Interventions for Tuberculosis Control and Elimination 2002

is scant. However, the limited evidence would suggest that a child born
into a household with an infectious tuberculosis patient only recently placed
on chemotherapy should receive prophylactic treatment with isoniazid, continued
for probably at least three months following cessation of relevant
exposure. Should the bacteriologic response of the index case be poor
(failing to convert sputum smears), prophylactic treatment should probably
be prolonged (or adjusted where feasible if the index case has a drug-resistant
strain).
Prophylactic treatment is an individual intervention primarily to protect
the child without separation from the mother. No great epidemiologic
or public health impact of this measure is to be anticipated.
Vaccination
Vaccination with BCG provides considerable protection against death from
tuberculosis, and the development of disseminated and meningeal tuberculosis,
particularly in infants. Neonatal BCG vaccination (or as early in life
as possible) is thus indicated where tuberculosis is frequent, childhood tuberculosis
rarely diagnosed, and adequate contact examinations rarely feasible.
There is insufficient evidence to recommend vaccination beyond infancy,
or re-vaccination.
BCG vaccination is an individual measure that is not expected to
improve the epidemiologic situation in a country. It is of public health
importance to the extent that it reduces disability and death from tuberculosis
in the target population.
Preventive chemotherapy
Preventive chemotherapy using nine to twelve months of isoniazid is efficacious
but operationally inefficient. In adults it carries the danger of
monotherapy of clinically active tuberculosis which might not be recognized
if mycobacterial culture facilities and chest radiography are not routinely
available. This is of particular concern in HIV infected patients who
would be most likely to benefit, because such patients frequently have active
tuberculosis that cannot be identified on sputum smear microscopy alone.
The drug of choice is isoniazid, although shorter regimens based on
rifampicin can be used where resources permit. Logistically and adminis-
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