Childhood Vaccinations in South Africa: Part 1
One of the questions I am asked most often is, “What vaccinations does my baby need, and are they safe?”
Understanding childhood vaccinations in South Africa can help parents make informed decisions for their families. This series aims to explain the South African vaccination schedule in plain English, discuss why each vaccine is given, and highlight any important points for parents to know.
BCG Vaccine: Protection Against Tuberculosis (TB)
The first vaccine most babies receive is the BCG vaccine (Bacille Calmette-Guérin). It is a live, weakened bacterial vaccine derived from Mycobacterium bovis (bovine TB) and has been used safely around the world for many decades.
In South Africa, where tuberculosis remains common, BCG is given at birth because it helps protect babies against the most severe forms of TB, particularly TB meningitis and miliary (disseminated) TB.
The vaccine is usually injected into the skin of the upper right arm. Parents are always welcome to watch while their baby is being vaccinated and can confirm that it is being given in the correct place.
What Should You Expect Afterwards?
Unlike many other vaccines, BCG almost always leaves a visible reaction.
Over the next few weeks, a small bump develops where the vaccine was given. This may turn into a small blister or ulcer and can sometimes discharge a little pus before healing. Although this can look alarming, it is a normal part of the immune response.
Healing can take several weeks and occasionally a few months, eventually leaving the familiar small scar on the upper arm.
However, if the area becomes very large, your baby develops a fever, appears unwell, or the lymph nodes under the arm become markedly swollen, you should seek medical advice.
Are There Babies Who Should Not Receive the BCG Vaccine?
Because BCG is a live bacterial vaccine, extra care is needed in babies who have a severe problem with their immune system.
This is uncommon, but families with a known history of severe inherited immune deficiencies, particularly conditions affecting baby boys such as severe combined immunodeficiency (SCID), should discuss the timing of BCG with their paediatrician before the vaccine is given.
Fortunately, these conditions are rare.
Polio Vaccine at Birth
South Africa also routinely offers an oral polio vaccine (OPV) at birth.
This is a live, weakened virus vaccine that helps provide early protection against polio.
Later in infancy, babies receive the injectable polio vaccine (IPV) as part of the routine immunisation programme. Unlike the oral vaccine, IPV contains inactivated (killed) virus and cannot cause polio.
Are Live Vaccines Safe?
This is an important question and one that deserves an honest answer.
Live vaccines such as BCG and the oral polio vaccine have protected millions of children worldwide and have an excellent safety record.
In extremely rare circumstances, almost always in children with previously unrecognised severe immune deficiencies, a live vaccine can itself cause infection. The risk is extraordinarily small, but I believe parents should know which vaccines are live vaccines, understand why they are recommended, and have the opportunity to ask questions before their child receives them.
Good medicine is about informed decisions made together.
Looking Ahead
In the next article, we’ll look at the vaccines given at 6, 10 and 14 weeks. I’ll explain what each vaccine protects against, the expected side effects, and some of the common questions parents ask in my practice.
Until then, remember that childhood vaccinations in South Africa remain one of the most effective ways we have of protecting children from serious infectious diseases. Understanding the vaccination schedule helps parents make informed and confident decisions for their families.
