BCG Vaccine for Babies: Ulcer, Pus, Scar & Lymph Node Swelling — What's Normal and What to Do

Dr. Sandip Gupta

A pediatrician explains the BCG vaccine given to babies at birth — why the nodule, ulcer, redness and pus discharge appear at the injection site on the left upper arm, why parents should not panic, and how to care for it. Covered in this video: When and why BCG is given BCG is given at the time of birth; healthy babies are generally given the BCG vaccine before being discharged from hospital. It is given to prevent tuberculosis (TB), a disease that is highly prevalent in India, especially where there is poor hygiene and overcrowding, and in families of lower economic status. TB usually presents in the lungs as cough or fever, but it can have many complications — it can reach the brain and affect all organs of the body, including the spine and bones. BCG is particularly effective at preventing two serious forms: TB of the brain (TB meningitis) and miliary TB, which spreads to solid organs like the spine, kidney and liver. Both the National Immunization Schedule and the IAP immunization schedule provide for BCG at birth, so all babies should get it. Normal reaction after BCG — the sequence of events BCG is given intradermally, unlike many vaccines given intramuscularly or subcutaneously. For the first few days there is generally no reaction. Around 2 to 3 weeks after the vaccine, a small red nodule starts forming at the site. The swelling gradually increases, crusting forms, and it then bursts and an ulcer forms. Pus — white or yellow material — keeps discharging slowly for some days. At around 3 to 4 months the wound dries and forms a scar. This whole sequence is normal after BCG vaccination. How to care for the BCG ulcer or nodule After the nodule bursts there is mild pain and pus-like material comes out. If the baby is troubled by the pain, paracetamol can be given in the dose recommended by your pediatrician. Do not apply any antibiotic cream or ointment at the local site, do not squeeze it, and do not put a bandage on it. Nothing extra needs to be done. Just keep cleaning it with cotton gauze, keep it dry and open, do not cover it — it will gradually dry, heal and form a scar with no problem. If there is no reaction at all If no nodule, ulcer or scar forms, it does not mean the vaccine had no effect or gave no benefit. In about 10% of babies there is no reaction to the BCG vaccine. If you have documentation showing BCG was given on a particular date with a signature, the baby has received it and you can assume the benefit; there is no need to repeat the vaccine. BCG lymphadenitis (lump in the armpit or neck) Rarely, a few months after BCG, a lump or lymph node swelling appears in the armpit on the same side or in the neck. This is called BCG lymphadenitis. If the lump has no pain, redness or swelling and is just a lump, it generally dries up and reduces in size on its own within a few months — sometimes taking up to 3 months. Nothing separate needs to be done. But if the lump or lymph node develops swelling, redness, starts to fester with pus, or bursts and discharges pus, consult your doctor. The doctor generally aspirates the pus material with a needle, and the wound gradually dries. Questions this video answers: When is the BCG vaccine given to a baby? What is the BCG vaccine for? Which forms of TB does it prevent? Why does my baby have a lump, swelling or redness where the BCG was given? Why is pus coming out of my baby's BCG site? Is it an infection? How many weeks after BCG does the nodule and ulcer appear? When does the BCG wound heal and form a scar? How do I care for the BCG ulcer? Should I apply cream, squeeze it or bandage it? What can I give if my baby is in pain from the BCG site? My baby has no BCG mark or scar — does that mean the vaccine didn't work? Do I need to repeat it? My baby has a lump in the armpit or neck after BCG — what is BCG lymphadenitis? When should I see a doctor about the BCG reaction or the lump? Relevant for: parents of newborns and infants, especially those worried about the BCG injection site reaction, ulcer, pus discharge, missing scar, or a lump after vaccination. Disclaimer: All information and suggestions given in this video are general health information. They are not a substitute for professional medical advice, diagnosis or treatment. Any medicine or dose should be given only as recommended by your pediatrician. If the reaction seems severe or a lump becomes red, swollen or starts discharging pus, consult your doctor.