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/HPSCrelating to complications from BCG e.g. ulceration, regional lymphadenopathy and dissemination have255, 257been reported.Infection prevention and control (see chapter 6)Hospital management of a HIV-TB case should include single room accommodation for a pulmonary case,preferably with negative pressure ventilation. HIV positive or other immunosuppressed individuals shouldnot be exposed to possible or confirmed infectious cases. 379 Aerosol-producing procedures should beconducted in isolation rooms with sufficient ventilation to ensure airborne particles are removed betweeneach patient’s use. Furthermore, exposure to HCWs should be minimised by reducing the number ofworkers involved in direct care, e.g. using a named-nurse system/primary nursing. Individual assessmentsshould be made with regards to risks for visitors.-131-
<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSC11. Education, Research and Information11.1 EducationThe increased rates of TB in Ireland over the last seven years demand better education of our medical,nursing and pharmacy personnel about this important disease. Our public health priorities include suchissues as dealing with LTBI in at-risk populations, TB disease prevention and treatment in immigrants andmultiple drug-resistant TB disease. The small amount of time invested in TB education of Irish HCWs leavesthem poorly prepared to address these emerging challenges.Recommendation:Given the increased importance of LTBI and TB diagnosis and treatment, TB education in theundergraduate and postgraduate medical/nursing disciplines needs to be strengthened.11.2 ResearchResearch into TB has progressed apace, since the publication of the last national TB guidelines, 113 with newdrug options, and new tests that seek to address resistant TB and difficult to diagnose TB disease. In thisregard, a diarylquinoline anti-TB drug is under development, 380 and the IGRA blood tests have become amainstream option to diagnose LTBI. 57 IGRA on pleural fluid and bronchoscopy washings are also understudy. 381 Meanwhile, basic research has improved our understanding of the host response to TB andallowed new vaccine designs that may improve on BCG. 382 Finally, our understanding of the host responsehas allowed us predict and prevent reactivation of TB in patients taking specific cytokine blockers whichmake these immunosuppressants safer. 93A number of researchers in TB have relocated to Ireland and they are collaborating with immunologists,epidemiologists and scientists with an interest in bovine TB. Such work will inform better treatment, testsand vaccine design. It is noted however, that we specifically lack any data on LTBI prevalence and also onthe use of IGRA in the diagnosis of LTBI in the Irish population.In contrast to other diseases, TB research often lacks industry sponsorship. We therefore encouragecontinued research funding of this neglected disease by our governmental funding agencies. Researchfellows willing to undertake TB research should be fostered and given seed money to try and promote suchactivity. The challenge falls to us to encourage our brightest investigators into the field of TB research.The development of the IGRA blood tests for LTBI, the development of immunotherapies to treat multipledrug-resistant TB cases and the advances in vaccinology makes the TB field a scientifically exciting one topursue. A number of worldwide consortia have been established to investigate TB (e.g. TBNET), and it isencouraged that Irish investigators should join such consortia to deliver answers to important questionsthat require a large number of patients (e.g. MDR-TB or XDR-TB treatment regimen development).Recommendation:Research that seeks to improve our understanding of the pathobiology of tuberculosis aswell as the nature of the disease in our own country is to be encouraged; research fundingagencies should foster such activity, which has the potential to improve the treatment of thedisease both locally and internationally.Studies to determine the prevalence rate of LTBI should be initiated and supported.-132-
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25-27 Middle Gardiner Street Dublin
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Guidelines on the Prevention and Control of Tuberculosis in Ireland

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