Prevention Bacille Calmette Guerin (BCG) Vaccine Live attenuated strain of Mycobacterium bovis; 1921 Efficacy Clinical trials UK: protective effect of 60 to 80%; Trials elsewhere have shown variable results; efficacy  the closer one gets to the equator – Meta-analysis Colditz et al. (1994) = 50 per cent effective Most important protective benefits are in minimising the risk of death, meningitis and miliary disease in neonates and young children WHO recommend  given to all children in countries highly endemic for TB Australian Recommendations: 1. Aboriginal neonates in areas of high incidence (e.g. NT, Far North Queensland, N WA & SA) 2. Individuals travelling to or living in areas with  prevalence of TB 3. Neonates born to parents with leprosy or a Fx of leprosy; 4. HCWs who may be at high risk of exposure to drug resistant cases

Very safe – Anaphylactoid reactions (rare); Most common is development of a localised abscess at the site of injection, especially if the vaccination is given too deeply – Immuno-compromised   risk for disseminated BCG infection C/I: Positive TST of greater than 5-mm diameter in duration; Immunocompromised (HIV, corticosteroids, chemo, malignancies  ); Pregnant (?); PHx TB; Febrile; Pt suffers from a generalised skin disease such as eczema and psoariasis Method Tuberculin skin test (Manoux) is done first (except infants below 6 months where Hx of TB excluded) C/I if reactive -  risk of severe local inflammation and scarring Single intradermal injection at the insertion of the deltoid – other sites: risk of keloid formation

Infection Control Isolation = Negative Pressure Rooms – prevent cross- contaminations from room to room – Generates negative pressure to allow air to flow into the isolation room but not escape from the room Educate patient about transmission  cover mouth when coughing etc

Prophylaxis Screen close contacts with tuberculin test +CXR – Tuberculin +ve, CXR –ve: nothing further – Pt with HIV, no BCG - isoniazid prophylaxis↓risk by 40% – Child with +ve tuberculin test  treatment – Tuberculin –ve in children/young adults  repeat in 6 wks; administer BCG if still –ve / treatment if +ve – Children <1y with family member with TB - isoniazid 6/12 + BCG with strain resistant to isoniazid