Tuberculosis Prevention

BCG vaccination should be given to all babies at birth - or at first contact with the child after birth - according to the national guidelines. While BCG does not offer complete immunity to tuberculosis, it offers protection from the severe forms of tuberculosis such as miliary TB and TB meningitis. 

• BCG vaccine should be given to all babies at birth or at first contact with the child after birth, except babies with clinical signs of HIV infection and/or in infants born to a mother with sputum positive TB. 
• BCG is given intradermally on the right upper arm, above the insertion of the deltoid muscle. 
• The batch number of the vaccine and the date must be recorded on the child's health card. 
• No booster dose should be given.

Dosage is as recommended by the EPI. 

Problems associated with BCG vaccination remain uncommon and are mainly due to faulty technique. 

Abscesses or ulcers should be treated with local hygienic care. Abscesses should be aspirated not incised. Secondary infections can be treated with antibiotics. Non-healing ulcers, (ulcers of duration > 8 weeks) or regional lymphadenopathy can be treated as follows, 

BCG related regional lymphadenopathy treatment

TPT priority target groups are PLHIV and household contacts of bacteriologically confirmed TB index cases including child (<15 years) and adult (>15 years) contacts. 

Table 1: Preferred LTBI Treatment Options

*The preventative treatment for MDR contacts should be individualized after a careful assessment of the intensity of exposure, the certainty of the source case, reliable information on the drug resistance pattern of the source case and potential adverse events. The preventative treatment should be given only to household contacts at high risk in whom active disease has been ruled out (e.g. children 5 years and below, people receiving immunosuppressive therapy and people living with HIV). Levofloxacin should be selected according to the drug susceptibility profile of the index case. Confirmation of the infection with LTBI tests is required. 

Table 2: Recommended TPT doses by regimen

More guidance on TB preventative therapy, especially on new approaches, may be found in the Tuberculosis and Leprosy Management Guidelines, Clinical Guidelines for the management of Drug Resistant Tuberculosis and the Guidelines for Antiretroviral Therapy for the Prevention and treatment of HIV in Zimbabwe.

Approach to new-born and under five TB contacts

An infant born to a mother with sputum positive TB should not be given BCG at birth:

• Give the child the appropriate TPT regimen preferably 3HR, for two months
• After two months, perform a Tuberculin skin test
• If the Tuberculin skin test is positive give full TB treatment
• If the Mantoux test is negative continue with TPT regimen 1 month for 3HR and 4 months for 6H. 
• Follow with BCG vaccination if not contraindicated. 

For all contacts of a sputum positive TB case, evaluate for signs of active TB; for children check the BCG vaccination status and vaccinate if not already done. Commence on the appropriate TPT regimen - see tables under Tuberculosis Case Management.  

Contact investigation should be conducted to screen and manage all household and close contacts of the index (initial TB case).

Refer to the Zimbabwe Tuberculosis and Leprosy Management guidelines for additional information.