TB can affect any part of the body but the most common type is pulmonary TB. Pulmonary TB infection is spread through inhalation of droplets from an infected person. These are passed on through coughing and you usually have to have prolonged contact with an infected person to contract TB yourself. Tuberculosis is responsible for nearly two million deaths each year, mainly in Africa, South and South East Asia. The majority of cases occur in Bangladesh, India, Indonesia, Myanmar and Thailand.(1) Those infected with HIV are more at risk of death as TB can enhance progression of HIV and visa versa.
Do I need a TB Vaccine for travel to infected areas?
This is a question we get asked often in travel clinic. The UK introduced a BCG vaccination programme in 1953 to inoculate children of school leaving age. The programme has undergone several changes since then and in the UK routine vaccination against TB is now not offered to school leavers. Studies have shown that the vaccine is less effective in preventing respiratory disease, which is the more common form in adults and so guidance has changed accordingly. The Department of Health Guidance now recommends only the following people should be vaccinated:
- all infants (aged 0 to 12 months) living in areas of the UK where the annual incidence of TB is 40/100,000 or greater*
- all infants (aged 0 to 12 months) with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater
- previously unvaccinated children aged one to five years with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater. These children should be identified at suitable opportunities, and can normally be vaccinated without tuberculin testing
- previously unvaccinated, tuberculin-negative children aged from six to under 16 years of age with a parent or grandparent who was born in a country where the annual incidence of TB is 40/100,000 or greater. These children should be identified at suitable opportunities, tuberculin tested and vaccinated if negative (see section on tuberculin testing prior to BCG vaccination)
- previously unvaccinated tuberculin-negative individuals under 16 years of age who are contacts of cases of respiratory TB (following recommended contact management advice – see National Institute for Health and Clinical Excellence (NICE), 2006)
- previously unvaccinated, tuberculin-negative individuals under 16 years of age who were born in or who have lived for a prolonged period (at least three months) in a country with an annual TB incidence of 40/100,000 or greater. BCG is not usually recommended for people aged over 16 years, unless the risk of exposure is great (e.g. healthcare or laboratory workers at occupational risk). If you think you may need a BCG vaccination discuss it with your doctor or nurse. References 1. Nathnac http://www.nathnac.org/pro/factsheets/TB.htm
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