Mantoux and BCG
Vaccination against Tuberculosis (TB)
Human tuberculosis (TB) is caused by infection by a type of
bacteria known as Mycobacterium and may affect almost any
part of the body. The most common form is pulmonary TB, which
accounts for almost 60% of all cases in the UK. Almost all
cases of TB in the UK are acquired through the respiratory route,
by breathing in infected droplets from a person with infectious
respiratory TB. Transmission is often after prolonged close contact
such as living in the same household.
In 2005, following a continued decline in TB rates in the
indigenous UK population, the schools BCG immunisation programme
for TB was stopped. BCG immunisation is now carried out on an
individual risk-assessment basis.
A Mantoux Test is performed prior to the BCG vaccination in all
persons over the age of 6. A Mantoux test is not
required prior to BCG vaccination for children under 6 years of
age, provided there is no history of:
- Residence in a high-risk area.
- Contact with a tuberculosis patient.
For all other patients, Mantoux testing is necessary before BCG
vaccination.
All Well Travelled Clinics keep Mantoux tests and BCG vaccine in
stock and can provide testing and vaccination for occupational
and/or travel purposes if indicated based on a detailed risk
assessment.
Individuals at occupational risk
People in the following occupational groups are more likely than
the general population to come into contact with someone with
TB:
- Healthcare workers who will have contact with patients or
clinical materials
- Laboratory staff who will have contact with patients, clinical
materials or derived isolates of tuberculosis
- Veterinary and staff such as abattoir workers who handle animal
species known to be susceptible to TB, e.g. simians
- Prison staff working directly with prisoners
- Staff of care homes for the elderly
- Staff of hostels for homeless people and facilities
accommodating refugees and asylum seekers.
Unvaccinated, tuberculin-negative individuals aged under 35
years in these occupations are recommended to receive BCG. There
are no data on the protection afforded by BCG vaccine when it is
given to adults aged 35 years or over.
Not all healthcare workers are at an equal risk of TB. There are
likely to be categories of healthcare workers who are at particular
risk of TB, and should be part of the clinical risk assessment when
the use of BCG is being considered for a healthcare worker over 35
years of age.
Travellers and those going to reside abroad
BCG may be required for previously unvaccinated,
tuberculin-negative individuals according to the destination and
the nature of travel. The vaccine is recommended for those
under 16 years who are going to live or work with local people for
more than three months in a country where the annual incidence of
TB is 40/100,000 or greater.
For detailed information on Tuberculosis go to:
Chapter 32-Immunisation against infectious Disease
"The Green Book" 2006 edition
