<str<strong>on</strong>g>Guidel<strong>in</strong>es</str<strong>on</strong>g> <strong>on</strong> <strong>the</strong> Preventi<strong>on</strong> <strong>and</strong> C<strong>on</strong>trol <strong>of</strong> <strong>Tuberculosis</strong> <strong>in</strong> Irel<strong>and</strong> 2010HSE/HPSCrelat<strong>in</strong>g to complicati<strong>on</strong>s from BCG e.g. ulcerati<strong>on</strong>, regi<strong>on</strong>al lymphadenopathy <strong>and</strong> dissem<strong>in</strong>ati<strong>on</strong> have255, 257been reported.Infecti<strong>on</strong> preventi<strong>on</strong> <strong>and</strong> c<strong>on</strong>trol (see chapter 6)Hospital management <strong>of</strong> a HIV-TB case should <strong>in</strong>clude s<strong>in</strong>gle room accommodati<strong>on</strong> for a pulm<strong>on</strong>ary case,preferably with negative pressure ventilati<strong>on</strong>. HIV positive or o<strong>the</strong>r immunosuppressed <strong>in</strong>dividuals shouldnot be exposed to possible or c<strong>on</strong>firmed <strong>in</strong>fectious cases. 379 Aerosol-produc<strong>in</strong>g procedures should bec<strong>on</strong>ducted <strong>in</strong> isolati<strong>on</strong> rooms with sufficient ventilati<strong>on</strong> to ensure airborne particles are removed betweeneach patient’s use. Fur<strong>the</strong>rmore, exposure to HCWs should be m<strong>in</strong>imised by reduc<strong>in</strong>g <strong>the</strong> number <strong>of</strong>workers <strong>in</strong>volved <strong>in</strong> direct care, e.g. us<strong>in</strong>g a named-nurse system/primary nurs<strong>in</strong>g. Individual assessmentsshould be made with regards to risks for visitors.-131-
<str<strong>on</strong>g>Guidel<strong>in</strong>es</str<strong>on</strong>g> <strong>on</strong> <strong>the</strong> Preventi<strong>on</strong> <strong>and</strong> C<strong>on</strong>trol <strong>of</strong> <strong>Tuberculosis</strong> <strong>in</strong> Irel<strong>and</strong> 2010HSE/HPSC11. Educati<strong>on</strong>, Research <strong>and</strong> Informati<strong>on</strong>11.1 Educati<strong>on</strong>The <strong>in</strong>creased rates <strong>of</strong> TB <strong>in</strong> Irel<strong>and</strong> over <strong>the</strong> last seven years dem<strong>and</strong> better educati<strong>on</strong> <strong>of</strong> our medical,nurs<strong>in</strong>g <strong>and</strong> pharmacy pers<strong>on</strong>nel about this important disease. Our public health priorities <strong>in</strong>clude suchissues as deal<strong>in</strong>g with LTBI <strong>in</strong> at-risk populati<strong>on</strong>s, TB disease preventi<strong>on</strong> <strong>and</strong> treatment <strong>in</strong> immigrants <strong>and</strong>multiple drug-resistant TB disease. The small amount <strong>of</strong> time <strong>in</strong>vested <strong>in</strong> TB educati<strong>on</strong> <strong>of</strong> Irish HCWs leaves<strong>the</strong>m poorly prepared to address <strong>the</strong>se emerg<strong>in</strong>g challenges.Recommendati<strong>on</strong>:Given <strong>the</strong> <strong>in</strong>creased importance <strong>of</strong> LTBI <strong>and</strong> TB diagnosis <strong>and</strong> treatment, TB educati<strong>on</strong> <strong>in</strong> <strong>the</strong>undergraduate <strong>and</strong> postgraduate medical/nurs<strong>in</strong>g discipl<strong>in</strong>es needs to be streng<strong>the</strong>ned.11.2 ResearchResearch <strong>in</strong>to TB has progressed apace, s<strong>in</strong>ce <strong>the</strong> publicati<strong>on</strong> <strong>of</strong> <strong>the</strong> last nati<strong>on</strong>al TB guidel<strong>in</strong>es, 113 with newdrug opti<strong>on</strong>s, <strong>and</strong> new tests that seek to address resistant TB <strong>and</strong> difficult to diagnose TB disease. In thisregard, a diarylqu<strong>in</strong>ol<strong>in</strong>e anti-TB drug is under development, 380 <strong>and</strong> <strong>the</strong> IGRA blood tests have become ama<strong>in</strong>stream opti<strong>on</strong> to diagnose LTBI. 57 IGRA <strong>on</strong> pleural fluid <strong>and</strong> br<strong>on</strong>choscopy wash<strong>in</strong>gs are also understudy. 381 Meanwhile, basic research has improved our underst<strong>and</strong><strong>in</strong>g <strong>of</strong> <strong>the</strong> host resp<strong>on</strong>se to TB <strong>and</strong>allowed new vacc<strong>in</strong>e designs that may improve <strong>on</strong> BCG. 382 F<strong>in</strong>ally, our underst<strong>and</strong><strong>in</strong>g <strong>of</strong> <strong>the</strong> host resp<strong>on</strong>sehas allowed us predict <strong>and</strong> prevent reactivati<strong>on</strong> <strong>of</strong> TB <strong>in</strong> patients tak<strong>in</strong>g specific cytok<strong>in</strong>e blockers whichmake <strong>the</strong>se immunosuppressants safer. 93A number <strong>of</strong> researchers <strong>in</strong> TB have relocated to Irel<strong>and</strong> <strong>and</strong> <strong>the</strong>y are collaborat<strong>in</strong>g with immunologists,epidemiologists <strong>and</strong> scientists with an <strong>in</strong>terest <strong>in</strong> bov<strong>in</strong>e TB. Such work will <strong>in</strong>form better treatment, tests<strong>and</strong> vacc<strong>in</strong>e design. It is noted however, that we specifically lack any data <strong>on</strong> LTBI prevalence <strong>and</strong> also <strong>on</strong><strong>the</strong> use <strong>of</strong> IGRA <strong>in</strong> <strong>the</strong> diagnosis <strong>of</strong> LTBI <strong>in</strong> <strong>the</strong> Irish populati<strong>on</strong>.In c<strong>on</strong>trast to o<strong>the</strong>r diseases, TB research <strong>of</strong>ten lacks <strong>in</strong>dustry sp<strong>on</strong>sorship. We <strong>the</strong>refore encouragec<strong>on</strong>t<strong>in</strong>ued research fund<strong>in</strong>g <strong>of</strong> this neglected disease by our governmental fund<strong>in</strong>g agencies. Researchfellows will<strong>in</strong>g to undertake TB research should be fostered <strong>and</strong> given seed m<strong>on</strong>ey to try <strong>and</strong> promote suchactivity. The challenge falls to us to encourage our brightest <strong>in</strong>vestigators <strong>in</strong>to <strong>the</strong> field <strong>of</strong> TB research.The development <strong>of</strong> <strong>the</strong> IGRA blood tests for LTBI, <strong>the</strong> development <strong>of</strong> immuno<strong>the</strong>rapies to treat multipledrug-resistant TB cases <strong>and</strong> <strong>the</strong> advances <strong>in</strong> vacc<strong>in</strong>ology makes <strong>the</strong> TB field a scientifically excit<strong>in</strong>g <strong>on</strong>e topursue. A number <strong>of</strong> worldwide c<strong>on</strong>sortia have been established to <strong>in</strong>vestigate TB (e.g. TBNET), <strong>and</strong> it isencouraged that Irish <strong>in</strong>vestigators should jo<strong>in</strong> such c<strong>on</strong>sortia to deliver answers to important questi<strong>on</strong>sthat require a large number <strong>of</strong> patients (e.g. MDR-TB or XDR-TB treatment regimen development).Recommendati<strong>on</strong>:Research that seeks to improve our underst<strong>and</strong><strong>in</strong>g <strong>of</strong> <strong>the</strong> pathobiology <strong>of</strong> tuberculosis aswell as <strong>the</strong> nature <strong>of</strong> <strong>the</strong> disease <strong>in</strong> our own country is to be encouraged; research fund<strong>in</strong>gagencies should foster such activity, which has <strong>the</strong> potential to improve <strong>the</strong> treatment <strong>of</strong> <strong>the</strong>disease both locally <strong>and</strong> <strong>in</strong>ternati<strong>on</strong>ally.Studies to determ<strong>in</strong>e <strong>the</strong> prevalence rate <strong>of</strong> LTBI should be <strong>in</strong>itiated <strong>and</strong> supported.-132-