In this section
Tuberculosis (TB) is due to infection with Mycobacterium tuberculosis. Approximately one third of the world's population is infected, although only 5-10% of people with infection develop TB disease.1 Transmission occurs by exposure to aerosolised droplets from people with respiratory infection.
LTBI is common in refugee children/young people. Australian data from the 2000s suggest the prevalence of a positive TST (10mm or greater) in refugees from Africa, Europe and the Middle East was 25-55%.4-7 More recent data from Syrian and Iraqi arrivals (2015-17) found a LTBI prevalence of 11.8%.8 TB disease has been found in 1.7-3.3% of refugee children attending a refugee service in NSW.4,5
A positive result is:
Although a cut-off of 15 mm or greater for a positive test result is suggested if the child has had a BCG in the preceding 5 years; BCG is usually given in early infancy, and the risk of progression to TB disease is greatest in children aged <5y. Most experts would recommend preventive treatment for children aged <5y with a TST of 10 mm or greater and no evidence of TB disease. It is safest to ignore BCG immunisation when interpreting the TST.
From May 2017, the
MBS item 69471 for IGRA testing was amended, allowing MBS rebate for IGRA testing in the following situations:
Children <5 years who are a close contact of a confirmed TB case should start preventive treatment regardless of TST results, with a 'break of contact' TST at 3 months to decide on further treatment.
Patients will require both a script and a category B SAS form (prescribers will need to be registered/authorised on the TGA website). Packet size is 84 tablets/pack. Order in EMR under facility list/database tab.
TB disease is usually managed by a respiratory or infectious diseases physician. Standard treatment
for pulmonary TB disease is 6 months of multi-agent therapy, longer durations are used for some extra-pulmonary sites and for multi-drug resistant TB disease. Tuberculosis disease is a
notifiable condition. If a diagnosis of TB disease is made, perform HIV testing after appropriate counselling. See
Victorian guidelines, Therapeutic guidelines (via
RCH Library), and
RCH Fact sheet - Tuberculosis.
Discuss with infectious diseases or respiratory physician. Other family members need assessment of their TB status. This will usually occur through the TB program, check this follow-up is in place.
Bacillus Calmette Guerin (BCG, an attenuated strain of M. bovis) has been used to vaccinate against TB since 1921 and there is 80% coverage worldwide.12 It does not protect against infection, overall protection against all forms of disease is around 50% with greater protective effect against death from TB (71%) and TB meningitis (64%).13 The reported efficacy against pulmonary TB varies widely (0-~80%).12 It offers good protection against leprosy.
Immigrant health resources. Initial: Georgie Paxton and Sarath Ranganathan, January 2007. Revisions: Georgie Paxton. Last updated April 2022. Contact: firstname.lastname@example.org