Tuberculosis primary prevention: Difference between revisions
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===Determining the Infectiousness of TB Patients=== | ===Determining the Infectiousness of TB Patients=== | ||
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Revision as of 19:16, 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 in tuberculosis is targeted to avoid the disease transmission and infection of healthy individuals. The BCG vaccine is used in children susceptible to TB infections, such as children living in endemic areas or having a close contact with a confirmed case of TB. Several preventive measures are used to avoid the transmission of the mycobacteria, such as respiratory isolation, use of respiratory masks among health-care professionals, and advising respiratory hygiene and cough etiquette.
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 | |
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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] |
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.
Determining the Infectiousness of TB Patients
Airborne Precautions |
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Patients who have suspected or confirmed TB disease should be considered infectious if they have the following characteristics:
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Airborne precautions can be discontinued when infectious TB disease is considered unlikely and either another diagnosis is made that explains the clinical syndrome or the patient produces three consecutive negative sputum smears collected in 8 to 24-hour intervals. |
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 treatment (minimum of 2 weeks) and demonstrate clinical improvement. |
Patients who have drug-susceptible TB should remain under airborne precautions until they meet all of the following:
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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".