These trials indicate that BCG has 60 80% protective efficacy against severe forms of tuberculosis in children, particularly meningitis,1 2 and its efficacy against pulmonary diseases varies geographically.3 4 5 BCG does not seem to protect against disease when it is given to people already infected or sensitised to environmental mycobacteria, which could explain the geographical variation.6 7 8 Until recently it was not possible to establish whether the protective effect of BCG vaccination against disease was from its action in preventing acquisition of infection or limited to prevention of progression from infection to clinical disease.The scarcity of evidence on whether the vaccine is effective against Mycobacterium tuberculosis infection was because of limitations of the tuberculin skin test. This test cannot distinguish a positive response caused by M tuberculosis infection from that caused by BCG vaccination or non tuberculous mycobacterial infection.9 The recently developed T cell based interferon release assays (IGRA) can detect M tuberculosis infection and discriminate this from previous BCG vaccination and most non tuberculous mycobacterial infections pandora jewelry,10 allowing investigation of whether BCG protects against M tuberculosis infection.11 12 13 If BCG is found to protect against infection, it will have key implications for its use in current immunisation programmes14 as well as in the future development of new improved tuberculosis vaccines.In this systematic review we examined the evidence for the protective effect of BCG against M tuberculosis infection, as opposed to against disease, in settings where children can be presumed to have been exposed to M tuberculosis. This therefore assesses the degree to which BCG vaccination before exposure is associated with a subsequent negative result on an interferon release assay.

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