Disclaimer: in this article, although I have covered all the latest information available globally, the subtopic- “contact tracing of tuberculosis patients” part is related to what we practice mainly in India and Himachal Pradesh.

Prevention of tuberculosis is a very important aspect of eliminating Tuberculosis disease. tuberculosis prevention is especially required in the high-risk population. since we don’t have any effective vaccine for tuberculosis (the BCG vaccine effect is mainly limited to childhood tuberculous meningitis and miliary disease¹⁴). it becomes even more important for us to have knowledge on prevention from tuberculosis.

Prevention from Tuberculosis in India

• According to a guiding document by the central TB division, ministry of Health and Family Welfare, GOI. around 26 lakh people fall sick and around 4 lakh people die of tuberculosis every year in India, the highest (in absolute numbers) in the world.
• 24.2 lakh cases were notified in India during the year 2022¹⁵
• India is one of the thirty high TB burden countries(contributing around 87% of all TB cases) in the world. 
• India along with other seven nations contribute to about two-thirds of all TB cases globally.
• More than 40% of the population in India is already infected with TB bacteria². (although there is only a 10% chance of them getting active TB.)

Therefore we must be aware of the prevention of tuberculosis.

Measure to Prevent Tuberculosis

• Immunization
• Awareness about the disease- Getting diagnosed early.
• Contact tracing of TB patients
• Prophylaxis for Children less than 5 years of age
• Precautions to be taken by patients of Tuberculosis
• Precautions to be taken by the others around Tuberculosis patient
• Controlling the risk factors of Tuberculosis
• following a Healthy lifestyle.
• Addressing the Inadequate housing

Immunization for the Prevention of Tuberculosis

• 🙂BCG Vaccine: The only vaccine available against tuberculosis has documented protective effects on tuberculous meningitis and disseminated TB³.
• 🙂Every child in India is offered the BCG vaccine as a birth dose in routine immunization in India, free of cost at all govt. health institutions³.  
• 🙁 The BCG vaccine is not able to prevent the primary infection of tuberculosis and also doesn’t prevent the latent TB from becoming active TB.
• 🙁BCG is not effective in the adult population and is not recommended.

An effective vaccine against Tuberculosis would be major breakthrough to end this ongoing war with tuberculosis spanned over centuries.

Getting Diagnosed Early

Despite having challenges in diagnosing TB, it is very important for us to present ourselves to the doctor for early diagnosis and not to overlook the symptoms suggestive of TB.

• Getting early diagnosed is extremely important as tuberculosis patients are the reservoir⁵ of the bacteria causing tuberculosis.
  • what it means that tuberculosis can spread from tuberculosis patients only.
• If we can diagnose the patient early, we can prevent the spread of infection from TB patients to those at risk (close contacts).
• To get diagnosed early we should be aware of symptoms of Tuberculosis- like
  • cough for more than 2 weeks, 
  • blood in sputum, 
  • weight loss,
  • Chest pain
  • low-grade fever  
  • evening rise in temperature etc.

And should seek medical care early by visiting the nearest govt medical officer. They shall be more than happy to serve you regarding the diagnosis of TB (thanks to NTEP).

Please Note: only Tuberculosis of the lungs (pulmonary TB) or of the throat (laryngeal TB) can spread to others. Tuberculosis can occur in any part of the body but pulmonary TB is the most common.

Contact Tracing of TB Patients

As a new patient is diagnosed with tuberculosis of the lungs, all eligible contacts of the patient should be screened for both active and latent TB :

• A family member who stayed more than 24 hours at stretch or cumulative 24 hours in a week- is eligible for screening
• All persons who stayed in close proximity for more than 24 hours a week at your workplace.-eligible for screening
• Relatives or friends visited by a patient recently or those who visited/stayed with the patient recently. The number of nights stayed and cumulative hours decide whether eligible for screening or not.

Symptomatic Contacts are screened by doctors using various tests like:

• Sputum smear microscopy
• CBNAAT
• Chest X-ray

To rule out any active tuberculosis.

Once Active tuberculosis (active infection ) is ruled out we proceed to check for latent infection (bacteria has entered the body but not developed disease yet) using:

• Tuberculin skin testing also known as the Mantoux test
• IGRA

Depending upon the results, If the latent infection is found in contacts, we put them on TPT (TB Preventive Treatment) to kill the bacteria before it can develop the disease.

Prophylaxis for Children Below 5 years of Age

If the age of eligible TB Patient contact is less than 5 years, 

• The first step is to rule out active TB. 
• We seek the help of a paediatrician for sample collection  (bronchoalveolar lavage) and send for CBNAAT directly without sputum smear microscopy. We can look for chest X-ray findings
• Once active TB is ruled out, we put the child on chemoprophylaxis of isoniazid for six months to protect the child from developing the disease.

Precautions to be Taken by Patients of Tuberculosis

Once the treatment of tuberculosis is started, it rapidly decreases the infectiousness. A newly diagnosed TB patient is no longer infectious after 2 weeks of treatment⁶. Therefore, some precautions should be taken by TB Patients during the initial few weeks⁷:

• Should use the face mask while interacting with others
• Following sneezing/cough etiquette like:
  •  covering mouth with tissue paper while coughing or sneezing
  • Washing hands with soap and water after coughing or sneezing
• Don’t visit or invite friends or relatives.
• Stay at home and refrain from work, school or other public spaces for at least the first 2 weeks. May apply for medical leave.
• If have to travel (like to a doctor), don’t use public transport.
• Avoid sharing the room with others for sleeping.
• Keep your room airy and well-ventilated.
• Take a nutritious diet, stay motivated and take your medicines as advised without fail.

Precautions to be taken by the Others Around Tuberculosis patient

Education and counselling:

• One must understand that treatment for TB is given over months but the patient does not spread the infection over all those months as we discussed above.
• Every TB patient is not infectious, only TB of the lungs and throat can spread to others, that too when a patient coughs or sneezes and releases the droplets.

• TB doesn’t spread by shaking hands, talking to TB patients, sharing food⁸, sharing drinking containers, or even sharing cigarettes¹⁵.
  • It spreads when Droplets containing TB bacteria are released when a pulmonary TB patient coughs, sneezes, laughs or sometimes when singing during the initial few weeks of treatment. 
  • Droplets are not released when a person is talking normally. 
  • Sometimes droplets may remain suspended in the atmosphere for hours and settle down. We should wash our hands and maintain our personal hygiene to prevent TB and a number of other diseases.
• TB patients should not be ignored and should be given psychological support. 
• It is still a practice seen that utensils of TB patients are separated and patients are made to live in strict isolation. It is not required at all. At the family level, the most important for a TB patient is psychological support.
• We should join the Nikshay Mitra initiative of Govt. of India by adopting a TB patient and providing psychosocial and nutritional support in addition to nutritional and free diagnostic and treatment provided by the government of India under NTEP.

Controlling the Risk Factors of Tuberculosis

Generally two categories are at increased risk of developing tuberculosis:

1. Persons recently infected- are the persons like close contacts as we discussed earlier.
2. Persons with medical conditions that weaken the immune system- include:
   1. Diabetes mellitus
   2. Chronic kidney disease
   3. Cancer patients
   4. HIV patients
   5. Malnutrition 
   6. Substance abuse like alcohol or drugs
   7. Smoking 
   8. The person on immuno-suppressive drugs
   9. Persons living in crowded places- prison inmates, slum dwellers, shared hostels etc.
   10. Certain occupations involved in generating and inhaling the silica dust (grinding, drilling, polishing stones or tiles.)

Therefore we should avoid avoidable risk factors like smoking, substance abuse etc. and adopt a healthier lifestyle. we should control the other risk factors like – keeping blood sugar under control, avoiding overcrowding, and following the advice of our doctor if suffering from the above-listed diseases.

Addressing Inadequate Housing

• Studies¹³ have shown that inadequate housing is not only related to exposure, incidence and transmission of tuberculosis but also the treatment adherence, success rates and recurrence of TB. 
• Inadequate housing means poor housing quality and poor housing affordability.
  • Poor housing quality includes- overcrowding, improper ventilation, lack of sunlight and dampness.
  • Poor housing affordability includes- instability and homelessness.