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Name : Mohamad Zaimey Bin Zulmanaf ID number : 10 - 4 - 170 Subtopics : Control measures for contacts (tuberculin testing & BCG

vaccination)

Control measures for contacts
    Enlistment Health education Investigation of contacts : Tuberculin testing BCG vaccination

Tuberculin

-ve
Repeat the test after 3 months

+ve
Do a chest radiograph

If -ve give BCG vaccination

If +ve give chemotherapy (INH for 1 year)

If -ve give chemotherapy (INH for 1 year)

If +ve give chemotherapy as case

Tuberculin testing
A delayed hypersensitivity reaction that assesses the prevalence of TB infection in the community. Positive reaction is characterized by induration (not erythematic) due to cell infiltration, reaches maximal after 48-72 hours. Techniques : 1. The mantoux test is intradermal injection of 0.1 ml of purified protein derivative (PPD, is the antigenic component of tubercle bacilli) containing 5 tuberculin units. 2. A disposable tuberculin syringe is used, with the bevel of the needle facing upward & administered on the volar surface of the forearm to produce a pale, discrete elevation of the skin (weal) 6 to 10 mm in diameter. The weal disappears shortly after the test is administered.

Evaluation of BCG vaccine as BCG vaccination converts tuberculin negative persons to tuberculin positive. old healed primary lesion or active diseases. False negative and false positive results. a cut off point of 5 mm is considered positive :     HIV infection Contacts of smear positive pulmonary TB cases Chest radiographs consistent with active or old healed lesion Clinical evidence of tuberculosis Importances of tuberculin test : 1. Do not consider the erythema that may surround the area of induration. However BCG could be administered to subjects whatever the tuberculin status. Identify tuberculin negative who are eligible fro vaccination. 2.3. Causes of false negative tuberculin test :      Pre-allergic state (incubation period of infection) High fever and exanthematous disease (measles) Advanced pulmonary TB. tuberculous meningitis. In the following situations. Positive tuberculin indicates sensitivity to tuberculin bacilli resulting from previous BCG vaccination. 2. Limitations of tuberculin test : Tuberculin test is of little value as a diagnostic tool for case finding of TB because : 1. 2. Read the test 48 to 72 hours after injection by measuring the diameter of induration (not erythema) transverse to the long axis of the forearm/ Record the actual millimeters of induration. Interpretations of tuberculin testing : 1. Tuberculin test cannot be used to differentiate between natural infection and previous BCG vaccination. and miliary TB Immunosuppression In late stage of pregnancy Causes of false positive tuberculin test :    Infection with atypical mycobacterium Tuberculoid leprosy Cutaneous leshmaniasis . The standard cut off point for positive tuberculin test is 10 mm area of induration.

3. 2. Dose. Normal reactions following BCG vaccination. thus hospital delivery offers a chance to give the vaccine to newborns (opportunity which may not occur again in many cases). in the newborn the dose is 0. tuberculin testing is unnecessary before BCG is given. If the prevalence of TB is low : administration of BCG is restricted to the high risk groups such as :    Health care personnel Tuberculin negative contacts of positive sputum pulmonary TB cases Industrial workers exposed to silica . mode and time of administration : Injection 2 weeks Papule 4 weeks Ulcer 6-12 weeks Healing with scar BCG is administered using an intra-dermal injection at the site of left deltoid insertion of 0. It could be administered immediately after birth since cell mediated maternal immunity cannot be transferred to the fetus.05 ml because skin of newborn at birth is rather thin and intradermal injection with full dose (0.1 ml. If the prevalence of TB is high : administration of BCG at birth is recommended. Indications of BCG vaccination : 1.1 ml) in them might penetrate into deeper tissues and give rise to local abscess and enlarged axillary lymph nodes.BCG vaccination Type : Live attenuated variant prepared from bovine tubercle bacilli. In new born.

cancer. immunosuppressive drugs users and patients suffering from eczema. BCG vaccine should not be given to immune-compromised as HIV. Local reactions include : unhealed prolonged severe ulceration and lymhadenitis. The risk of the local reactions is related to : BCG strains produced by manufactures. It is freeze dried : should be reconstituted in saline and used within six hours after reconstitution.htm • [assessed at 4th January 2014] Module Semester 7 2013 Year 4. 3. It could be kept frozen in dark bottles not to be damages by direct sunlight. 2. Don’t use local antiseptic before its injection because it may damage BCG vaccine . BCG does not prevent infection in adults but possibly decrease the probability of progression to active disease. BCG should be stored at temperature ranging from +2 to +8 at the health center. Department of Community Medicine.nlm. BCG efficacy is more than 80 % in preventing TB meningitis and military TB in children. Contraindications of BCG vaccination : 1.gov/tb/publications/factsheets/prevention/bcg. Centers for Disease Control and Prevention : BCG Vaccine. Disseminated infection & death is rare & associated with defects in cellular immunity.gov/medlineplus/ency/article/000077. available from : http://www. Precautions during handling of BCG vaccine : 1. Essential of Community Medicine. the dose of the vaccine and the mode of administration.com/lung/tc/tuberculosis-tb-exams-and-tests • • [assessed at 3th January 2014] CDC. 2. Faculty of Medicine-Alexandria University : Tuberculosis.htm [assessed at 3th January 2014] WebMD : Tuberculosis (TB) – Exams and Tests. page 26-36 [cited at 4th January 2014] .cdc. available from : http://www. 2. Trusted Health Information for You : Pulmonary Tuberculosis.nih. available from : http://www.webmd. References • MedlinePlus.Complications of BCG vaccination : 1. Efficacy of BCG : 1.