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New tuberculosis guideline focuses on improving uptake of BCG vaccine

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Education for midwives and health visitors is key Education for midwives and health visitors is key for infant vaccine uptake

Recommendations to improve the uptake of the BCG vaccination have been included in new tuberculosis (TB) guidelines published by NICE.

According to research cited by NICE, there were 6523 TB cases in England in 2014, the highest number of cases in Western Europe.

The guidelines state that education should be provided for midwives, health visitors and other clinicians to identify babies eligible for vaccination, to ensure that babies are vaccinated either before the handover to primary care or at their six week checkup.

‘We know what needs to be done to address the problem of TB in England; identify cases earlier, support patients through prolonged treatment and invest in co-ordinated services which are resourced to engage with socially complex cases,’ said Professor Andrew Hayward, co-chair of NICE guideline development for infectious disease epidemiology and inclusion health research.

Additionally, primary care services in areas with a high prevalence of TB should consider vaccinating all neonates soon after birth. This is especially important in areas such as London, which reported over 2572 cases, or 39% of the country’s total, with a rate of around 30 TB cases per 100,000 people.

The guidance recommends that healthcare professionals working in these areas should include TB awareness in existing health programmes for the target groups, which include newly arrived immigrants and homeless people.

‘If rigorously applied the recommendations in this guidance will help to minimise the spread of infection, prevent the development of drug resistant disease and reduce the numbers of TB cases in the UK,’ said Professor Hayward.

Similarly, the risk of contracting TB is linked to socioeconomic status, with rates almost seven times higher in deprived areas compared to the least deprived in England. The guidance says many members of these groups may be unwilling to access healthcare providers. This may be due to stigma associated with their circumstances, or because they are unaware that the service is free. However, it is is essential that these groups attend, as their treatment is a key part of the new strategy.

‘The new NICE guidance sets out the systematic and robust approach we need to reduce the current impact of TB, effectively treat those infected and reduce its spread. This guideline, together with Public Health England’s TB strategy will undoubtedly contribute to the goal of eliminating TB from England,’ said Professor Mark Baker, director for the centre of clinical practice at NICE.

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