Tuberculosis primary prevention: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Tuberculosis}} | {{Tuberculosis}} | ||
{{CMG}}; {{AE}} {{AL}} | {{CMG}}; {{AE}} {{Mashal Awais}}; {{AL}} | ||
==Overview== | ==Overview== | ||
Primary prevention in [[tuberculosis]] is | Primary prevention in [[tuberculosis]] is necessary to avoid the disease transmission and causing infection in healthy people. The [[BCG]] vaccine is given to children who are predisposed to get [[TB]] infections, such as children living in [[Endemic (epidemiology)|endemic]] countries or close contacts with a confirmed case of [[TB]]. Several preventive measures are adopted to avoid the transmission of the [[mycobacteria]] [[tuberculosis]], such as [[respiratory isolation]], use of respiratory [[masks]] among health-care workers, and emphasizing respiratory hygiene and [[cough]] etiquette. | ||
== Primary Prevention == | ==Primary Prevention== | ||
===BCG Vaccine=== | ===BCG Vaccine=== | ||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 550px;" align=center | *[[Bacille Calmmette-Guerin|Bacille Calmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the [[vaccination]] against [[M. tuberculosis]]. | ||
|valign=top| | *[[Bacille Calmmette-Guerin|BCG vaccination]] is highly recommended for each infant who is living in an endemic area of TB or who is at high risk of getting [[Tuberculosis|TB]] [[infection]] due to exposure to TB. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref> | ||
*The [[BCG]] [[vaccine]] is effective and can protect against severe types of [[tuberculosis]] infections including [[miliary TB|miliary]] or [[tuberculous meningitis|meningeal tuberculosis]]. | |||
*[[BCG vaccine]] is not recommended for [[Human Immunodeficiency Virus (HIV)|HIV]] positive children; however, children with unknown [[HIV]] status and born to [[HIV]] positive women, have to be be vaccinated. <ref name="WHO TB Children"> {{cite web |url=http://apps.who.int/iris/bitstream/10665/112360/1/9789241548748_eng.pdf| title=WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014}} </ref> | |||
*There is no established value of the [[vaccine]] for patients who have been infected by tuberculosis.<ref name="RoyEisenhut2014">{{cite journal|last1=Roy|first1=A.|last2=Eisenhut|first2=M.|last3=Harris|first3=R. J.|last4=Rodrigues|first4=L. C.|last5=Sridhar|first5=S.|last6=Habermann|first6=S.|last7=Snell|first7=L.|last8=Mangtani|first8=P.|last9=Adetifa|first9=I.|last10=Lalvani|first10=A.|last11=Abubakar|first11=I.|title=Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis|journal=BMJ|volume=349|issue=aug04 5|year=2014|pages=g4643–g4643|issn=1756-1833|doi=10.1136/bmj.g4643}}</ref> | |||
*[[BCG]] vaccination should be given to [[health care workers]] in any of the following conditions:<ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref> | |||
:*TB patients have been infected with TB strains resistant to both [[isoniazid]] and [[rifampin]] | |||
:*Ongoing [[Transmission (medicine)|transmission]] of [[drug-resistant TB|multi-drug resistant TB]] strains to health care workers | |||
:*Failure of the implemented [[Tuberculosis|TB]] [[infection-control]] [[precautions]] | |||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 550px;" align="center" | |||
| valign="top" | | |||
|+ | |+ | ||
!style="background: #4479BA; width: 150px;" | ! colspan="2" style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Contraindications for BCG}} | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Immunosuppression]] | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Immunosuppression]] | ||
| style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to | | style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to [[immunosuppressed]] individuals (e.g., persons who are [[HIV]] infected) or who may become [[immunocompromised]] (e.g., candidates for [[organ transplant]]). | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pregnancy]] | | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |[[Pregnancy]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. Although no harmful effects of [[Bacillus Calmmette-Guerin|BCG vaccination]] on the fetus have been noticed, further studies are required to establish its safety. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | colspan="2" style="padding: 5px 5px; background: #F5F5F5;" |<small>Adapted from CDC <ref name="CDC Vaccines"> {{cite web| url=http://www.cdc.gov/tb/publications/factsheets/prevention/BCG.htm| title=CDC Tuberculosis Fact Sheets Vaccines and Immunizayions}}</ref></small> | ||
|} | |} | ||
===Prevention for International Travelers=== | ===Prevention for International Travelers=== | ||
*Travelers | |||
*Travelers who anticipate | *Travelers must avoid prolonged close contact with known TB patients in crowded or enclosed places. | ||
*Travelers who anticipate probable prolonged exposure to TB, such as medical staff, people in prison, or homeless shelter populations must have a [[tuberculin skin test]] ([[TST]]) or [[interferon-gamma release assay]] ([[Interferon-γ release assays|IGRA]]) test before leaving the U.S. <ref> {{cite web| url=http://www.cdc.gov/TB/topic/infectioncontrol/default.htm| title= CDC Tuberculosis Infection Control and Prevention}} </ref> | |||
===Prevention in Health-Care Settings=== | ===Prevention in Health-Care Settings=== | ||
*Confirmed cases of TB during hospitalization | |||
*Confirmed cases of TB during hospitalization must fulfill the following recommendations:<ref name="CDC Prevention"> {{cite web | title=Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005| url=http://www.cdc.gov/tb/publications/slidesets/infectionguidelines/airborne.htm}} </ref> | |||
:*Single-patient room with private bathroom. | :*Single-patient room with private bathroom. | ||
:*Healthcare workers and visitors should wear disposable respirators (at least N95). | :*Healthcare workers and visitors should wear disposable respirators (at least N95). | ||
:*Doors should be closed as much time as possible. | :*Doors should be closed as much time as possible. | ||
:*Adequate room ventilation or negative pressure | :*Adequate room ventilation or negative pressure. | ||
===Determining the Infectiousness of TB Patients=== | ===Determining the Infectiousness of TB Patients=== | ||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px;" align=center | {| style="border: 0px; font-size: 90%; margin: 3px; width: 600px;" align="center" | ||
|valign=top| | | valign="top" | | ||
|+ | |+ | ||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Airborne Precautions}} | ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Airborne Precautions}} | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" |Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics: | | style="padding: 5px 5px; background: #DCDCDC;" |Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics: | ||
* They are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for acid-fast bacilli (AFB); and | |||
* They are not receiving adequate antituberculosis | *They are coughing, undergoing cough-inducing procedures, or have positive sputum smear results for [[acid-fast bacilli]] (AFB); and | ||
*They are not receiving adequate [[antituberculosis treatment]], have just started treatment, or have a poor clinical or bacteriologic therapeutic response. | |||
|- | |- | ||
| style=" padding: 5px 5px; background: #F5F5F5;" | Airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis | | style=" padding: 5px 5px; background: #F5F5F5;" |[[Airborne]] precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis explaining the clinical manifestations is established or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" | If infectious TB is still suspected after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard multidrug antituberculosis | | style="padding: 5px 5px; background: #DCDCDC;" |If infectious TB is still suspected even after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard [[multidrug antituberculosis]] therapy (minimum of 2 weeks) and show clinical improvement. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" |Patients who have drug-susceptible TB should remain under airborne precautions until they meet all of the following: | | style="padding: 5px 5px; background: #F5F5F5;" |Patients who have [[drug-susceptible]] TB should remain under airborne precautions until they meet all of the following: | ||
* Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals. | |||
* Receive standard multidrug antituberculosis treatment (minimum of 2 weeks). | *Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals. | ||
* Demonstrate clinical improvement. | *Receive standard multidrug antituberculosis treatment (minimum of 2 weeks period). | ||
*Demonstrate clinical improvement. | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC;" | <small> Adapted from CDC TB Infection Control in Health-Care Settings<ref>{{cite web| title=CDC Tuberculosis Infection Control in Health-Care Settings| url=http://www.cdc.gov/tb/publications/factsheets/prevention/ichcs.htm}}</ref></small> | | style="padding: 5px 5px; background: #DCDCDC;" |<small> Adapted from CDC TB Infection Control in Health-Care Settings<ref>{{cite web| title=CDC Tuberculosis Infection Control in Health-Care Settings| url=http://www.cdc.gov/tb/publications/factsheets/prevention/ichcs.htm}}</ref></small> | ||
|} | |} | ||
Latest revision as of 04:49, 27 March 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mashal Awais, M.D.[2]; Alejandro Lemor, M.D. [3]
Overview
Primary prevention in tuberculosis is necessary to avoid the disease transmission and causing infection in healthy people. The BCG vaccine is given to children who are predisposed to get TB infections, such as children living in endemic countries or close contacts with a confirmed case of TB. Several preventive measures are adopted to avoid the transmission of the mycobacteria tuberculosis, such as respiratory isolation, use of respiratory masks among health-care workers, and emphasizing respiratory hygiene and cough etiquette.
Primary Prevention
BCG Vaccine
- Bacille Calmette-Guerin (BCG) is a live attenuated vaccine derived from M. bovis used for the vaccination against M. tuberculosis.
- BCG vaccination is highly recommended for each infant who is living in an endemic area of TB or who is at high risk of getting TB infection due to exposure to TB. [1]
- The BCG vaccine is effective and can protect against severe types of tuberculosis infections including miliary or meningeal tuberculosis.
- BCG vaccine is not recommended for HIV positive children; however, children with unknown HIV status and born to HIV positive women, have to be be vaccinated. [1]
- There is no established value of the vaccine for patients who have been infected by tuberculosis.[2]
- BCG vaccination should be given to health care workers in any of the following conditions:[3]
- TB patients have been infected with TB strains resistant to both isoniazid and rifampin
- Ongoing transmission of multi-drug resistant TB strains to health care workers
- Failure of the implemented TB infection-control precautions
| Contraindications for BCG | |
|---|---|
| Immunosuppression | BCG vaccination should not be given to immunosuppressed individuals (e.g., persons who are HIV infected) or who may become immunocompromised (e.g., candidates for organ transplant). |
| Pregnancy | BCG vaccination should not be given during pregnancy. Although no harmful effects of BCG vaccination on the fetus have been noticed, further studies are required to establish its safety. |
| Adapted from CDC [3] | |
Prevention for International Travelers
- Travelers must avoid prolonged close contact with known TB patients in crowded or enclosed places.
- Travelers who anticipate probable prolonged exposure to TB, such as medical staff, people in prison, or homeless shelter populations must have a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) test before leaving the U.S. [4]
Prevention in Health-Care Settings
- Confirmed cases of TB during hospitalization must fulfill the following recommendations:[5]
- Single-patient room with private bathroom.
- Healthcare workers and visitors should wear disposable respirators (at least N95).
- Doors should be closed as much time as possible.
- Adequate room ventilation or negative pressure.
Determining the Infectiousness of TB Patients
| Airborne Precautions |
|---|
Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics:
|
| Airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis explaining the clinical manifestations is established or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals. |
| If infectious TB is still suspected even after the collection of three negative sputum smear results, patients should not be released from airborne precautions until they receive standard multidrug antituberculosis therapy (minimum of 2 weeks) and show clinical improvement. |
Patients who have drug-susceptible TB should remain under airborne precautions until they meet all of the following:
|
| Adapted from CDC TB Infection Control in Health-Care Settings[6] |
References
- ↑ 1.0 1.1 "WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014" (PDF).
- ↑ Roy, A.; Eisenhut, M.; Harris, R. J.; Rodrigues, L. C.; Sridhar, S.; Habermann, S.; Snell, L.; Mangtani, P.; Adetifa, I.; Lalvani, A.; Abubakar, I. (2014). "Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis". BMJ. 349 (aug04 5): g4643–g4643. doi:10.1136/bmj.g4643. ISSN 1756-1833.
- ↑ 3.0 3.1 "CDC Tuberculosis Fact Sheets Vaccines and Immunizayions".
- ↑ "CDC Tuberculosis Infection Control and Prevention".
- ↑ "Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005".
- ↑ "CDC Tuberculosis Infection Control in Health-Care Settings".