'UIDELINESONTHE0REVENTIONAND#ONTROLOF4UBERCULOSISIN)RELAND 'UIDELINESONTHE 0REVENTIONAND #ONTROLOF4UBERCULOSIS IN)RELAND (EALTH0ROTECTION3URVEILLANCE#ENTRE (EALTH0ROTECTION3URVEILLANCE#ENTRE 25-27 Middle Gardiner Street Dublin 1 Ireland Tel +353 1 876 5300 Fax +353 1 856 1299 Email [email protected] www.hpsc.ie This report is also available to download at www.hpsc.ie TB Cover Full.indd 1 23/04/2010 13:20:55 Guidelines on the Prevention and Control of Tuberculosis in Ireland 2010 National TB Advisory Committee April 2010 Amended 2014 ISBN: 978-0-9551236-5-8 Guidelines on the Prevention and Control of Tuberculosis in Ireland 2010 HSE/HPSC Published by Health Protection Surveillance Centre 25-27 Middle Gardiner Street Dublin 1 Tel: 01-8765300 Fax: 01-8561299 © Health Protection Surveillance Centre 2010 -ii- Guidelines on the Prevention and Control of Tuberculosis in Ireland 2010 HSE/HPSC Contents National TB Advisory Committee v Terms of reference vii Foreword viii Key recommendations ix 1. Epidemiology and Surveillance of Tuberculosis ..................................................................1 1.1 Global trends ..........................................................................................................................1 1.2 Tuberculosis in Europe ............................................................................................................2 1.3 Tuberculosis in Ireland ............................................................................................................3 1.4 Surveillance of TB ...................................................................................................................5 1.5 Notification Procedures ..........................................................................................................7 1.6 Mycobacterium Bovis .............................................................................................................9 1.7 Non-Tuberculous Mycobacteria ............................................................................................10 2. Methods of Tuberculosis Screening .............................................................................. 11 2.1 Definition of Active TB ..........................................................................................................11 2.2 Definition of Latent TB Infection .........................................................................................11 2.3 Tuberculin Skin Test ..............................................................................................................11 2.4 Factors Affecting the Result of the Tuberculin Skin Test ......................................................15 2.5 Conversion and Boosting .....................................................................................................16 2.6 Interferon-Gamma Release Assays (IGRA) ............................................................................18 2.7 Interpretation of TST and IGRA Results ...............................................................................22 2.8 Chest X-Ray ..........................................................................................................................22 3. Management of Latent TB Infection ............................................................................. 26 3.1 Epidemiology of LTBI ............................................................................................................26 3.2 Risk factors for LTBI ..............................................................................................................27 3.3 Selecting People for Treatment of LTBI ................................................................................29 3.4 Treatment of LTBI ..................................................................................................................31 3.5 Treatment of Multidrug-Resistant or XDR LTBI ....................................................................33 3.6 Pre-treatment Evaluation ......................................................................................................34 3.7 Drug Regimens for LTBI ........................................................................................................36 3.8 Risk of TB Associated with the Use of TNF- α Antagonists .................................................41 4. Laboratory Diagnosis of Tuberculosis ........................................................................... 44 4.1 Role and Goals of the Modern TB Laboratory .....................................................................44 4.2 Specimens .............................................................................................................................46 4.3 Specimen Processing ............................................................................................................48 4.4 Processing of Positive Cultures ............................................................................................51 4.5 False Positive Cultures ..........................................................................................................53 4.6 Interferon Gamma Release Assays (IGRA) ............................................................................54 4.7 Laboratory Safety .................................................................................................................56 4.8 Quality Assurance .................................................................................................................58 5. Clinical Management .................................................................................................... 60 5.1 Diagnosis ..............................................................................................................................60 5.2 Supervision of TB Treatment ................................................................................................62 5.3 Role of Public Health Staff in Clinical Management .............................................................63 5.4 Treatment of Tuberculosis .....................................................................................................64 5.5 Inpatient or Outpatient Management ..................................................................................70 5.6 Adherence and Directly Observed Therapy (DOT) ..............................................................71 5.7 Legislation .............................................................................................................................73 6. Infection Prevention and Control ................................................................................. 74 6.1 Classification of Risk of Procedures in Healthcare ................................................................74 6.2 Definition of an Infectious TB Case ......................................................................................74 6.3 Administrative Aspects .........................................................................................................75 6.4 Standard Precautions ............................................................................................................75 6.5 Airborne Precautions ............................................................................................................76 6.6 Discontinuation of Airborne Precautions ..............................................................................84 -iii- Guidelines on the Prevention and Control of Tuberculosis in Ireland 2010 HSE/HPSC 6.7 Discharging Patients with TB from Hospital .........................................................................84 6.8 Education ..............................................................................................................................86 7. BCG Vaccination ........................................................................................................... 88 7.1 Clinical Efficacy .....................................................................................................................88 7.2 Criteria for Discontinuation of a Universal BCG Vaccination Programme ............................88 7.3 Dose and Route of Administration .......................................................................................90 7.4 Indications for BCG Vaccine .................................................................................................90 7.5 Contraindictions....................................................................................................................91 7.6 Interactions ...........................................................................................................................92 7.7 Administration of BCG Vaccination ......................................................................................92 7.8 Immunisation Reaction and Care of the Immunisation Site .................................................92 7.9 Adverse Reactions ................................................................................................................92 7.10 Tuberculin Testing prior to BCG Immunisation .....................................................................93 8. Contact Tracing ............................................................................................................ 94 8.1 Factors Predicting TB Transmission ......................................................................................94 8.2 Initiating the Contact Investigation ......................................................................................96