Tuberculosis primary prevention

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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

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:
  • 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.
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:
  • Produce 3 consecutive negative sputum smears collected in 8 to 24-hour intervals.
  • Receive standard multidrug antituberculosis treatment (minimum of 2 weeks period).
  • Demonstrate clinical improvement.
Adapted from CDC TB Infection Control in Health-Care Settings[6]

References

  1. 1.0 1.1 "WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children, 2014" (PDF).
  2. 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. 3.0 3.1 "CDC Tuberculosis Fact Sheets Vaccines and Immunizayions".
  4. "CDC Tuberculosis Infection Control and Prevention".
  5. "Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005".
  6. "CDC Tuberculosis Infection Control in Health-Care Settings".

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