Vaccination

Tuberculosis

Almost one third of the world's population is infected with Mycobacterium tuberculosis − the main etiologic agent of tuberculosis (TB). Among infectious diseases in adults, TB is the leading cause of death worldwide ⁽¹⁾.

In general, short-medium term (<3 months) non-HIV infected travellers are at low risk for TB. However, duration of travel, activities and living conditions are factors that should be considered for a rough assessment of the infection risk. HIV infected persons are at higher risk of TB.

According to the destination and nature of travel, the administration of the Bacillus Calmette-Guérin (BCG) vaccine − the "anti-TB vaccine" − may be recommended for previously unvaccinated and tuberculin-negative individuals. Although BCG vaccine is of limited use in travellers, it should be considered for infants travelling from low to high incidence areas, as well as for those under 16 years of age who are going to live abroad or contact with local populations in areas with medium-high TB incidence − more than 3 months in areas with an incidence over 40/100000 cases per year.

All available BCG vaccines are based on live attenuated mycobacterial strains. BCG is administered intradermally, and can be given simultaneously with other childhood vaccines. Booster doses are not recommended.

BCG is contraindicated for persons with severely impaired immunity, due to disease or treatment, such as, symptomatic HIV-positive individuals, persons with Hodgkin's disease, leukaemia and lymphoma, or those receiving immunosuppressive or corticosteroid treatments (inhaled steroids are not contraindication).

(1) Raviglione M, Snider D, Kochi A. Global epidemiology of tuberculosis: morbidity and mortality of a worldwide epidemic. JAMA, 1995;273:220-6.

Fernando Costa Silva, 2008