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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. Transmission occurs by exposure to aerosolised droplets from people with respiratory infection.
LTBI is common in refugee children/young people. Australian data suggest the prevalence of a positive TST (10mm or greater) in refugees from Africa, Europe and the Middle East is 25-55%.[3-6] TB disease has been found in 1.7-3.3% of refugee children attending a refugee service in NSW.[3,4]
A positive result is:
Although some authors suggest using a cut-off of 15 mm or greater for a positive test result 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 <5 years. Most experts would recommend preventive treatment for children aged <5 years 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 has been amended, allowing MBS rebate for IGRA testing in the following situations:
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 extrapulmonary 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, and Therapeutic guidelines (via RCH Library).
Discuss with infectious diseases or respiratory physician. Other family members need assessment of their TB status. This will usually occur through the local 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. 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%). The reported efficacy against pulmonary TB varies widely (0-~80%). It offers good protection against leprosy.
Immigrant health resources. Initial: Georgie Paxton and Sarath Ranganathan, January 2007. Revisions: Georgie Paxton. Last updated March 2018. Contact: email@example.com