Guidelines on the Prevention and Control of Tuberculosis in Ireland

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<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCBCG vaccination and natural infection points to a shorter interval. After inadvertent vaccination with M.tuberculosis (the Lubeck Disaster), children developed positive reactions in three to seven weeks. Otherstudies have shown clinical illness with a positive tuberculin test from 19-57 days after exposure with amean of 37 days. 297There continues to be international variation in practice. The 2003 New Zealand TB Control guidelineslowered the window period for testing from twelve to eight weeks based on the findings of the studiesoutlined above. 52 Current US guidelines 51 cite eight to ten weeks, while the UK advises a six-week intervalbetween tuberculin tests (a recommendation based on consensus opinion of clinicians and experts). 26It is the view of this committee, based on available best evidence, that six-eight weeks constitutes agood timing interval as it is important to leave long enough for conversion to occur but not too long for adelayed diagnosis. Eight weeks is a good compromise and well within evidence for conversion times statedin the literature.Recommendation:The recommended interval between first and second screening rounds (TST ± IGRA) in contactinvestigations is eight weeks. If the last contact with the infectious case exceeded an eightweekperiod, one TST is sufficient.-101-
<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCFigure 8.1: Algorithm for close contacts (adults and children ≥ 5 years) of all cases of infectious/presumed infectious TBFor all at outset:• Medical history• Physical examinationIf relevant symptoms:• Sputum for microscopy & culture• Chest X-rayAny abnormal chest X-ray:Refer for full evaluation for TB diseaseMantoux 2TUNegative (0-5mm)Positive (6-9mm)Positive (≥ 10mm)Non-infectiousindex caseInfectiousindex caseCXR negativeCXR negativeNoContact withcase withinprevious 8 weeksNon-infectiousIndex caseInfectious indexcaseNon-infectiousIndex caseInfectiousindex caseDischargeInform andadviseConsiderBCG if ≤35yearsYesRepeat TST orTST and IGRAMantoux conversion(≥ 5mm increase) orIGRA positiveCXR negativeConsider IGRAregardless ofBCG statusContact withindex case withinprevious 8 weeksNoIf no BCG: LTBI treatment*If BCG vaccinated:consider IGRAIGRA positive: LTBItreatmentIGRA negative: Informand adviseYesIf no BCGLTBItreatment *Repeat TST orTST and IGRAIf TST (≥10mm)or IGRA positiveand repeat CXR isnegative: LTBItreatment*IGRA ifBCGvaccinated &Mantoux
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Guidelines on the Prevention and Control of Tuberculosis in Ireland

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