MANTOUX TESTING AND BCG VACCINATION
Deposit of £20 will be required to book an appointment for the Mantoux Test. Remainder of the payment will be required on the day.
The Mantoux test is a widely used test for latent TB. It involves injecting a substance called PPD tuberculin into the skin of your forearm.
If you have a latent TB infection, your skin will be sensitive to PPD tuberculin and a hard red bump will develop at the site of the injection, usually within 48 to 72 hours of having the test. If you have a very strong skin reaction, you may need a chest X-ray to confirm whether you have an active TB infection.
If you do not have a latent infection, your skin will not react to the Mantoux test. However, as TB can take a long time to develop, you may need to be screened again within a year.
If you have had the Bacillus Calmette-Guérin (BCG) vaccination, you may have a mild skin reaction to the Mantoux test. This does not mean you have latent TB, but that your immune system (the body's natural defence against infection and illness) recognises TB.
The BCG vaccination was introduced in 1953. The incidence of TB was already declining due to improved public health and social measures and so the impact of immunisation has been difficult to assess. Over the last 50 years, epidemiological changes have also occurred necessitating various alterations to the immunisation policy (see separate article Tuberculosis).
In 2005 the schools' BCG immunisation programme was stopped following continued decline in TB rates in the indigenous UK population.
The new immunisation schedule is based on risk assessment and involves targeted immunisation of neonates and others at high risk. BCG immunisation is now recommended for:
- Infants (0 to 12 months of age) living in areas of the UK where the annual incidence of TB is significant (greater than 40/100,000), or neonates born into a family where there has been a family member with TB in the past 5 years.
- Infants (0 to 12 months of age, and children who have not previously been immunised) with a parent or grandparent who was born in a country with a significant annual incidence of TB (greater than 40/100,000).
- Previously unvaccinated children aged 1 to 5 years with the same background (that is, with a parent or grandparent who was born in a country with a significant annual incidence of TB greater than 40/100,000) and this can be done without tuberculin testing.
- Children aged 6 to 16 years who are previously unvaccinated and tuberculin-negative with a parent or grandparent who was born in a country with a significant annual incidence of TB (greater than 40/100,000) after opportunistic identification and, in this case, negative tuberculin testing.
- Previously unvaccinated, tuberculin-negative immigrants under the age of 16 years from countries with a significant incidence of TB (greater than 40/100,000).
- Previously unvaccinated, tuberculin-negative contacts of respiratory TB cases or individuals with high risk of occupational or travel exposure.
It is important to note that:
- The majority of vaccinations should be given to neonates whilst still in hospital.
- However, other individuals will also meet the criteria for immunisation and, as the schools' programme has now ceased, local policy will be needed to identify these outliers.
- Individuals without risk factors for TB, who request vaccination, should not be offered the BCG vaccine.
The Green Book recommends vaccination of unvaccinated, tuberculin-negative individuals under the age of 35 in the following occupations:
- Healthcare workers who will have contact with patients or clinical materials.
- Laboratory staff who will have contact with patients, clinical materials or derived isolates
- Veterinary staff and staff such as abattoir workers who handle animal species known to be susceptible to TB, eg simians.
- Prison staff working directly with prisoners.
- Staff of care homes for the elderly.
- Staff of hostels for homeless people and facilities accommodating refugees and asylum seekers.
Efficacy of vaccination over the age of 35 is unknown but it may be offered where the risk of TB is considered particularly high.
