BCG vaccination: the stamp method and what parents need to know

Newborn · Health · Reviewed 20 June 2026 · All articles

If your baby is due for a BCG vaccination, you may have heard that there are different ways the vaccine can be given. In some countries the nurse or doctor applies a small stamp-like device to the upper arm. In others, a fine needle delivers the vaccine just under the surface of the skin. Both approaches protect against the same serious infection, yet they look and feel different on the day.

This article explains what BCG is, why it is given to newborns, how the two main administration methods differ, what you can expect at the appointment, and how to care for the site in the weeks that follow. It is intended as general information only. Your GP, midwife, or health visitor is the right person to answer questions specific to your baby's situation.

What is BCG and what does it protect against?

BCG stands for Bacillus Calmette-Guerin, named after the two French scientists who developed the vaccine in the early twentieth century. It contains a live but weakened strain of Mycobacterium bovis, a bacterium closely related to Mycobacterium tuberculosis, the organism that causes tuberculosis (TB).

Tuberculosis is a serious infectious disease that primarily affects the lungs, though it can spread to other organs including the brain, bones, and kidneys. TB is spread through the air when a person with active pulmonary TB coughs, sneezes, or speaks. Globally, tuberculosis remains one of the leading infectious causes of death. Young children, especially infants, are at much greater risk of developing severe and life-threatening forms of the disease, including TB meningitis and disseminated TB (sometimes called miliary TB), if they become infected.

The BCG vaccine does not prevent a person from ever being infected with the TB bacterium, but it is highly effective at preventing the severe forms of the disease in young children. Studies consistently show that BCG reduces the risk of TB meningitis in infants by around 70 to 80 percent. This is the primary reason it is given in the newborn period in countries or communities where TB is more common, or where a baby may travel to higher-risk areas.

BCG also offers some protection against leprosy and Buruli ulcer, two other mycobacterial infections. These additional benefits are considered a bonus rather than the main reason the vaccine is recommended.

The two main administration methods

Worldwide, BCG is given using one of two techniques: the intradermal injection (also called the Mantoux technique) or the multiple-puncture stamp method. Which method is used depends on the country and, in some cases, the healthcare setting.

The intradermal injection

The intradermal method is used in the United Kingdom, Australia, and most of Europe. A very fine, short needle is inserted at a shallow angle of about 10 to 15 degrees into the uppermost layer of skin on the left upper arm, just below the shoulder. The needle is almost parallel to the skin surface. A small amount of vaccine (usually 0.05 ml for newborns and 0.1 ml for older children) is injected directly into the dermis, the layer just beneath the outer surface.

When done correctly, a small pale raised bleb forms at the injection site. This bleb, which looks a little like a mosquito bite, shows that the vaccine has gone into the right layer of skin. If the vaccine goes too deep, into the subcutaneous layer beneath the dermis, it does not produce the same immune response and the vaccination may need to be repeated. The intradermal technique requires skill and practice. Most nurses and doctors who administer BCG routinely have significant experience with it.

The multiple-puncture stamp method

The stamp method, also called the percutaneous method or the multipuncture method, is standard practice in Japan and has been used in several other countries historically. Instead of a single needle, a small handheld device is used. The device has a head containing multiple fine needles arranged in a circular pattern, typically 9 or 18 needles in a ring formation. The needles are very short, around 1 mm in length.

To administer the vaccine, a small drop of BCG liquid is placed on the cleaned skin of the upper arm. The stamp device is then pressed firmly against the skin and the needles puncture through the drop of vaccine, driving the liquid into the outer layer of skin with multiple tiny pricks at once. The device is lifted, repositioned slightly, and the process is repeated once or twice to cover a small area. The procedure takes only a few seconds.

Because the needles are very short and there are many of them, the sensation is described as more of a firm pressure than a sharp sting. Many parents and healthcare providers note that babies tolerate the stamp method well. The multiple tiny entry points allow the vaccine to be absorbed across a wider surface area of skin compared with the single-needle intradermal technique.

Which countries use which method?

Japan adopted the multiple-puncture stamp method as its standard approach for BCG vaccination and has used it for decades. The stamp device is used for all infants, typically given between birth and 5 months of age as part of the national immunisation schedule. Vaccination is carried out at local health centres, and parents are given an appointment card after birth.

The United Kingdom uses the intradermal injection for all BCG vaccinations. The National Health Service (NHS) recommends BCG for babies who have a higher chance of coming into contact with TB, including babies born in areas of the United Kingdom with high TB rates, babies with a parent or grandparent born in a high-TB country, and babies who are close contacts of someone with TB. Vaccination is typically given within the first few weeks of life for eligible babies.

Australia also uses the intradermal method. BCG is not on the universal National Immunisation Program schedule in Australia but is recommended for certain groups, including babies of Aboriginal and Torres Strait Islander people in parts of Australia where TB rates are higher, and babies who will travel to or live in high-risk countries during the first five years of life.

Many other countries with high TB burdens, including those in sub-Saharan Africa and parts of Asia, give BCG to all newborns universally in hospital shortly after birth, using the intradermal method. The World Health Organization recommends BCG vaccination for all newborns in countries with high incidence of TB.

What to expect on the day

Whether your baby receives the stamp method or the intradermal injection, the appointment itself is usually brief. The healthcare provider will ask a few questions to confirm there are no reasons to delay or avoid the vaccine. Reasons to postpone BCG can include a current fever or illness, a known immunodeficiency, or the recent administration of another live vaccine. If there are no concerns, the vaccination usually takes only a few minutes.

For the intradermal injection, your baby will typically lie or sit on your lap. The upper arm is gently held still and the skin is cleaned. The nurse inserts the needle at a shallow angle and injects the vaccine. A small bleb should form. The needle is withdrawn and no bandage or plaster is applied. Some babies cry briefly at the moment of injection; many do not react much at all.

For the stamp method, the arm is cleaned and a drop of vaccine liquid is placed on the skin. The stamp device is pressed against the skin two or three times over the same small area. Babies often cry less with this method than with a conventional injection because the sensation is more of a press than a jab. Again, no bandage is applied.

In the hours after BCG vaccination, the site may look a little red or slightly swollen. This is normal and usually settles within a day. Do not be concerned if there is no visible reaction on the day itself. The main response develops slowly over the following weeks.

Scar development: what happens over the following weeks

The BCG scar forms through a predictable process that unfolds over two to three months. Understanding what is normal at each stage can save parents a great deal of unnecessary worry.

Weeks 2 to 4: A small red papule, similar to a pimple or insect bite, appears at the vaccination site. For the intradermal method this is typically a single raised bump 5 to 10 mm in diameter. For the stamp method you may see a cluster of tiny red dots or a slightly wider area of redness corresponding to the multiple puncture points. This papule is the first visible sign that the immune system is responding to the vaccine.

Weeks 4 to 12: The papule may enlarge, become softer at the centre, and develop into a small blister or pustule. It may weep a little clear or slightly yellow fluid and may then crust over. This is completely normal. Do not squeeze it, pick at the crust, or try to drain any fluid. The blistering and crusting are part of the normal healing process and show that the body is building its immune memory.

After 12 weeks: The crust gradually falls away on its own, leaving a flat or slightly indented pale scar. The final scar is typically 2 to 10 mm in diameter for the intradermal method. The stamp method may leave a slightly different pattern: a small area of flat scarring that may look like several tiny dots rather than one round mark. Both are normal outcomes.

Occasionally a baby's site heals with very little visible scarring. This does not necessarily mean the vaccine has not worked. The presence or absence of a scar is not a reliable indicator of immunity, and repeat BCG vaccination is not routinely recommended on the basis of scar appearance alone. If you have questions about whether your baby's vaccination was successful, speak to your GP.

Aftercare instructions

Caring for the BCG site correctly in the weeks after vaccination helps the normal healing process proceed without complications. The instructions are simple but worth following carefully.

Leave it open to air. Do not apply a plaster, bandage, or dressing over the site. Covering the area can trap moisture and increase the risk of secondary infection or delayed healing. The site heals best when exposed to air.

Keep it dry when bathing. During the weeks when the site is blistering or crusting, try to keep it dry during baths and when washing your baby's arm. You do not need to go to extreme lengths, but avoiding prolonged soaking of the area is sensible.

Do not squeeze or pick. If a blister forms, leave it alone. Squeezing, popping, or picking at the blister or crust can introduce bacteria, prolong healing, and increase the risk of a more pronounced scar.

Avoid tight clothing over the site. Loose sleeves help prevent rubbing and irritation during the healing phase.

When to call your doctor. Contact your GP or health visitor if redness spreads significantly beyond the original site onto the surrounding arm, if the lymph node in your baby's armpit on the same side becomes noticeably enlarged and hard (a small, soft, pea-sized node is not unusual and usually resolves on its own), if your baby develops a fever that you think may be related to the vaccination, or if the site looks genuinely infected rather than simply in the normal healing process. Genuine BCG site infections are uncommon but do occur occasionally and are treatable.

Common concerns parents have

BCG is one of the more visually dramatic vaccines because of the skin reaction it produces. Parents often have questions in the weeks after vaccination when the site starts to blister or ooze. The most important reassurance is that a blistering, weeping, or crusted BCG site between 4 and 12 weeks after vaccination is completely expected. It is not a sign of infection or that something has gone wrong.

Some parents worry about the vaccine because it contains a live bacterium. The strain used in BCG (Mycobacterium bovis BCG) is highly attenuated, meaning it has been deliberately weakened over many generations of laboratory cultivation. In healthy babies with normal immune systems it cannot cause disease. The exception is in babies with severe combined immunodeficiency (SCID) or other serious immune conditions, which is one of the reasons healthcare providers screen briefly for immune problems before giving BCG.

Parents sometimes ask whether BCG can cause tuberculosis. The answer is no. The BCG strain cannot cause the disease in children with a healthy immune system. Very rarely, BCG can cause a local infection at the injection site (BCG-itis) or, in children with undiagnosed immune deficiencies, a more widespread infection. These situations are rare and the risk is far outweighed by the protection BCG provides in communities where TB is present.

Another common question is about timing. BCG is most effective when given early in life. In countries and communities where it is recommended, the vaccine is typically offered in the first weeks or months after birth. If you are unsure whether your newborn should receive BCG, the best starting point is a conversation with your midwife, GP, or health visitor, who can assess your baby's individual risk.

Frequently asked questions

Why does BCG leave a scar?

The BCG vaccine triggers a controlled immune response in the skin. A small red papule forms within 2 to 4 weeks, may develop into a blister, and eventually heals into a flat pale scar about 2 to 10 mm wide. This is a normal sign that the vaccine has worked.

What is the difference between the stamp method and the intradermal injection?

The stamp method, used in Japan, uses a device with multiple small needles arranged in a circular pattern that punctures the skin through a drop of vaccine liquid. The intradermal injection, used in the United Kingdom and Australia, delivers vaccine directly into the top layer of skin using a fine needle at a shallow angle. Both methods are effective at generating immunity.

My baby's BCG site looks red and swollen at 6 weeks. Is this normal?

Yes, this is expected. Redness, swelling, and even a small blister between 4 and 12 weeks after BCG vaccination are normal parts of the immune response and scar formation. You should only contact your doctor if the redness spreads widely beyond the injection site, the lymph node under the armpit becomes very enlarged, or your baby develops a fever.

Should I cover the BCG vaccination site?

No. Leave the site open to air. Do not apply a plaster or bandage, do not squeeze or pick at any blister, and try to keep the area dry during bathing. Covering the site can trap moisture and slow normal healing.

Keeping track of your baby's vaccinations, feeding, and development is a lot to hold in your head. Cubby is the calm, private logbook built for the early months. Try Cubby free.