title: The impact of Bacille Calmette-Guérin shortage on immunisation practice and policies in Europe - A Paediatric Tuberculosis Network European Trials Group (ptbnet) survey.
abstract: Recent reports indicate an ongoing BCG shortage that may influence immunisation practice. This study aimed to determine current availability of BCG vaccine across Europe, and implications on immunisation practices and policies in Europe.
  
  
  
  Web-based survey among Paediatric Tuberculosis Network European Trials Group (ptbnet) members, between May and October 2015.
  
  
  
  Twenty individuals from 13 European countries participated. Ongoing shortages were reported in eight countries routinely using BCG (8/11, 73%). As a consequence of the shortage, BCG was not given as completely unavailable in some countries (2/8, 25%), was given only whenever available (1/8, 13%), or only in certain regions of the country (1/8, 13%). Strategies reported to reduce loss of immunisation were administration to selected high-risk individuals (2/8, 25%), or cohorting vaccinees on specific days to maximise the use of multi-dose vials (3/8, 38%). Authorities in two countries each were considering a change of manufacturer/supplier (2/8, 25%).
  
  
  
  The BCG shortage in Europe leads to significant changes in immunisation policies including changes of BCG vaccine strain and manufacturer. In addition, infants and children eligible for immunisation are at risk of not receiving BCG. To ensure necessary BCG immunisations, collaboration between national health agencies and vaccine manufacturers is crucial.
authors.affiliation: Department of Paediatrics, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Clinicum, Department of Public Health, Faculty of Medicine, Doctoral Programme in Population Health, University of Helsinki, Finland. Electronic address: antti.kontturi@helsinki.fi.
authors.forename: Antti
authors.initials: A
authors.lastname: Kontturi
authors.affiliation: Sección Enfermedades Infecciosas Pediátricas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain. Electronic address: bsantiagogarcia@gmail.com.
authors.forename: Begoña
authors.initials: B
authors.lastname: Santiago
authors.affiliation: Faculty of Medicine & Global Health Research Institute, University of Southampton, Southampton, UK; Department of Paediatric Immunology and Infectious Diseases & NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Department of Paediatrics, The University of Melbourne, Parkville, Australia. Electronic address: m.tebruegge@soton.ac.uk.
authors.forename: Marc
authors.initials: M
authors.lastname: Tebruegge
authors.affiliation: Division of Paediatric Infectious Diseases, Dr von Hauner Children's Hospital, LMU, Munich, Germany; German Centre for Infection Research (DZIF), Germany. Electronic address: uvb9@gmx.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: von Both
authors.affiliation: Department of Paediatrics, Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. Electronic address: eeva.salo@hus.fi.
authors.forename: Eeva
authors.initials: E
authors.lastname: Salo
authors.affiliation: Department of Paediatrics, The University of Melbourne, Parkville, Australia; University Children's Hospital Basel, Paediatric Infectious Diseases, Vaccinology, and Paediatric Pharmacology, Basel, Switzerland. Electronic address: nicole.ritz@unibas.ch.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ritz
mesh_terms: D001500:BCG Vaccine / Q000600:supply & distribution*; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration; D004363:Drug Utilization / Q000706:statistics & numerical data; D005060:Europe; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D007114:Immunization / Q000379:methods*; D007223:Infant; D014376:Tuberculosis / Q000517:prevention & control*
chemical_list: D001500:BCG Vaccine
keywords: BCG; Public health; Supply; TB; Tuberculosis; Vaccine