Tuberculosis primary prevention: Difference between revisions
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===BCG Vaccine=== | ===BCG Vaccine=== | ||
*[[Bacille Calmmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the immunization against [[M. tuberculosis]]. | *[[Bacille Calmmette-Guerin]] ([[Bacille Calmmette-Guerin|BCG]]) is a live attenuated vaccine derived from [[M. bovis]] used for the immunization against [[M. tuberculosis]]. | ||
*BCG vaccination is recommended for every infant that lives in a highly endemic area of TB or has a high risk of 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> | *[[Bacille Calmmette-Guerin|BCG vaccination]] is recommended for every infant that lives in a highly endemic area of TB or has a high risk of 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 administration of the vaccine protects against severe types of tuberculosis, such as [[miliary TB|miliary]] or [[tuberculous meningitis|meningeal tuberculosis]]. | *The administration of the vaccine protects against severe types of tuberculosis, such as [[miliary TB|miliary]] or [[tuberculous meningitis|meningeal tuberculosis]]. | ||
*BCG vaccine is not recommended for children with HIV infection, however, children with unknown HIV status and born to HIV positive women, should 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> | *[[BCG vaccine]] is not recommended for children with [[HIV]] infection, however, children with unknown [[HIV]] status and born to [[HIV]] positive women, should 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 proven benefit of the vaccine for patients that already 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> | *There is no proven benefit of the vaccine for patients that already 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 of health care workers should be considered on an individual basis in any of the following settings:<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> | *BCG vaccination of health care workers should be considered on an individual basis in any of the following settings:<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> | ||
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:*There is ongoing transmission of [[drug-resistant TB]] strains to health care workers and subsequent infection is likely | :*There is ongoing transmission of [[drug-resistant TB]] strains to health care workers and subsequent infection is likely | ||
:*Comprehensive TB infection-control precautions have been implemented, but have not been successful. | :*Comprehensive TB infection-control precautions have been implemented, but have not been successful. | ||
*Health care workers considered for BCG vaccination should be counseled regarding the risks and benefits associated with both BCG vaccination and treatment of latent TB infection. | *Health care workers considered for [[Bacille Calmmette-Guerin|BCG vaccination]] should be counseled regarding the risks and benefits associated with both [[Bacille Calmmette-Guerin|BCG vaccination]] and treatment of latent TB infection. | ||
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!style="background: #4479BA; width: 150px;" colspan=2| {{fontcolor|#FFF|Contraindications for BCG}} | !style="background: #4479BA; width: 150px;" colspan=2| {{fontcolor|#FFF|Contraindications for BCG}} | ||
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| 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" |BCG vaccination should not be given to persons who are immunosuppressed (e.g., persons who are HIV infected) or who are likely to become immunocompromised (e.g., persons who are candidates for organ transplant). | | style="padding: 5px 5px; background: #F5F5F5; width: 400px" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given to persons who are [[immunosuppressed]] (e.g., persons who are [[HIV]] infected) or who are likely to become [[immunocompromised]] (e.g., persons who are 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;" |BCG vaccination should not be given during pregnancy. Even though no harmful effects of BCG vaccination on the fetus have been observed, further studies are needed to prove its safety. | | style="padding: 5px 5px; background: #F5F5F5;" |[[Bacille Calmmette-Guerin|BCG vaccination]] should not be given during pregnancy. Even though no harmful effects of [[Bacille Calmmette-Guerin|BCG vaccination]] on the fetus have been observed, further studies are needed to prove its safety. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #F5F5F5;" colspan=2 | <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> | | style="padding: 5px 5px; background: #F5F5F5;" colspan=2 | <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> | ||
Revision as of 15:37, 24 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
Primary Prevention
BCG Vaccine
- Bacille Calmmette-Guerin (BCG) is a live attenuated vaccine derived from M. bovis used for the immunization against M. tuberculosis.
- BCG vaccination is recommended for every infant that lives in a highly endemic area of TB or has a high risk of exposure to TB. [1]
- The administration of the vaccine protects against severe types of tuberculosis, such as miliary or meningeal tuberculosis.
- BCG vaccine is not recommended for children with HIV infection, however, children with unknown HIV status and born to HIV positive women, should be vaccinated. [1]
- There is no proven benefit of the vaccine for patients that already have been infected by tuberculosis.[2]
- BCG vaccination of health care workers should be considered on an individual basis in any of the following settings:[3]
- A high percentage of TB patients are infected with TB strains resistant to both isoniazid and rifampin
- There is ongoing transmission of drug-resistant TB strains to health care workers and subsequent infection is likely
- Comprehensive TB infection-control precautions have been implemented, but have not been successful.
- Health care workers considered for BCG vaccination should be counseled regarding the risks and benefits associated with both BCG vaccination and treatment of latent TB infection.
| Contraindications for BCG | |
|---|---|
| Immunosuppression | BCG vaccination should not be given to persons who are immunosuppressed (e.g., persons who are HIV infected) or who are likely to become immunocompromised (e.g., persons who are candidates for organ transplant). |
| Pregnancy | BCG vaccination should not be given during pregnancy. Even though no harmful effects of BCG vaccination on the fetus have been observed, further studies are needed to prove its safety. |
| Adapted from CDC [3] | |
Screening
- Children with close contact with a TB confirmed case should be evaluated for tuberculosis infection.
- TST is the test of choice for screening for tuberculosis infection.
Prevention for International Travelers
- Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments.
- Travelers who anticipate possible prolonged exposure to TB, such as medical staff, individuals in prison, or homeless shelter populations should have a tuberculin skin test (TST) or interferon-gamma release assay (IGRA) test before leaving the United States. [4]
Prevention in Health-Care Settings
- Confirmed cases of TB during hospitalization should meet 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 should be assessed daily.
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".