Tuberculosis primary prevention: Difference between revisions

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:*Doors should be closed as much time as possible.
:*Doors should be closed as much time as possible.
:*Adequate room  ventilation or negative pressure should be assessed daily.
:*Adequate room  ventilation or negative pressure should be assessed daily.
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Many countries use [[Bacillus Calmette-Guérin|BCG]] vaccine as part of their TB control programs, especially for infants. This was the first vaccine for TB and developed at the [[Pasteur Institute]] in France between 1905 and 1921.<ref name=Bonah>{{cite journal |author=Bonah C |title=The 'experimental stable' of the BCG vaccine: safety, efficacy, proof, and standards, 1921–1933 |journal=Stud Hist Philos Biol Biomed Sci |volume=36 |issue=4 |pages=696–721 |year=2005 | pmid = 16337557}}</ref> However, mass vaccination with BCG did not start until after World War II.<ref name=Comstock>{{cite journal |author=Comstock G |title=The International Tuberculosis Campaign: a pioneering venture in mass vaccination and research |journal=Clin Infect Dis |volume=19 |issue=3 |pages=528-40 |year=1994 | pmid = 7811874}}</ref> The protective efficacy of BCG for preventing serious forms of TB (e.g. [[meningitis]]) in children is greater than 80%; its protective efficacy for preventing pulmonary TB in adolescents and adults is variable, ranging from 0 to 80%.<ref name=Bannon_1999>{{cite journal |author=Bannon M |title=BCG and tuberculosis |journal=Arch Dis Child |volume=80 |issue=1 |pages=80-3 |year=1999 | pmid = 10325767}}</ref>
In South Africa, the country with the highest prevalence of TB, BCG is given to all children under the age of three.<ref>[http://web.archive.org/web/20070630073246/http://www.who.int/immunization_monitoring/data/south_africa.pdf WHO/UNICEF Review of National Immunization Coverage 1980–2005: South Africa] (PDF). World Health Organization (August 2006).  Retrieved on 2007-06-08.</ref> However, the effectiveness of BCG is lower in areas where mycobacteria are less [[prevalence|prevalent]], therefore BCG is not given to the entire population in these countries. In the USA, for example, BCG vaccine is not recommended except for people who meet specific criteria:
*Infants or children with negative skin-test results who are continually exposed to untreated or ineffectively treated patients or will be continually exposed to [[Multidrug resistance|multidrug-resistant]] TB.
*Healthcare workers considered on an individual basis in settings in which a high percentage of MDR-TB patients has been found, transmission of MDR-TB is likely, and TB control precautions have been implemented and were not successful.
Several new vaccines to prevent TB infection are being developed. The first recombinant tuberculosis [[vaccine]] entered [[clinical trial]]s in the United States in 2004, sponsored by the [[National Institute of Allergy and Infectious Diseases]] (NIAID).<ref>[[National Institute of Allergy and Infectious Diseases]] (NIAID).[http://www.nih.gov/news/pr/jan2004/niaid-26.htm First U.S. Tuberculosis Vaccine Trial in 60 Years Begins.] ''National Institutes of Health News'' 26 January 2004. Retrieved on 19 October 2007.</ref> A 2005 study showed that a [[DNA vaccine|DNA TB vaccine]] given with conventional [[chemotherapy]] can accelerate the disappearance of bacteria as well as protect against re-infection in mice; it may take four to five years to be available in humans.<ref name=Ha_2005>{{cite journal |author=Ha S, Jeon B, Youn J, Kim S, Cho S, Sung Y |title=Protective effect of DNA vaccine during chemotherapy on reactivation and reinfection of Mycobacterium tuberculosis |journal=Gene Ther |volume=12 |issue=7 |pages=634-8 |year=2005 | pmid = 15690060}}</ref> A very promising TB vaccine, [[MVA85A]], is currently in [[clinical trial|phase II trials]] in South Africa by a group led by Oxford University,<ref name=Ibanga_2006>{{cite journal |author=Ibanga H, Brookes R, Hill P, Owiafe P, Fletcher H, Lienhardt C, Hill A, Adegbola R, McShane H |title=Early clinical trials with a new tuberculosis vaccine, MVA85A, in tuberculosis-endemic countries: issues in study design |journal=Lancet Infect Dis |volume=6 |issue=8 |pages=522-8 |year=2006 |url=http://linkinghub.elsevier.com/retrieve/pii/S1473309906705527|  pmid = 16870530}}</ref> and is based on a genetically modified [[vaccinia]] virus. Because of the limitations of current vaccines, researchers and policymakers are promoting new economic models of vaccine development including prizes, tax incentives and [[advance market commitments]].<ref>Webber, David and Kremer, Michael. [http://www.who.int/bulletin/archives/79(8)735.pdf Stimulating Industrial R&D for Neglected Infectious Diseases: Economic Perspectives (PDF).] ''Bulletin of the World Health Organization'' 79(8), 2001, pp. 693–801.</ref><ref>Barder, Owen; Kremer, Michael; Williams, Heidi.  [http://www.bepress.com/ev/vol3/iss3/art1 "Advance Market Commitments: A Policy to Stimulate Investment in Vaccines for Neglected Diseases,"] ''The Economists' Voice'', Vol. 3 (2006) Issue 3.</ref>
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==References==
==References==

Revision as of 15:33, 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

Further information: [[:Tuberculosis 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. ↑ 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".

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