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What about TB?

Val Watson Haamla Team Leeds Teaching Hospitals NHS Trust. What about TB?. 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?.

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What about TB?

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  1. Val Watson Haamla Team Leeds Teaching Hospitals NHS Trust What about TB?

  2. 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

  3. 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)

  4. How is TB Spread?

  5. Hasn’t TB gone away?

  6. TB in UK is on the rise – among people born outside UK

  7. Where in the UK has the most TB?

  8. The good news in Leeds

  9. 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.

  10. 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.

  11. Which of these countries are high risk? • Afghanistan • Brazil • Bulgaria • Chile • China • Haiti • India • Iran • Iraq • Jamaica • Japan • Kenya • Libya • Lithuania • Pakistan • Romania • Russia

  12. Where are the hot spots?

  13. 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

  14. 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

  15. 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

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