I write in response to the article by Al Jaradet al 1 on this topic. The first study to compare the efficacy of BCG vaccination and its side effects using the Bignal multipuncture device with the reusable handle and disposable heads was the pilot study of neonatal BCG vaccination carried out in 1992 for the Department of Health in our health authority.2

In previous studies in neonates and children under two, referenced in the paper by Al Jarad et al,1an 18–20 needle percutaneous head gave approximately the same degree of tuberculin conversion as did intradermal vaccination but, to achieve this in older children and adults, 36–40 punctures were required. This would require either a 40 needle head or a double vaccination with two × 18–20 needles. This is why percutaneous BCG is currently only …

Dr N Al Jarad