WHAT ABOUT TB?
Val Watson
Haamla Team
Leeds Teaching Hospitals NHS Trust
Tuberculosis and BCG
 What is TB?
 How is it spread?
 Is it still a problem?
 Why BCG for babies?
 Which Babies should have BCG?
 Which babies should not have BCG?
 Case study
What is TB?
 TB: Disease caused by organisms of the
Mycobacterium tuberculosis complex
 M. tuberculosis, M. bovis, M. africanum
 Commonly affects lungs, but can affect any
part of body
 Most dangerous:
 TB Meningitis
 Miliary TB (generalised spread throughout body)
How is TB Spread?
Hasn’t TB gone away?
Tuberculosis notifications
England & Wales 1913-2001
140000
120000
100000
80000
60000
40000
20000
0
Non-respiratory
Total
19
1
19 3
1
19 8
2
19 3
28
19
3
19 3
3
19 8
4
19 3
48
19
5
19 3
5
19 8
63
19
6
19 8
73
19
7
19 8
83
19
8
19 8
9
19 3
98
Notifications
Respiratory
Year
TB in UK is on the rise –
among people born outside UK
Where in
the UK has
the most
TB?
The good news in Leeds
Why give BCG to babies?
 Protect children at risk of TB exposure
 Does not completely protect against
future TB disease
 Reduces risk of Miliary TB and TB
meningitis
 Young children particularly susceptible to
these
 The most serious forms with highest risk of
death.
Which children are at risk
of exposure?
 Parent or grandparent born in high risk
country
 more than 40 cases per 100,000
 Child will travel to a high risk area for more
than one month
 Close family member with history of TB in
past 5 years
 Asylum seekers / refugees or from war torn
countries.
Which of these countries are
high risk?
 Afghanistan
 Jamaica
 Brazil
 Japan
 Bulgaria
 Kenya
 Chile
 Libya
 China
 Lithuania
 Haiti
 Pakistan
 India
 Romania
 Iran
 Russia
 Iraq
Where are the hot spots?
Contraindications for BCG
 Unwell baby
 Known HIV in mother
 Until child checked HIV negative age 3 months
 Lack of consent
 Within 4 weeks of a live vaccine
 Hepatits B vaccine CAN be given at same time in
opposite arm
Case study (1)
 Baby L born Leeds May 2012
 White (both parents) - no BCG given
 July – unwell ? Pneumonia
 Admitted 2-3 times under paediatrics
 August very unwell
 Cough, fever, poor feeding
 CXR Diffuse nodules – miliary TB appearance
 Sputum smear positive for TB
 MRI scan – TB lesions in Brain
 Culture – MDR TB
Case study (2)
 Father – CXR
 Widespread pulmonary TB
 Culture MDRTB
 Mother – CXR
 Early pulmonary TB
 Child from other family sharing house also
infected
 Parents white – both born in Lithuania
 All 4 patients on treatment and doing well