RESPIRATORY DISEASES Health Evidence Bulletins - Wales
Team Leader: Dr Michael Burr Date of completion: 5/3/98

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available


11. Tuberculosis

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

The Statements The Evidence
11a. Prevention of tuberculosis is by means of BCG vaccination. The effectiveness of BCG, and the criteria for its use, are not entirely clear. It prevents tuberculous meningitis and miliary disease, but the protection given against pulmonary tuberculosis varies widely in different countries, some studies even showing a negative effecti. A large trial in Britain showed substantial and lasting protection against all forms of tuberculosisii, so vaccination is recommended for many groups and official guidance is available iii.

(Health gain notation - 2 "likely to be beneficial")

i. Rodrigues LC, Diwan VK, Wheeler JG. Protective effect of BCG against tuberculous meningitis and miliary tuberculosis: a meta-analysis. International Journal of Epidemiology 1993; 22: 1154-1158
(Type I evidence - meta-analysis);
ii. Medical Research Council. BCG and vole bacillus vaccines in the prevention of tuberculoses in adolescence and early adult life. Bulletin of the World Health Organisation 1972; 46: 371-385
(Type II evidence - randomised controlled trial);
iii. Salisbury DM, Begg NT (eds.) Immunisation against infectious disease.   Department of Health and Others,   London: HMSO, 1996 pp. 221-225
(Type V evidence - expert opinion)
11b. Tuberculosis must be considered as a possible diagnosis especially in the elderly, the homeless, those at risk of HIV infection, those with existing immune deficiency and members of the immigrant population. Treatment is readily available and patients with pulmonary tuberculosis become non-infectious within two weeks of starting effective chemotherapyi,ii.

(Health gain notation - 1 "beneficial")

i. Ormerod LP for a subcommittee of the Joint Tuberculosis Committee. Chemotherapy and management of tuberculosis in the United Kingdom: recommendations of the Joint Tuberculosis Committee of the British Thoracic Society. Thorax 1990; 45: 403-408
(Type V evidence - expert opinion);
ii. Joint Tuberculosis Committee of the British Thoracic Society. Control and prevention of tuberculosis in the United Kingdom: code of practice 1994. Thorax 1994; 49: 1193-1200
(Type V evidence - expert opinion)
11c. Guidance concerning good practice for the prevention and treatment of tuberculosis is available i,ii.

 

 

 

i. Ormerod LP for a subcommittee of the Joint Tuberculosis Committee. Chemotherapy and management of tuberculosis in the United Kingdom: recommendations of the Joint Tuberculosis Committee of the British Thoracic Society. Thorax 1990; 45: 403-408
(Type V evidence - expert opinion);
ii. Joint Tuberculosis Committee of the British Thoracic Society. Control and prevention of tuberculosis in the United Kingdom: code of practice 1994. Thorax 1994; 49: 1193-1200
(Type V evidence - expert opinion)
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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk