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/HPSCChest X-rayChest X-rays should be offered to all new entrants aged ≥16 years (provided they are not pregnant). Allthose with abnormal chest X-ray results suggestive of active disease or of inactive TB (chapter 2) should bereferred for medical evaluation. Treatment of LTBI should be considered in those with radiological evidenceof inactive TB. Asymptomatic individuals with a normal chest X-ray in a selected group i.e. those aged 16 to35 years from sub-Saharan Africa or a country with a TB incidence greater than 500 per 100,000 §§§§ shouldbe offered a TST (2TU Mantoux test) regardless of BCG vaccination status.TST (Mantoux test)Individuals ≥ 16 yearsAsymptomatic individuals with a normal chest X-ray in a selected group i.e. those aged 16 to 35 years fromsub-Saharan Africa or a country with a TB incidence greater than 500 per 100,000 §§§§4 should be offered aTST (2TU Mantoux test) regardless of BCG vaccination status. Pregnant females (no chest X-ray, see above)should also have a TST (2TU Mantoux test), regardless of BCG vaccination status. A risk assessment forHIV should be undertaken for all individuals having a TST or receiving BCG vaccination which takes intoaccount the HIV rates in the individual’s country of origin.Those with TST results ≥ 10mm should be referred for further medical evaluation and considered forLTBI treatment. Individuals with TST results < 10mm should be informed and advised of the signs andsymptoms of TB disease and asked to seek medical care if they experience these symptoms. Consider BCGvaccination for all those aged ≤ 35 years with TST results ≤ 5mm who are previously unvaccinated (figure9.2 - see page 120).While all age groups should be considered for treatment of LTBI, care should be taken when prescribingLTBI therapy for those with co-morbidities which increase the likelihood of hepatotoxicity. The use of DOTshould also be considered in this population (chapter 3).Individuals
<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCFigure 9.2: Algorithm for screening new entrants from countries with ≥ 40 cases of TB per 100,000 perannumAsymptomaticHealthQuestionnaire*SymptomaticReferral to clinic formedical evaluation,CXR and sputumexaminationAge ≥16 years**Age < 16 years orpregnant**2 TU MantouxChest X-rayNormalAbnormalSelectedgroups?***NoInform andadviseRefer for investigation1. If active TB: treat2. If CXR suggestive ofinactive TB: considertreatment for LTBI if notpreviously adequatelytreatedYes2 TU MantouxBCGvaccinatedBCGunvaccinated 500/100,000**** Timing of X-ray and BCG may be dependent on pregnancy status9.3 Prisons, Remand and Detention CentresHigh TB incidence rates 308 and outbreaks associated with multidrug-resistance and HIV co-infection 309;311have been observed in prison populations in recent decades. High rates have been attributed to adisproportionate number of prisoners being of low socioeconomic status, at risk of disease due to alcohol,substance misuse, HIV infection and having recently arrived from areas of high endemnicity (the risk ofdisease development is greatest within five years or arrival). 331 Prison facilities can often be over-crowded,poorly ventilated, with prisoners living in close proximity. 333-336 Short stays and movement between andwithin prison facilities increase the likelihood of exposure to TB patients and enhance the potential fortransmission. This mobility also creates difficulties for the implementation of control strategies. Despitethis, the congregation of many disadvantaged individuals in this setting provides an opportunity to improvethe health of those who may not otherwise receive medical care.-120-
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Guidelines on the Prevention and Control of Tuberculosis in Ireland

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