccinator or were not previously gazetted. There is a small charge for the course.
If planning to seek BCG endorsement, please confirm eligibility with your local Medical Officer of Health BEFORE enrolling. Please note, completing the course does not by itself confer or renew BCG endorsement.
Qualifying criteria for BCG Clinical Assessors
BCG clinical assessors must be approved by their local Medical Officer of Health. To qualify for approval, the assessor must currently be an authorised vaccinator who is both BCG-endorsed and employed as a BCG vaccinator.
Renewal of BCG vaccinator endorsement
To renew BCG endorsement, vaccinators must apply to their local Medical Officer of Health prior to the expiry date and provide documented evidence that they:
- are a current authorised vaccinator, and
- have completed an online vaccination course that includes an update on BCG*.
*NOTE: this course will only be available online from March 2020. It will be available as part of IMAC education and you will be able to choose an Immunisation Update that includes BCG. If you have any questions, please email firstname.lastname@example.org
BCG Vaccinator practising in another region, or ceasing practice
BCG-endorsed authorised vaccinators are approved regionally by Medical Officers of Health and must notify their Medical Officer of Health if ceasing practice or no longer practising in the region. Individuals wishing to practise in another region must be approved beforehand by the Medical Officer of Health, and provide the new local Medical Officer of Health with:
- evidence of their current vaccinator authorisation and BCG endorsement in another health district, and
- details of their proposed work in the district.
Register of BCG vaccinators
Please note the Ministry of Health's previous register of gazetted BCG vaccinators was retired on 4 January 2019 as it was no longer applicable under the new legislation.
Any new or previously-gazetted BCG vaccinators are confirmed as BCG-endorsed vaccinators by their Medical Officer of Health, who will maintain records locally. No further notification is required to the Ministry of Health.
For further information on tuberculosis disease, BCG vaccine or becoming a BCG-endorsed vaccinator, please contact your local Medical Officer of Health or the appropriate regional Public Health Unit, or refer to the following publications:
- Your Health - Tuberculosis guide
- Guidelines for Tuberculosis Control in New Zealand, 2019
- Technical Guidelines for Tuberculin Skin Test
- The Immunisation Advisory Centre website
- Resources on BCG for parents and health professionals from HealthEd
- Tuberculosis chapter of the Immunisation Handbook
- Tuberculosis chapter of the Communicable Disease Control Manual (updated Aug 2019)
- BCG Vaccine datasheet