TUBERCULOSIS

:: TABLE 5.3
Provision of TB preventive therapy to other at-risk populations in 2015,for selected low TB burden countries for
which data could be reported a
NUMBER OF INDIVIDUALS AMONG AT RISK POPULATIONS ELIGIBLE AND STARTED ON TB PREVENTIVE TREATMENT
AT-RISK POPULATIONS FOR WHICH THERE IS A STRONG
RECOMMENDATION TO PROVIDE PREVENTIVE TREATMENT
AT-RISK POPULATIONS FOR WHICH THERE IS A CONDITIONAL
RECOMMENDATION TO PROVIDE PREVENTIVE TREATMENT
ADULT
CONTACTS
OF TB
CASES
PATIENTS
INITIATING
ANTI-TNF
TREATMENT
PATIENTS
RECEIVING
DIALYSIS
PATIENTS PREPAR-
ING FOR ORGAN OR
HAEMATOLOGICAL
TRANSPLANTATION
PATIENTS
WITH
SILICOSIS
IMMIGRANTS
FROM HIGH
TB BURDEN
COUNTRIES
HEALTH
WORKERS
PRISONERS
HOMELESS
PEOPLE
ILLICIT DRUG
USERS
France 1 224 — — — — — — — — —
Japan 4 063 — — — — 400 1785 — 20 —
Netherlands 595 — — — — 10 17 — — —
Norway 30 35 3 0 0 327 — — — —
Portugal 1 798 — 25 — 10 202 381 70 1 105
Republic of Korea 539 — — — — — 368 76 — —
Slovakia 1 400 252 354 — 31 3 — — — —
— indicates data not available.
a
Data for France and Norway are for 2014.
prevention and control policy, and TB and HIV programmes
at national and subnational level should provide managerial
direction to implement TB infection control measures.
In health-care facilities and congregate settings, a comprehensive
set of infection control measures – comprising
administrative, environmental and personal protection
measures – should be implemented. 1 Periodic assessment
of TB infection control in health-care facilities is essential
to ensure that appropriate measures are in place. 2
In the latest revision of WHO guidance on monitoring
and evaluation of collaborative TB/HIV activities, 3 the risk
of TB among health-care workers relative to the general
adult population is an indicator recommended to measure
the impact of TB infection control activities in health-care
facilities. If effective TB infection control measures are in
place, the relative risk of TB in health-care workers compared
with the general adult population should be close to
one.
In 2015, 9977 TB cases among health-care workers were
reported from 67 countries; China accounted for 30% of
these cases and South Africa for 21%. The notification rate
among health-care workers could be calculated for 46 of
the 67 countries; it ranged from zero in Belize, Gambia, Haiti,
Jordan and Marshall Islands to 1565 cases per 100 000
1
World Health Organization. WHO policy on TB infection control in
health-care facilities. Geneva: WHO; 2009 (http://apps.who.int/iris/
bitstream/10665/44148/1/9789241598323_eng.pdf, accessed 31
August 2016).
2
World Health Organization. Checklist for Periodic Evaluation of TB
Infection Controlin Health-Care Facilities. Geneva. WHO; 2015
(http://www.who.int/tb/areas-of-work/preventive-care/checklist_
for_periodic_evaluation_of_tb_infection_control_in_health_facilities.
pdf, accessed 16 September 2016).
3
World Health Organization. A guide to monitoring and evaluation for
collaborative TB/HIV activities: 2015 revision. Geneva: WHO; 2015
(http://www.who.int/tb/publications/monitoring-evaluationcollaborative-tb-hiv/en/,
accessed 31 August 2016).
population in South Africa. The notification rate among the
general adult population in each country was calculated
based on the number of notified TB cases in adults and the
estimated size of the adult populations from the United Nations
(UN) population division (2015 revision). The ratios
of the TB notification rate among health-care workers to
the rate in the general adult population are shown in Fig.
5.3. The ratio was above 2 in 16 countries, including South
Africa. In the other four high TB/HIV burden countries for
which the ratio could be calculated, the ratio was between 1
and 2 in three countries (Botswana, the Russian Federation
and Zimbabwe) and below 1 in one country (China).
5.3 TB vaccination
There is a clear need for a vaccine that is more effective
than BCG, especially to reduce the risk of infection with
Mycobacterium tuberculosis and the risk of progression from
infection to active TB disease in adults. Although there are
13 candidates in the TB vaccine pipeline, a new TB vaccine
is not expected in the near future (Chapter 8).
BCG vaccination has been shown to prevent disseminated
disease; this category includes TB meningitis and miliary
TB, which are associated with high mortality in infants
and young children. Currently, WHO recommends that in
countries with a high TB burden, a single dose of the BCG
vaccine should be provided to all infants as soon as possible
after birth, as part of childhood immunization programmes.
In countries with low TB incidence rates, provision of BCG
may be limited to neonates and infants in recognized highrisk
groups, or to skin-test negative older children.
A summary of national policies on BCG vaccination 4 is
4
Zwerling A, Behr MA, Verma A, Brewer TF, Menzies D, Pai M. The
BCG World Atlas: a database of global BCG vaccination policies and
practices. PLoS Medicine. 2011;8(3):e1001012.
GLOBAL TUBERCULOSIS REPORT 2016 :: 87