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:
BCG is usually given in early infancy, and almost all humanitarian arrivals have evidence of previous BCG vaccination (scar, +/- record). It is safest to ignore BCG status when interpreting the TST (and guidelines for TST interpretation no longer account for prior BCG).
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 TB preventive treatment (TPT) regardless of TST results, with a 'break of contact' TST at 3 months to decide on further treatment.
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 Oct 2023. Contact: email@example.com