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Tuberculosis

  

Tuberculosis (TB) is an infectious disease caused by Mycobacterium Tuberculosis commonly affecting lungs but can present in any part of the body


COVENTRY AND WARWICKSHIRE COMMUNITY TUBERCULOSIS (TB) SERVICE

(for referral pathways see bottom of page or link right)

Room 3021 City of Coventry Health Centre

2 Stoney Stanton Road, Coventry CV1 4FS

Email: uhc-tr.covwarkstb@nhs.net

Tel 02476 961 351     Monday – Friday 0830-1630hrs

The team: administrator, specialist TB nurses and health care support workers

Work and support the TB clinics in acute service but mostly visit patients and their families/ contacts in their homes and work places.

Aims:

  • Reduce the risk of acquiring new tuberculosis infection within Coventry and Warwickshire and prevent secondary cases
  • Minimise morbidity and prevent mortality while ensuring treatment completion
  • Prevent the emergence of drug resistance, particularly multi drug resistant tuberculosis (MDR TB and XDR TB)
  • Management by clinicians with regular and continuing experience of the TB
  • Treatment is supplied to the patient free of charge.
  • All patients have named case workers
  • Providing treatment is taken correctly, patients clinically responding to treatment are regarded as non-infectious after two weeks of treatment and may be able to return to work.
  • TB is curable with targeted antibiotics taken for at least 6 months and those with suspected latent TB require 3 months chemoprophylaxis.
  • TB nurses specialists will identify and assess individuals at risk and inform GP’s of all screening outcomes.
  • Identification and contact tracing among household and other ‘close’ contacts

Vulnerable groups

  • HIV infection
  • Long-term, high dose steroid treatment
  • Immuno-suppressive disorders eg leukaemia
  • Anti TNF therapy
  • Elderly and very young
  • Homeless
  • Alcohol / drug misuse
  • Malnutrition
  • Born in high TB incidence countries now residing in the UK

Public Health England (PHE) and TB Incidents

An ‘incident’ is where potential transmission of TB to non-household contacts is identified, warranting wider public investigation beyond routine contact tracing.

Overseen by Public Health England (PHE) and  includes potential TB transmission in the following settings;

  • Educational setting involving a child, student or member of staff
  • Prison, reception centre or detention setting
  • Healthcare setting involving a patient or healthcare worker
  • Aircraft exposure to passengers or staff
  • Patients warranting public health action, such as applications made under the Part 2 A Public Health Act 1984

BCG vaccine

National policy (Green Book Chapter 32 Tuberculosis Department of Health for  BCG vaccination) recommends immunisation for the following groups provided BCG immunisation has not previously been carried out, the tuberculin skin test (where required) is negative and there are no other contraindications such that individuals are known or suspected to be immunocompromised, including those infected with HIV:

In an area with a low incidence of TB the BCG vaccination is offered to selected neonates before discharge or through maternity service clinics to those who:

  • Were born in an area with a high incidence of TB, or
  • Have one or more parents or grandparents who were born in a high-incidence country, or
  • Have a family history of TB in the past five years.
  • Mantoux testing should not be done routinely before BCG vaccination in children younger than six years.

Maternity units are responsible for this provision across Coventry and Warwickshire.

Eligible infants missed at birth will be identified by Health visitors and refer back to these BCG clinics until the child is 12 months old.

The TB service is responsible for offering BCG to eligible infants (to 12 months of age) who transfer into Coventry and Warwickshire – please refer to the TB team directly.

Individuals over 16yrs seeking BCG vaccination may need to be referred to a private travel clinic for tuberculin testing and BCG vaccination.

The TB specialist nurses will only offer BCG vaccinations in the community to those who are eligible infants, who have moved into the areas (as above), as well as those who are under 16 and eligible according to the Green Book, and those who have been screened as TB contacts.

References;

Green Book Chapter 32 (2013) Tuberculosis Department of Health. BCG vaccination

Follow link : Green Book BCG Vaccination

NICE TB Management & Control guidelines

Follow link : NICE guidance

PHE TB epidemiology

Follow link : TB in England Annual Report

Baseline Investigations and Actions

Recommend baseline investigations organised by GP

FBC, U+Es, LFT’s  &  CRP 3 x sputum’s for AFB TB culture

CXR

Contact TB community team 0830 -1630hrs for advice/discussion Tel: 02476 961351

Email: uhc-tr.covwarkstb@nhs.net

Referrals

  • If suggestive of TB, urgently refer to TB clinic
  • 2 week Tuberculosis clinic appointment needed.
  • Arrange via Respiratory Consultants secretary (see below)
  • If patient is ill and needs admission, please see TB referral pathway for more details.

TB Referral Pathway UHCW

Follow link

TB Referral Pathway George Eliot and Warwick Hospital (SWFT)

Follow link

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

           

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

           

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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