TUBERCULOSIS - THE FACTS
What is Tuberculosis (TB)?
Tuberculosis (TB) is an infectious disease which is mostly caused by a germ called Mycobacterium Tuberculosis. It is a major cause of illness worldwide. The most common site of infection is the lung, but it can also affect other parts of the body including the kidneys, bowel and lymph nodes.
How do people catch TB?
In the UK, the majority of cases of TB are caught through close contact with someone who already has the infection - eg. family members, people living in close proximity to others, etc. Like the common cold it is most commonly passed on through coughing or sneezing. TB can also be contracted from unpasteurised milk or contact with infected cattle.
Multiple factors have led to a massive reduction in TB in the UK over the last century. These include vaccination, milk pasteurisation and general improvements in standards of living. However, in recent years there has been an increase in incidence of the disease in some areas of the UK. In the South East, the number of cases increased by 7.7% between 2006 and 2007; in the Thames Valley the increase was 16.8%.*
* Health Protection Agency's 2007 Tuberculosis Annual Report (published September 2008)
Is TB preventable?
A vaccine known as the BCG (Bacille Calmette-Guerin) has been shown to give 70% - 80% protection against TB. The vaccination is safe as well as quick and simple to administer.
TB can be treated with antibiotics, but the treatment is prolonged and occasionally, resistant cases are found. Prevention, therefore, really is better than cure.
Who is immunised against TB?
Until 2005, all schoolchildren were routinely given the BCG vaccine at about the age of 13. However, national policy changed in Autumn 2005 and only those in 'high risk' groups are now immunised under the current Department of Health (DoH) programme.
High risk groups are defined as:
- Infants living in areas of the UK where there is a high rate of TB
- Infants whose parents or grandparents have lived in a country with a high rate of TB
- Children with risk factors for TB who have not previously been vaccinated
- Immigrants from countries where TB is common
- People at risk due to their job, eg. health workers, prison staff, etc
- Close contacts of people with active TB
- People who intend to live for one month or more in countries with a high TB rate
OUR CONCERNS
Many parents are unaware that the DoH BCG vaccination programme no longer exists within schools and that, unless they fall into one of the high risk groups, their children will not be offered the BCG vaccine.
Increasing numbers of young people are taking exotic holidays or undertaking gap year travel. Many countries have a much higher prevalence of TB than the UK and antibiotic resistant TB is on the increase, particularly in Russia, China and India. Therefore, more young people are now potentially at risk of coming into contact with the disease.
Worldwide, 1 in every 3 people is infected with TB. Each year, 8-9 million individuals develop active TB infection, with half a million cases being multi-drug resistant; and around 2 million people die of TB or related complications each year. Although TB has a worldwide distribution it is largely a problem among developing nations - Africa and Asia account for 86% of all cases.*
* World Health Organisation Global TB Report 2008
HOW CAN WE HELP?
In order to support parents wishing to protect their children against the disease, DOCTORnow offers BCG vaccination clinics, both at our Beaconsfield surgery and on a 'Mobile BCG Clinic' basis in schools.
The BCG Nursing team is led by Nurse Paula Chamberlain. Paula has over 12 years' experience in running BCG clinics, both within and outside the NHS, and is a highly trained and respected clinician. Practice Nurse Liz D'Arcy Evans is also fully trained and experienced in administering the vaccine.
Our in-surgery clinics are held once every 4 weeks. On Day 1 we administer the Mantoux Test and on Day 4 we review the results and administer the BCG vaccine or offer advice as appropriate.
VACCINATION PROCEDURE
The TB vaccination, which is also referred to as the BCG, is never given to a person who has previously been exposed to the disease. In the past, a Heaf test was performed to assess previous exposure, but this has now been replaced by the Mantoux test.
Mantoux test
Before having the BCG vaccine a Mantoux test is carried out for all people over the age of 6 years, or younger if the child is in a high risk group.
It is given 'intradermally' into the skin surface of the lower forearm. After the injection some people experience mild itching or swelling but this usually goes within a week.
The Mantoux test site is inspected 3 days after it has been administered. At this stage the injection site is measured and recorded to determine whether or not the BCG vaccination is necessary. If the test is 'negative' the BCG vaccination will be offered. If the test is 'positive' advice will be given as to the appropriate course of action.
BCG Vaccination
To administer a BCG vaccination, the skin is stretched slightly and the vaccine injected into the skin of the upper arm or upper thigh.
Between 2-6 weeks after the vaccination a small red spot usually develops. This will eventually heal to form a round flat scar (a useful proof of vaccination). A small shallow ulcer can appear. In the rare situation that a reaction occurs you should contact our team.
No other live vaccines can be administered from 4 weeks before and until 4 weeks after the BCG vaccination. Should another live vaccine be required, it can be administered at the same time as the BCG vaccination.
Please note that no other vaccinations should be given in the same arm as the BCG for up to 3 months.
HOW LONG DOES THE BCG VACCINATION PROTECT FOR?
In schoolchildren, studies have shown immunity to last for at least 15 years, and is probably life long. A booster is not recommended.
WHAT ADVERSE REACTIONS MAY BE SEEN AFTER THE VACCINATION?
A few children feel faint or dizzy immediately following the BCG vaccination. More rarely a child may have a transient reaction (usually a rash) or, very rarely, an anaphylactic reaction.
Commonly a shallow ulcer up to about 10mm in diameter may develop at the injection site. Should the site ooze then a dry dressing, rather than a plaster, is recommended until a scar forms. Uncommonly it may take several months to heal.
There is usually a small scar, but very rarely the skin at the injection site heals with a raised scar called a keloid.
If you think your reaction is more severe than you expected, please do not hesitate to contact us.
WHAT DOES IT COST?
Most children under 6 years of age do not require a Mantoux Test and not everyone who has a Mantoux Test will go on to have the BCG vaccination. Therefore our fees are as follows:
| Mantoux Test alone | £50 |
| BCG vaccination alone | £45 |
| Mantoux Test & BCG vaccination combined | £75 |
Payment for the Mantoux Test is required on the day.
Should a BCG vaccination then be required, the balance of £25 is payable at that time.
Payment for the BCG vaccination alone is required at the time of administration.
