Deirdre Clune (Cork South Central, Fine Gael)
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I am glad to have the opportunity to raise this issue and to get a response from the Government on possible changes to TB services, particularly in the Cork region and particularly in regard to screening and the administration of the BCG vaccine. I raise this issue because towards the end of August there was an outbreak of TB at Crab Lane national school, Ballintemple, which resulted in the return to school being postponed for a week while the HSE notified parents, children and staff. There are 220 children in the school and the HSE initiated a screening process, the end result of which was that 31 pupils and three staff tested positive for latent TB and six pupils tested positive for active TB. Anyone who knows someone who has been diagnosed with TB in even its latent form will know it requires a dose of antibiotics for a minimum of six months, and we are talking about children in this case.

This is the second outbreak in Cork in recent history. In 2008 there were two outbreaks in crèches when 15 children and two adults were affected, and hundreds of children required X-rays and antibiotics.

While I have never received a definitive answer as to whether it was a policy decision based on prevention or for a financial reason, the administration of BCG vaccines to newborn children was discontinued in the 1970s. My children, many children of their age and many children currently of school-going age did not receive the BCG vaccine as a routine act when they were infants. In 2008, however, the BCG vaccine was reintroduced and the result is that we now have lengthy waiting lists. I have asked the Minister, Deputy Harney, in regard to the number of children awaiting the BCG vaccine, which is provided to newborns in the maternity hospital at present, and she has forwarded the question to the HSE. The figures for the Cork region are above average. Does the Minister believe this is because the BCG vaccine was not available?

There is also the issue of whether the screening process should be extended. Revised guidelines which recommended the extension of screening were proposed to the HSE. I would like to hear from the Minister of State whether there is any intention to revise and expand the screening process. The chief medical officer has requested that the HSE would provide information to him regarding the routine administration of the BCG vaccine.

There is concern among parents, not just those of children in this school and their community but in the wider Cork community, that TB services have not been up to the same standard provided throughout the rest of the country. A consultant, Dr. Cathal Bredin, was quoted in the media as stating he believed there were still hidden reservoirs of TB in the Cork region which would account for the kind of sudden outbreak that occurred in August. I wish to express the concern of parents and the community in Cork that services would be provided to prevent TB outbreaks and to ensure that children are immunised against TB. The BCG vaccine has proven effective against 70% to 80% of TB strains, so it is very important. it is also national immunisation policy that the vaccination would be provided as a matter of course.

There was no recent outbreak of TB prior to 2008. I would like the Minister of State to address that issue and also the issue of whether screening for TB is to be extended.

Dara Calleary (Mayo, Fianna Fail)
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I am taking the Adjournment on behalf of the Minister for Health and Children, Deputy Harney. I thank Deputy Clune for raising this matter as it provides an opportunity to outline to the House a number of issues in this area.

As the House is aware, TB remains a significant cause of morbidity and mortality worldwide. An estimated 9.3 million new cases were reported in 2007, of which 7.8 million were detected in Asia and Africa. The first national survey of TB in Ireland in 1952 gave a notification rate of 230 cases per 100,000 population. A downward trend was sustained until 2001, with a rate of 9.7 per 100,000 population, after which cases remained stable with minor fluctuations in annual figures thereafter.

The National Immunisation Advisory Committee recommends that BCG for newborns be continued. The Deputy will be aware that in Cork for a number of years the BCG vaccine was offered to newborns who were at risk of developing TB, namely, babies whose parents or siblings have a history of TB, whose parents work in a health care setting with patients affected by TB, whose parents come from countries where there is a high incidence of TB and children intending to visit high incidence countries for more than one month. The BCG vaccine was also given to the child contacts of confirmed TB cases.

In recent years, the practice in Cork was reviewed and a commitment was given by HSE South that all newborn babies in Cork would, from October 2007, be routinely offered the BCG vaccine against TB. Due to the increase in demand for BCG vaccination in 2007, HSE South as an interim measure ran a number of additional clinics during the summer period. In parallel with this interim measure, plans had been put in place in regard to the commencement of offering routine neo-natal BCG vaccinations in conjunction with Cork University Maternity Hospital.

A difficulty with the supply of vaccine in Ireland and across Europe emerged in October 2007. The supply shortage was due to technical difficulties at the manufacturer's laboratory and resulted in a European-wide shortage of this vaccine. This manufacturer was the only company which supplied the vaccine to the European market. While some vaccine was in stock, the shortage in supply meant that clinics were not held in HSE South during November or December of 2007. The issue was subsequently resolved in April and May of 2008 and the supply of vaccine recommenced in the Irish market.

On 13 October 2008, the HSE proceeded with the commencement of the neo-natal BCG programme in Cork University Maternity Hospital. Protocols with regard to the availability of information leaflets and the issuing of consent forms have been agreed with Cork University Maternity Hospital staff. This has enabled the HSE to introduce a BCG vaccination programme as a routine measure to newborn babies whose parents request it. In addition to the above clinics, the HSE will continue to provide vaccinations to deal with older children on a priority basis.

The Minister is very concerned about the recent outbreak of TB in the HSE South area. The HSE established an outbreak control team to manage the situation in accordance with the guidance report of the National Immunisation Advisory Committee. Cases of active and latent TB found have been referred for appropriate treatment and follow-up care. All involved with the school have been reassured that, first, the children with active TB are on treatment and are not currently infectious; second, children or staff with latent TB infection are not infectious and, third, other children or staff are not at risk from contact with either the cases of active TB or of latent TB.

In order to assess the position fully, the chief medical officer of the Department of Health and Children immediately requested the HSE to provide clarification and information regarding the routine administration of BCG in all regions of the country. It also requested it to identify areas where this is not the case and specify what arrangements are being made to deliver these services with a timescale for implementation. The HSE has also been requested to plan for the undertaking of an ongoing audit of the delivery of BCG and TB services throughout the country.