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Tuberculosis (TB)

By Dr. Mark Wise

TB is a bacterial infection which primarily affects the lungs, though it may affect other organs such as the kidney, the bowel and the lymph nodes. Unfortunately, it is on the increase throughout the world, as are drug-resistant strains of the bacteria. Many people, especially in less developed countries, have been exposed to TB in the past, and have developed some immunity to the infection. However this so-called immunity may break down, sometimes because of other medications or medical problems, and the infection may "reactivate".

Infection with TB is a fairly small risk to most travellers, but it does occur. Those who are at the greatest risk are travellers going off to highly endemic areas for longer periods of time, and who will have lots of exposure to the local population. Long term volunteers and missionaries  fit this description.

There is a fair bit of controversy regarding immunization to prevent TB. Most of the world outside of North America routinely administers BCG to children at birth. This is supposed to prevent TB. In fact, from the studies that have been done, it is not absolutely certain whether BCG works best in certain age groups, against certain forms of TB, and in certain geographic areas.

The Canadian approach has always been to do a TB skin test (Mantoux test) prior to travel. This test is usually normal or negative, unless there has been past exposure or vaccination with BCG. Being negative, the usual plan is to repeat the test a few months after return. In this way, we detect those who have "converted" from negative to positive. It is this group who is at higher risk of developing active TB, and hence would be offered some form of medication, usually INH, as chemoprophylaxis for 6 months.

Considering the spread of multi-drug resistant TB and the difficulty in doing yearly skin tests, it might be worthwhile to at least discuss the pros and cons of BCG with high risk travellers, particularly young children.

See also:

© Copyright 2000 Dr. Mark Wise

Dr. Mark Wise is the director of The Travel Clinic (TM)) in Thornhill, Ontario, Canada and the Medical Director of The Travel Wise (TM) Clinic in Scarborough, Ontario, Canada. He is a family physician with training from the London School of Tropical Medicine in Tropical Diseases. He is a parent himself and often see potential adoptive parents in his clinic. Dr. Wise gives lectures and writes articles on the subject of travel medicine, for both medical and non-medical groups.

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On the Road
Jet Lag
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Too Much Sun

Traveler's Diseases & Parasites
Honey - I Passed A Worm!
Parasites Outdoors
Tuberculosis (TB)

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