Man has always had to protect himself against numerous dangers,
and enemies of all sorts.
He used to be defenceless against the invisible enemies
that caused great epidemics
wreaking havoc on humanity throughout centuries.
Then, his only protection was isolating the sick.
In the Middle Ages,
lepers were excluded from the community for life.
Those with infections were treated with caution.
Doctors wore this strange outfit
when caring for people with the plague.
In the 19th century, scientists
started exploring
the infinitely small.
They discovered parasites, germs,
and viruses.
This knowledge
gave us an efficient weapon:
vaccination.
With this means of protection,
dreadful diseases such as diphtheria, smallpox, yellow fever
have become rare.
As will poliomyelitis, very soon.
However, the danger remains.
Swift epidemics
are still to be feared.
That's why vaccination is still necessary.
WHAT ABOUT TUBERCULOSIS?
Tuberculosis
is far from a rare disease.
It is still responsible for the death
of 3 million worldwide every year.
In my own unit, where we have about 100 beds,
since January, we've admitted
28 children with tuberculosis, 2 of which had meningitis.
They were contaminated by people who were unaware of their condition
or by patients who didn't follow their treatment properly,
thus becoming a potent source of contamination.
These children wouldn't have got TB
had they had the BCG vaccination.
And yet, currently in France,
less than one in two children has this protection.
One wonders why.
- You need to sign this paper. - Let me see.
Another vaccination?
So sorry to bother you. I'm a little upset.
Isabelle has just given me this notification for the BCG vaccine.
What do you think?
BCG.
We've discussed it a lot. We should really make our minds.
If we decided to have her vaccinated,
the vaccine could tire her.
Her friend, Catherine, had the same vaccine,
and had to go to the mountains.
What do you think, for our daughter?
But everyone doesn't agree on that.
Many have been vaccinated without incident.
But there's still a risk and...
Isabelle may never be vaccinated.
It's the same for many children.
Jean-Paul won't get the vaccine. Nobody has TB at home.
And tuberculosis isn't a danger anymore.
Indeed, the number of TB patients has declined.
But don't forget that 40,000 patients
enter a sanatorium each year.
Tuberculosis is no longer as grim.
Properly treated, it can be cured.
But it always brings about its share of hardships.
At the beginning, I couldn't see the problem.
But then the doctor told me that it's a very long disease,
and that I had to stay in a sanatorium for at least 6 months.
So I began to realize
that it would really change everything.
First, for my family,
my wife and I had never been apart since our wedding.
And suddenly, we were separated.
Then, financially...
I had a career, you know, a career in the arts,
but everything stopped overnight.
I was isolated.
Well, this has raised major challenges for me.
First,
I was separated from my very young daughter.
And there was also the possibility
that my husband had been contaminated.
My husband is OK but I've been separated
from my daughter for a long time,
and that's really hard.
Here's the thing.
I had a shop for 24 years.
I'd just finished renovating it thanks to a government-backed loan,
which I hadn't paid off yet.
I have 3 children.
I had to stop working.
My wife had to quit her job.
It causes incredible problems.
As my wife was seriously ill,
the doctor said we all had to have X-rays,
all 4 children and me.
Out of 4, 3 children were ill.
We were all admitted to hospital. We stayed there for 4 months.
My wife and I went from hospital
to a sanatorium for 6 months.
After the children were discharged, they spent 12 months in a preventorium.
And so we see that tuberculosis remains a great risk
in our country,
much more so than in most European countries.
In France, there are
twice as many TB-related deaths as in England,
and 6 times as many as in Denmark.
And yet,
it was French scientists, Calmette
and Guérin,
who discovered the TB vaccine, BCG.
It was first used in Paris in 1921.
How does BCG work inside the body?
To understand it, imagine our organism is a new, empty house.
BCG is like a good tenant moving into this new, empty house.
He leads a quiet life.
He builds a strong fence around his house,
to stop the intrusion of the tubercle bacillus.
If the tubercle bacillus,
aka Koch's bacillus, arrives,
he finds the house occupied and well protected.
He won't be able to get in because the place is already taken.
However, if the tubercle bacillus is the first to move into the new house,
he behaves like a bad tenant,
and causes untold damage to the house.
These damages can be tiny and invisible from the outside.
But it's paramount to keep a close eye on the bad tenant for a long time.
The entry of the tubercle bacillus into the body
is called a primary infection.
It enters most often through the trachea and bronchial tubes,
and settles in the lung.
When a GP discovers a primary infection,
he prescribes treatment and monitors closely the infected child.
At the next stage,
the bad tenant causes real damage to the house.
Specialized workers will have to repair it.
In the body, the primary infection
comes with lymph node involvement and pulmonary lesions.
The affected child needs to go to a preventorium.
Schooling is stopped,
and family ties are severed.
If the house is fragile
and the tubercle bacillus especially nasty,
the damages are vast and sometimes beyond repair.
In the body, the bacillus disseminates to all organs,
the most serious outcome being
tuberculous meningitis, always dreadful,
for it can cause permanent after-effects.
To prevent all this damage,
it is crucial to put BCG in empty houses fast,
as the good tenant.
But how can we know whether the house is empty or occupied?
To "knock on the door",
a cutireaction or any other TB test is performed.
If the house is empty, there is no response.
The cutireaction is negative.
If the house is occupied,
either by the good tenant, BCG,
or the bad tenant, the tubercle bacillus,
the tenant answers by showing his card.
The cutireaction is positive.
How do you "knock on the door"?
How is the TB test done?
The cutireaction is the best known and most common test.
A patch can also be used.
But the best, most accurate, most sensible test
is the intradermal reaction.
We read the tests after 3 days.
Here are 2 tests.
The first one is negative.
The second one is positive.
Here are 2 positive tests,
one after BCG, the other without BCG.
In the first case, all is well.
The vaccine is working, the subject is protected.
In the second case, this boy was to be vaccinated,
his test was negative 3 months ago.
The intradermal is positive now.
He's come in contact with Koch's bacillus,
the skin test is positive, he needs to see his doctor.
Although we have similar results, these are very different cases.
There's no ambiguity whatsoever.
In the first case, we know the subject has been vaccinated.
In the second case,
we know he hasn't.
The reading of a negative test is followed by the BCG vaccination.
It is usually done intradermally,
on the inner side of the arm or on the hip.
Scarification can also be used.
After vaccination, a vaccine reaction appears.
It proves that the vaccine is working,
that the vaccination is successful.
It fades within 6 to 8 weeks,
leaving a small scar.
BCG doesn't tire children.
No need to take any special precaution
after vaccination.
The vaccinated child
can lead a normal life.
Vaccination-induced protection diminishes with time.
Protection is demonstrated
by the positive response to the TB test.
When the response is negative again,
a booster shot needs to be given, as with all other vaccines.
TheAcadémie de médecine recommends
vaccinating children in their first months.
At any rate,
children need to be vaccinated by the age of 6,
either by their GP,
or at a vaccination centre,
or at school.
Vaccination squads travel to rural schools.
Vaccination is offered to students who aren't immunized yet
or who need a booster shot.
Some professional categories
particularly need to be
protected.
Such is the case for people working in the food industry,
and airline companies.
WHAT EVIDENCE DO WE HAVE OF THE EFFICACY OF BCG?
Children who have been properly vaccinated with BCG
are usually well protected against tuberculosis.
We have ample evidence of this.
For example,
we can recall the story of 300 girls
who attended the same school in Denmark.
A teacher had tuberculosis.
Among the children,
one group was vaccinated,
and the other wasn't.
In the non-vaccinated group,
70 children became ill,
11 of which got severe tuberculosis and one died.
In subsequent years, 5 more got TB.
However, in the group of vaccinated children,
there were only 2 benign primary infections.
All the other girls stayed healthy,
even after 12 years.
Here's another example,
from France.
In a Parisian hospital unit, a study was conducted of 126 families
who all had a tuberculosis patient at home.
As chance would have it, among these families,
about half of the children had been immunized by BCG.
The others hadn't.
Out of the 239 vaccinated children, only 9 had a primary infection.
The other 230 stayed healthy.
Out of the 250 non-vaccinated children,
143 fell ill,
and only 107 stayed healthy.
In England, vaccination isn't compulsory,
but all schoolchildren get BCG, with parental consent.
An international survey was made there.
It started in 1950.
It involves 56,700 children,
half of which were vaccinated while the others weren't.
After 5 years, the results are convincing.
There are 6 times fewer TB patients among vaccinated children
than among the others.
To prove how efficient BCG is,
we'll just have to remember that it is used practically worldwide,
often on a wide scale.
In Brazil, 2.5 million children are vaccinated.
In Japan, 6 million.
In India, 7 million.
In the USSR, 4 million newborns each year,
and 10 million schoolchildren.
The World Health Organization
has undertaken mass vaccination
in newly independent countries
in Africa and Asia.
It chose BCG vaccination as one of the primary weapons
to fight tuberculosis.
Over the last few years,
170 million children have been vaccinated.
Vaccination often takes place
in countries with precarious health infrastructures.
Vaccination is performed
in the bush,
under a tent.
Hundreds of mothers bring their children
to have them vaccinated.
This is really
a crusade against TB
using the BCG vaccine
as its weapon.
"What about France?", you ask.
In France,
over the past 10 years,
approximately 6 million children
were vaccinated.
But 6 million more haven't been vaccinated yet.
Let us hope,
for their families and themselves,
that they will be very soon.
THE NATIONAL COMMITTEE AGAINST TUBERCULOSIS
AND THERAPLIX PRESENTED
BCG WILL PROTECT YOU
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ICONOGRAPHY
Subtitles: Ariane Fénart & Élisabeth Fuchs