World TB Day - 24th March 2011

Today is World Tuberculosis (TB) Day. World TB Day commemorates the day when in 1882 when Dr Robert Koch announced he had discovered the cause of tuberculosis. The goal of the Stop TB Campaign is to inspire innovation in TB research and care in the fight for TB elimination worldwide.
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

Call for boys to be vaccinated against Human Papilloma Virus (HPV)

There has been a lot in the media this week suggesting that boys should now be vaccinated against the human papilloma virus (HPV) after a study found that 50% of boys are infected with the virus. The study was carried out by researchers in Florida and the results published in the medical journal, The Lancet.
HPV causes 99% of all cervical cancers. Cervical cancer is cancer of the cervix (the entrance to the womb) and the HPV vaccine has been shown to prevent pre- cancerous legions caused by HPV types 16 and 18. The UK currently has a vaccination programme for girls age 12 - 18 years, but boys are not included in the current campaign. This new study has raised the debate on whether it is cost effective for the NHS to include boys in the National Vaccination programme.
A few weeks ago there was a very interesting documentary on the BBC presented by actress Jaime Winstone. The programme highlighted the increase in throat cancers caused by infection with HPV through oral sex.Again the HPV vaccine was discussed and Professor Stanley on the programme suggested the vaccine should be available to both men and women. However, David Salisbury, Director of Immunisation, said the government had no current plans to extend the scheme.
In our clinic we have recently seen an increase in the numbers of enquiries about the HPV vaccine from both men and women aged over 18 years who are not included in the NHS vaccination programme. Sussex Travel Clinic offers the Gardasil vaccine. Gardasil is the only cervical cancer vaccine that helps protect against 4 types of papillomavirus: 2 types cause 70% or cervical cancer cases, and 2 more types that cause 90% of genital warts cases. The vaccine is given on day 0, 1-2 months later and a booster dose at 6 months.
Gardasil is licensed for use in women up to the age of 45 and for use in boys age 9 - 15 years.