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. 1994 Dec;49(12):1193–1200. doi: 10.1136/thx.49.12.1193

Control and prevention of tuberculosis in the United Kingdom: Code of Practice 1994. Joint Tuberculosis Committee of the British Thoracic Society.

PMCID: PMC475322  PMID: 7878551

Abstract

BACKGROUND--The guidelines on control and prevention of tuberculosis in the United Kingdom have been reviewed and updated. METHODS--A subcommittee was appointed by the Joint Tuberculosis Committee (JTC). Each member of this group drafted one or more sections of the guidelines, and drafts were made available to all members of the group. In the course of several meetings drafts were altered and incorporated into a final text. The guidelines were approved by the full JTC and by the Standards of Care Committee of the British Thoracic Society. In revising the guidelines the authors took account of new published evidence and recent concerns about drug resistance and possible effects of HIV on tuberculosis. CONCLUSIONS--(1) All cases of tuberculosis must be notified. (2) A few patients need hospital admission. (3) Patients with positive sputum smears and sensitive organisms should be considered infectious until they have received two weeks' chemotherapy. (4) Treatment of all tuberculosis patients should be supervised by a respiratory physician employing standard medication guidelines and monitoring compliance at least monthly. (5) Health care workers at risk should be protected by BCG vaccination and appropriate infection control measures, and evidence of infectious tuberculosis should be sought among prospective NHS staff, school teachers, and others. (6) Prison staff should be protected. (7) Tuberculosis should be considered in the elderly in long stay care with persistent chest symptoms. (8) Contact tracing should be vigorously pursued with chemoprophylaxis, BCG vaccination, or follow up where applicable. (9) Entrants to the UK from high risk countries (tuberculosis incidence more than 40/100,000 population per year) should be screened. (10) BCG vaccination should be offered where appropriate but not in subjects with known or suspected HIV infection. (11) The local organisation of tuberculosis services should be strengthened and should include adequate nursing and support staff. (12) Contracts between purchasers and providers should specify management of tuberculosis in line with this and other JTC guidelines.

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Selected References

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  1. Bradley B. L., Kerr K. M., Leitch A. G., Lamb D. Notification of tuberculosis: can the pathologist help? BMJ. 1988 Sep 3;297(6648):595–595. doi: 10.1136/bmj.297.6648.595. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brindle R. J., Nunn P. P., Githui W., Allen B. W., Gathua S., Waiyaki P. Quantitative bacillary response to treatment in HIV-associated pulmonary tuberculosis. Am Rev Respir Dis. 1993 Apr;147(4):958–961. doi: 10.1164/ajrccm/147.4.958. [DOI] [PubMed] [Google Scholar]
  3. Chaturvedi N., Cockcroft A. Tuberculosis screening in health service employees: who needs chest X-rays? Occup Med (Lond) 1992 Nov;42(4):179–182. doi: 10.1093/occmed/42.4.179. [DOI] [PubMed] [Google Scholar]
  4. Cockcroft A. Pre-employment chest radiography and NHS staff. BMJ. 1993 May 15;306(6888):1286–1286. doi: 10.1136/bmj.306.6888.1286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Darbyshire J. H. Tuberculosis in prisons. BMJ. 1989 Oct 7;299(6704):874–874. doi: 10.1136/bmj.299.6704.874. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Esmonde T. F., Petheram I. S. Audit of tuberculosis contact tracing procedures in south Gwent. Respir Med. 1991 Sep;85(5):421–424. doi: 10.1016/s0954-6111(06)80188-5. [DOI] [PubMed] [Google Scholar]
  7. Frieden T. R., Sterling T., Pablos-Mendez A., Kilburn J. O., Cauthen G. M., Dooley S. W. The emergence of drug-resistant tuberculosis in New York City. N Engl J Med. 1993 Feb 25;328(8):521–526. doi: 10.1056/NEJM199302253280801. [DOI] [PubMed] [Google Scholar]
  8. George R. H., Gully P. R., Gill O. N., Innes J. A., Bakhshi S. S., Connolly M. An outbreak of tuberculosis in a children's hospital. J Hosp Infect. 1986 Sep;8(2):129–142. doi: 10.1016/0195-6701(86)90039-3. [DOI] [PubMed] [Google Scholar]
  9. Glass B. J., Van Dis M. L., Langlais R. P., Miles D. A. Xerostomia: diagnosis and treatment planning considerations. Oral Surg Oral Med Oral Pathol. 1984 Aug;58(2):248–252. doi: 10.1016/0030-4220(84)90146-4. [DOI] [PubMed] [Google Scholar]
  10. Hardie R. M., Watson J. M. Screening migrants at risk of tuberculosis. BMJ. 1993 Dec 11;307(6918):1539–1540. doi: 10.1136/bmj.307.6918.1539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hickman M., Ellam T., Hargreaves S., Gazzard B., Porter J. Managing tuberculosis and HIV infection. BMJ. 1992 Jun 13;304(6841):1567–1568. doi: 10.1136/bmj.304.6841.1567-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hussain S. F., Watura R., Cashman B., Campbell I. A., Evans M. R. Tuberculosis contact tracing: are the British Thoracic Society guidelines still appropriate? Thorax. 1992 Nov;47(11):984–985. doi: 10.1136/thx.47.11.984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Leitch A. G. Rationalising tuberculosis contact tracing in low prevalence areas. Respir Med. 1992 Sep;86(5):371–373. doi: 10.1016/s0954-6111(06)80003-x. [DOI] [PubMed] [Google Scholar]
  14. Lunn J. A., Mayho V. Incidence of pulmonary tuberculosis by occupation of hospital employees in the National Health Service in England and Wales 1980-84. J Soc Occup Med. 1989 Spring;39(1):30–32. doi: 10.1093/occmed/39.1.30. [DOI] [PubMed] [Google Scholar]
  15. Madan I. Pre-employment chest radiography for health service staff: who needs it? BMJ. 1993 Apr 17;306(6884):1041–1042. doi: 10.1136/bmj.306.6884.1041. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. McCarthy O. R. Asian immigrant tuberculosis--the effect of visiting Asia. Br J Dis Chest. 1984 Jul;78(3):248–253. [PubMed] [Google Scholar]
  17. Monie R. D., Hunter A. M., Rocchiccioli K. M., White J. P., Campbell I. A., Kilpatrick G. S. Management of extra-pulmonary tuberculosis (excluding miliary and meningeal) in south and west Wales (1976-8). Br Med J (Clin Res Ed) 1982 Aug 7;285(6339):415–418. doi: 10.1136/bmj.285.6339.415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Monie R. D., Hunter A. M., Rocchiccioli K., White J., Campbell I. A., Kilpatrick G. S. Survey of pulmonary tuberculosis in south and west Wales (1976-8). Br Med J (Clin Res Ed) 1982 Feb 20;284(6315):571–573. doi: 10.1136/bmj.284.6315.571. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Nisar M., Williams C. S., Ashby D., Davies P. D. Tuberculin testing in residential homes for the elderly. Thorax. 1993 Dec;48(12):1257–1260. doi: 10.1136/thx.48.12.1257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Ormerod L. P. Results of tuberculosis contact tracing: Blackburn 1982-90. Respir Med. 1993 Feb;87(2):127–131. doi: 10.1016/0954-6111(93)90140-u. [DOI] [PubMed] [Google Scholar]
  21. Ormerod L. P. Tuberculosis screening and prevention in new immigrants 1983-88. Respir Med. 1990 Jul;84(4):269–271. doi: 10.1016/s0954-6111(08)80051-0. [DOI] [PubMed] [Google Scholar]
  22. Packe G. E., Innes J. A. Protective effect of BCG vaccination in infant Asians: a case-control study. Arch Dis Child. 1988 Mar;63(3):277–281. doi: 10.1136/adc.63.3.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Packe G. E., Innes J. A. Protective effect of BCG vaccination in infant Asians: a case-control study. Arch Dis Child. 1988 Mar;63(3):277–281. doi: 10.1136/adc.63.3.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Riley R. L., Moodie A. S. Infectivity of patients with pulmonary tuberculosis in inner city homes. Am Rev Respir Dis. 1974 Dec;110(6):810–812. doi: 10.1164/arrd.1974.110.6P1.810. [DOI] [PubMed] [Google Scholar]
  25. Rouillon A., Perdrizet S., Parrot R. Transmission of tubercle bacilli: The effects of chemotherapy. Tubercle. 1976 Dec;57(4):275–299. doi: 10.1016/s0041-3879(76)80006-2. [DOI] [PubMed] [Google Scholar]
  26. Sheldon C. D., King K., Cock H., Wilkinson P., Barnes N. C. Notification of tuberculosis: how many cases are never reported? Thorax. 1992 Dec;47(12):1015–1018. doi: 10.1136/thx.47.12.1015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Stead W. W., Dutt A. K. Tuberculosis in elderly persons. Annu Rev Med. 1991;42:267–276. doi: 10.1146/annurev.me.42.020191.001411. [DOI] [PubMed] [Google Scholar]
  28. Stead W. W., Lofgren J. P., Warren E., Thomas C. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. N Engl J Med. 1985 Jun 6;312(23):1483–1487. doi: 10.1056/NEJM198506063122304. [DOI] [PubMed] [Google Scholar]
  29. Stead W. W. Tuberculosis among elderly persons: an outbreak in a nursing home. Ann Intern Med. 1981 May;94(5):606–610. doi: 10.7326/0003-4819-94-5-606. [DOI] [PubMed] [Google Scholar]
  30. Sutherland I., Springett V. H. The effects of the scheme for BCG vaccination of schoolchildren in England and Wales and the consequences of discontinuing the scheme at various dates. J Epidemiol Community Health. 1989 Mar;43(1):15–24. doi: 10.1136/jech.43.1.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Teale C., Cundall D. B., Pearson S. B. Time of development of tuberculosis in contacts. Respir Med. 1991 Nov;85(6):475–477. doi: 10.1016/s0954-6111(06)80264-7. [DOI] [PubMed] [Google Scholar]
  32. Veen J. Microepidemics of tuberculosis: the stone-in-the-pond principle. Tuber Lung Dis. 1992 Apr;73(2):73–76. doi: 10.1016/0962-8479(92)90058-R. [DOI] [PubMed] [Google Scholar]
  33. Warburton A. R., Jenkins P. A., Waight P. A., Watson J. M. Drug resistance in initial isolates of Mycobacterium tuberculosis in England and Wales, 1982-1991. Commun Dis Rep CDR Rev. 1993 Dec 3;3(13):R175–R179. [PubMed] [Google Scholar]
  34. Wardman A. G., Williams S. E., Curzon P. G., Page R. L., Cooke N. J. Tuberculosis: who should prescribe? Br Med J (Clin Res Ed) 1982 Feb 20;284(6315):569–571. doi: 10.1136/bmj.284.6315.569. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Welty C., Burstin S., Muspratt S., Tager I. B. Epidemiology of tuberculous infection in a chronic care population. Am Rev Respir Dis. 1985 Jul;132(1):133–136. doi: 10.1164/arrd.1985.132.1.133. [DOI] [PubMed] [Google Scholar]

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