Tuberculosis primary prevention: Difference between revisions
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*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: | |||
:*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. | |||
===Screening=== | ===Screening=== | ||
Revision as of 14:57, 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.
- 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:
- 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.
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. [3]
Prevention in Health-Care Settings
- Confirmed cases of TB during hospitalization should meet the following recommendations:[4]
- 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.
- ↑ "CDC Tuberculosis Infection Control and Prevention".
- ↑ "Guidelines for Preventing the Transmission of M. tuberculosis in Health-Care Settings, 2005".