Prevention

The most important elements of prevention are screening for exposure, detection and follow-up of active cases, and prophylaxis of infected but clinically asymptomatic patients. PPD testing and treatment of latent infection is a more effective strategy than BCG vaccination in patient populations with relatively low incidence of pulmonary TB, but in highly endemic areas, infant BCG vaccination strategies can reduce childhood TB infection rates by as much as 50% (Colditz et al., 1995). Patients with a positive PPD but no symptoms and a negative chest film should be treated with isoniazid daily for 9 months or rifampin for 4 months. Maintaining an effective public health infrastructure, including TB surveillance, screening, and contact tracing, is essential. Sputum culture and sensitivity testing is an increasingly relevant component of an effective public health strategy to identify and contain the spread of multidrug-resistant TB.

A 9-month course of isoniazid or a 4-month course of rifampin is effective in preventing developmetnt of active TB in asymptomatic patients with a positive PPD test and negative chest x-ray film (i.e., latent infection), even in patients with HIV co-infection (Smieja et al., 1999; Wilkinson et al., 1998) (SOR: A).

Treatment with intermittent therapy 2 days per week has been less effective than daily therapy in RCTs (Mwandumba and Squire, 2001) (SOR: A).

BCG vaccine effectively reduces infection rates by about 50% in highly endemic populations (Colditz et al., 1995) (SOR: B).

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