Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000

Abstract

BACKGROUND The guidelines on control and prevention of tuberculosis in the United Kingdom have been reviewed and updated. METHODS A subcommittee was appointed by the Joint Tuberculosis Committee (JTC) of the British Thoracic Society to revise the guidelines published in 1994 by the JTC, including representatives of the Royal College of Nursing, Public Health Medicine Environmental Group, and Medical Society for Study of Venereal Diseases. In preparing the revised guidelines the authors took account of new published evidence and graded the strength of evidence for their recommendations. The guidelines have been approved by the JTC and the Standards of Care Committee of the British Thoracic Society. RECOMMENDATIONS Tuberculosis services in each district should have staffing and resources to fulfil both the control and prevention recommendations in this document and to ensure adequate treatment monitoring. Notification of tuberculosis is required for surveillance and to initiate contact tracing (where appropriate). The following areas are discussed and recommendations made where appropriate: (1) public health law in relation to tuberculosis; (2) the organisational requirements for tuberculosis services; (3) measures for control of tuberculosis in hospitals, including segregation of patients; (4) the requirements for health care worker protection, including HIV infected health care workers; (5) measures for control of tuberculosis in prisons; (6) protection for other groups with potential exposure to tuberculosis; (7) awareness of the high rates of tuberculosis in the homeless together with local plans for detection and action; (8) detailed advice on contact tracing; (9) contact tracing required for close contacts of bovine tuberculosis; (10) management of tuberculosis in schools; (11) screening of new immigrants and how this should be performed; (12) outbreak contingency investigation; and (13) BCG vaccination and the management of positive reactors found in the schools programme.

Review of Epidemiological Studies on the Occupational Risk of Tuberculosis in Low-Incidence Areas

“…Therefore, we would like to emphasize the importance of regular information and training measures concerning protective measures as well as the diagnosis and treatment of tuberculosis. Early recognition, efficient treatment and isolation of patients with tuberculosis are key issues regarding the prevention of work-related tuberculosis [91,92,93,94,95,96]. A patient with lung tuberculosis should be instructed about coughing hygiene and should wear a surgical mask.…”

BTS statement on criteria for specialist referral, admission, discharge and follow-up for adults with respiratory disease

“…Several key areas relating to the control and prevention of TB have been identified in the BTS and NICE guidelines27 28 including:…”

Tracing contacts of TB patients in Malaysia: costs and practicality

“…Taking this recommendation into account, this strategy could perhaps save valuable resources, especially in our setting. Contrary to this, other guidelines (Richard and Kerri 2010; National Institute of Health and Clinical Excellence National Institute for Health and Clinical Excellence 2006), including the United Kingdom guidelines (Joint Tuberculosis Committee on the British Thoracic Society Joint Tuberculosis Committee of the British Thoracic Society 2000), suggest investigating through both TST and chest X-ray. NICE guidelines further advice an interferon-gamma test if TST is positive (National Institute of Health and Clinical Excellence National Institute for Health and Clinical Excellence 2006).…”

“…Tuberculin Skin Testing (TST) and chest X-ray are the most commonly employed contact tracing procedures (Australasian Society for HIV Medicine 2010; Centers of Disease Control and Prevention 2005; Richard and Kerri 2010); however TST is comparatively less cost-effective than radiological examination (Schwartzam and Menzies 2000). Guidelines (Centers of Disease Control and Prevention 2005; Richard and Kerri 2010;Joint Tuberculosis Committee of the British Thoracic Society 2000) on contact tracing recommends TST to all HIV-negative household members and/or close contacts of infectious TB cases who are five years of age or older, and have had active TB excluded. Furthermore, guidelines recommend administering IPT in contacts with positive TST.…”