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Published byClarence Watkins Modified over 9 years ago
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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
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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
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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
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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
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