Traveller vaccination tuberculosis

Template:Traveller vaccination tuberculosis Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Overview

Vaccination of young children against tuberculosis is not specific to the needs of travellers. In many countries BCG-vaccination of newborns and infants is routinely administered. Unvaccinated young children who are brought to an environment of high prevalence for tuberculosis should be offered vaccination according to the respective national recommendations.

Disease cause

The tubercle bacillus Mycobacterium tuberculosis.

Transmission

By inhalation of M. tuberculosis-containing microscopic droplets.

Nature of the disease

In most cases, exposure to M. tuberculosis results in latent infection, which only occasionally turns into active disease. Tuberculosis may affect any organ but, from a public health point of view, active pulmonary disease with mycobacterial dissemination is the most important manifestation. In infants, tuberculous meningitis or disseminated disease may occur. Multidrug-resistance of M. tuberculosis is a rapidly increasing problem.

Geographical distribution

Worldwide among deprived populations, but most common in poor countries (see map). Tuberculosis is highly prevalent among HIVinfected individuals.

Risk for travellers

Most travellers are at low risk for tuberculosis. On the other hand, for those coming from countries where its endemicity is low to work in, for example, emergency relief in countries highly endemic for tuberculosis the risk may be considerable. Individuals with HIV infection are particularly susceptible.

Vaccine

BCG vaccines are based on live attenuated mycobacterial strains descended from the original, attenuated bacillus CalmetteGuérin. Apart from its documented effect against tuberculous meningitis and disseminated disease in infants, BCG vaccination is of very limited value for most travellers.

Precautions

Where possible, travellers should avoid prolonged and close contact with people with known or suspected cases of pulmonary tuberculosis. A tuberculin skin test before and after a high-risk mission abroad may be advisable for example for health professionals and humanitarian relief workers.