BCG vaccination practices in Victoria

To determine the patterns of usage of bacille Calmette-Guerin (BCG) vaccine in Victoria and assess whether the vaccine was being administered to those in high-risk groups, as identified by the National Health and Medical Research Council, an audit of BCG vaccine unit sales and expenditure, over the past four years was conducted. A postal survey covering all registered Victorian BCG vaccinators inquired about BCG vaccination practices during 1993. Vaccine sales and expenditure had nearly doubled since 1991. The number of registered vaccinators had also increased. The survey response rate was 77 per cent, (228 of 295). Half of the vaccinators were working in general practice, 11 per cent of vaccinators used no set guideline for client selection, 69 per cent vaccinated fewer than 25 people in 1993, 26 per cent had vaccinated neonates (mainly southeast Asian), with few of these vaccinations being carried out in maternity hospitals. Tertiary students and ethnic groups were the most commonly vaccinated groups. Only small amounts of BCG were being given to people outside risk groups, mainly travellers and anxious public. There has been significant increase in numbers of registered vaccinators and use of BCG with much wastage. Application of guidelines was inconsistent and coverage of high-risk groups varied. Despite some selection for vaccination by personal choice, little vaccine appeared to be used in nonrecommended groups. Subsequent changes in practice have resulted, including publicising and clarifying guidelines, reduction in the number of vaccinators, vaccinator upgrading courses, and restructuring of the vaccine ordering system.