[2006], 1.6.1.11 The consultant in communicable disease control or health protection should provide the airline with 'inform and advise' information to send to passengers seated in the same part of the aircraft as the index case. Malaise (7-40%) Fever (17-38%) Pain (17%) Chills (9-34%) Nausea/vomiting (3-16%) Dysuria (52-60%) Hematutia (26-39%) Urinary urgency (6-18%) Infection (2-18%) Anemia (21%) Flu-lik syndrome (24-33%) Active smear‑positive pulmonary TB, that is with acid fast bacilli visible on microscopy. This vaccine is not widely used in the United States, but it is often given to infants and small children in other countries where TB is common. The risk assessment would take into consideration factors such as infectiousness of the index case, vulnerability of contacts to TB infection, length of contact with or exposure to an infectious case and the built environment (for example, size of the rooms, ventilation and overcrowding). Have the resources to provide a continuous service throughout the year, ensuring the TB service accounts for the following to manage continuity of care: planned absence (for example, professional development, mandatory training, annual, maternity or paternity leave), unplanned absence (such as sickness absence). 1.4.1.1 For people with clinically suspected TB, a TB specialist should request rapid diagnostic nucleic acid amplification tests for rifampicin resistance on primary specimens if a risk assessment for multidrug resistance identifies any of the following risk factors: history of previous TB drug treatment, particularly if there was known to be poor adherence to that treatment, contact with a known case of multidrug-resistant TB, birth or residence in a country in which the World Health Organization reports that a high proportion (5% or more) of new TB cases are multidrug‑resistant.Start infection control measures (see section 1.5). BCG vaccine is recommended for previously unvaccinated, tuberculin-negative children aged under 16 years who intend to travel for 3 months or more in a country where the annual incidence of tuberculosis is 40 cases per 100 000 or greater, or where the risk of multi-drug resistant tuberculosis is high. They are often in a good position to help convey, with empathy, the need for testing or treatment. TB control boards should ensure services take into account the barriers facing vulnerable migrants who may need treatment, and in particular the stigma they may face. The groups classified as under‑served in this guideline are: Groups of children identified as potentially under served include: children whose parents are under served, including vulnerable migrants, children whose parents are in prison or who abuse substances, children from Gypsy and Traveller communities. The Pfizer BioNTech vaccine is for use in people 16 years of age or older and is administered in 2 doses, 3 weeks apart. Tuberculosis is the leading cause of death from infectious disease worldwide [].The widely used Bacillus Calmette-Guérin (BCG) vaccine is the only licensed vaccine against Mycobacterium tuberculosis [].Infant BCG vaccination has shown consistently high efficacy of 70%–80% against childhood tuberculosis, namely meningitis and miliary tuberculosis []. Offer: 3 months of isoniazid (with pyridoxine) and rifampicin to people younger than 35 years if hepatotoxicity is a concern after an assessment of both liver function (including transaminase levels) and risk factors, 6 months of isoniazid (with pyridoxine) if interactions with rifamycins are a concern, for example, in people with HIV or who have had a transplant. 1.4.1.8 Consider surgery as a therapeutic intervention in people with potentially resectable multidrug‑resistant disease if: optimal medical therapy under direct observation has not worked or, medical therapy is likely to fail because of extensively drug-resistant TB. BCG vaccine has a documented protective effect against meningitis and disseminated TB in children. Flu vaccination (see influenza) Food allergy in under 19s; Foot care for people with diabetes; Fractured neck of femur (see hip fracture) Fractures (see trauma) Fragility fractures (see osteoporosis) Gallstone disease; Gastric cancer (see oesophageal and gastric cancer) Gastroenteritis in children (see diarrhoea and vomiting in children) 1.3.7.1 Once a diagnosis of active TB is made: the clinician responsible for care should refer the person with TB to a clinician with training in, and experience of, the specialised care of people with TB, the TB service should include specialised nurses and health visitors, active TB in children should be managed by a TB specialist (see recommendation 1.3.4.3), and by paediatric trained nursing staff, where possible.If these arrangements are not possible, seek advice from more specialised colleagues throughout the treatment period. - Use warm water compresses over the injection site or suppurating lymph node(s) 4–5 times/day. C’est alors qu’il lance ses travaux sur la tuberculose. [2006], 1.1.4.2 Employees new to the NHS who will not have contact with patients or clinical specimens should not start work if they have signs or symptoms of TB. [2006], 1.1.4.15 Healthcare workers who are found to be HIV‑positive during employment should have medical and occupational assessments of TB risk, and may need to modify their work to reduce exposure. [2006, amended 2016], 1.1.4.1 Employees new to the NHS who will be working with patients or clinical specimens should not start work until they have completed a TB screen or health check, or documentary evidence is provided of such screening having taken place within the preceding 12 months. It also includes when a decision is made to broaden the investigation to the next stage using the concentric circle method for risk assessment. [2016], 1.3.2.2 Send multiple respiratory samples (3 deep cough sputum samples, preferably including 1 early morning sample) for TB microscopy and culture. [new 2016], Include a range of clinical specialties in the multidisciplinary TB team, including paediatrics, infection control and respiratory medicine. They could, for example, set up a network including areas with high and low incidence of TB. Ensure all healthcare professionals who suspect or treat a case of multidrug‑resistant TB are informed about and have access to specialist advisory services for multidrug‑resistant TB. 1.5.2.2 In prisons or immigration removal centres, everyone with X‑ray changes indicative of active TB, as well as those with symptoms who are awaiting X‑ray, should be isolated in an adequately ventilated individual room or cell. [2012, amended 2016], 1.8.10.3 Multidisciplinary TB teams, in conjunction with prisons, custody suites and immigration removal centre healthcare services, should agree a care pathway for TB. Clinical investigations (diagnostic testing) of people identified as having had significant exposure to a case of TB, including tests to diagnose latent or active TB. [new 2016], 1.5.3.5 Staff and visitors should wear filtering face piece (FFP3) masks during contact with a person with suspected or known multidrug‑resistant TB while the person is thought to be infectious. 1.3.5.15 Use the site‑specific investigations listed in table 9 to diagnose and assess disseminated TB. [4] The staffing ratios used in Public Health England and NHS England's collaborative tuberculosis strategy for England (published in 2015) came from NICE's guideline on tuberculosis: identification and management in under-served groups (published in 2012) which has been replaced by this guideline. [new 2016], 1.2.6.1 Consider testing children and young people for hepatitis B and C before starting treatment for latent TB. [2006, amended 2016]. 1.8.8.1 TB control boards and local TB services should consider employing trained, non‑clinically qualified professionals to work alongside clinical teams to agreed protocols, and to contribute to a variety of activities. [2006], 1.6.1.16 If a teacher has smear‑positive TB, assess the pupils in his or her classes during the preceding 3 months as part of contact tracing. [2006], 1.6.1.26 In cases of doubt when planning contact tracing after diagnosing smear‑positive TB in an inpatient, seek further advice from the local or national Public Health England or Wales unit or people experienced in the field. This includes for example, situations in which large numbers need to be tested (see section 1.6.4 and recommendation 1.2.3.2). [new 2016]. [new 2016], 1.3.7.20 At the start of an anti‑TB treatment regimen, offer adults with active pericardial TB oral prednisolone at a starting dose of 60 mg/day, gradually withdrawing it 2–3 weeks after starting treatment. Multidisciplinary TB teams should aim to find people with active TB who are lost to follow-up, or who stop using services before completing diagnostic investigations. For the purposes of TB control, a broad and inclusive definition of homelessness has been adopted that incorporates overcrowded and substandard accommodation. This is so that case management and infection control procedures start promptly. [2006, amended 2016]. [2006], 1.1.3.6 Preferably vaccinate babies at increased risk of TB before discharge from hospital or before handover from midwifery to primary care. People born in countries with an incidence of more than 150 per 100,000 per year should be made a priority for latent TB testing when they arrive here. A place where people congregate or an institutional setting such as a workplace, prison, hostel, or childcare or educational setting, where social contacts might have had significant exposure to TB. De 1909 à 1912, Albert Calmette prendra quatorze fois le bateau de Toulon pour Alger. [new 2016]. Il prépare des décoctions de bacilles aux jaunes d’œuf, il chauffe du venin de cobra mêlé à du sérum de cheval. Combine these meetings with others if possible, or use technology to make it easier for clinicians and case managers to attend. Funds may also be used to provide accommodation during treatment (see section 1.8.11). [new 2016], 1.5.3.3 Consider earlier discharge for people with confirmed multidrug‑resistant TB, if there are suitable facilities for home isolation and the person will adhere to the care plan. [new 2016], 1.8.5.1 Directors of public health, in discussion with local health protection teams, should ensure that TB is part of the joint strategic needs assessment. [5] NICE's 2012 guideline on tuberculosis: identification and management in under-served groups recommended 1 WTE case manager per 40 incident cases needing standard management and 1 WTE case manager per 20 incident cases needing enhanced case management. [new 2016], 1.2.4.5 If a person also has severe liver disease, for example, Child‑Pugh level B or C, work with a specialist multidisciplinary team with experience of managing TB and liver disease. Marie assura l’instruction d’Albert jusqu’à ce qu’il aille au collège. Warnings include: stopping treatment at first signs of a serious adverse reaction (such as tendonitis), prescribing with special caution in people over 60 years and avoiding coadministration with a corticosteroid (March 2019). Give the contact 'inform and advise' information, and inform their GP. A break in the prescribed anti‑TB regimen for 2 weeks or more in the initial phase, or more than 20% of prescribed doses missed intermittently. Curieuse rencontre avec l’Histoire! See NICE guidelines on hepatitis B and C: ways to promote and offer testing to people at increased risk of infection and hepatitis B (chronic): diagnosis and management of chronic hepatitis B in children, young people and adults. Les bovins dont Calmette a besoin sont réquisitionnés… pour nourrir les troupes d'occupation. This could be, for example, if the person needs enhanced case management or if there could be adverse events from treatment. Team members will include a social worker, voluntary sector and local housing representatives, TB lead physician and nurse, a case manager, a pharmacist, an infectious disease doctor or consultant in communicable disease control or health protection, a peer supporter or advocate and a psychiatrist. 1.3.7.18 At the start of an anti‑TB treatment regimen, offer people with active TB of the central nervous system dexamethasone or prednisolone, initially at a high dose with gradual withdrawal over 4–8 weeks. [2006, amended 2016]. [new 2016], 1.8.8.2 TB control boards should ensure that people working in the TB service have the right knowledge, engagement, advocacy and communication skills to meet the needs (for example, language, cultural or other requirements) of all the groups they may work with. If the Mantoux test is positive (5 mm or larger, regardless of BCG history), assess for active TB; if this assessment is negative, offer them treatment for latent TB infection. Many foreign-born persons have been BCG-vaccinated. [2012], 1.6.3.1 Multidisciplinary TB teams should follow NICE recommendations on contact tracing (see section 1.6.1).They should coordinate contact investigations at places where the person with TB spends significant amounts of time. a, Additional tests (if it would alter management), preferably spontaneously‑produced, deep cough sputum samples, otherwise induced sputum or bronchoscopy and lavage, Pulmonary (young people aged 16–17 years), preferably spontaneously‑produced, deep cough sputum samples, otherwise induced sputum or gastric lavage, Pulmonary (children aged 15 years or younger), Nucleic acid amplification tests (1 per specimen type), Interferon‑gamma release assay and/or tuberculin skin test (with expert input). [new 2016], 1.2.3.2 In an incident situation when large numbers of people may need to be screened, consider a single interferon‑gamma release assay for people aged 18–65 years. Where there is a housing need they should work with allied agencies to ensure that all those who are entitled to state‑funded accommodation receive it as early as possible during their treatment, for example, as a result of a statutory homelessness review and identified need. They should also consider using mobile X‑ray to check for further cases. [2006, amended 2016], 1.1.3.12 Mantoux testing should not be done routinely before BCG vaccination in children younger than 6 years unless they have a history of residence or prolonged stay (more than 1 month) in a country with a high incidence of TB. Tools such as health equity audit and health impact assessment have been used systematically to assess the potential effect of all policies, programmes and activities (including those without an explicit health focus) on health inequalities. [2011, amended 2016], 1.2.3.3 Offer people younger than 65 years from under-served groups a single interferon‑gamma release assay. [2006, amended 2016], 1.3.5.3 Think about a diagnosis of extrapulmonary TB even if rapid diagnostic tests in, for example, cerebrospinal fluid, pleural fluid or ascitic fluid are negative. [2006, amended 2016]. Multidisciplinary TB teams should consider using simple incentives, such as providing hot drinks and snacks, to encourage people to attend for testing. This includes people who are not sleeping rough but do not have access to housing or recourse to public funds. Examples include workplaces, schools, colleges, universities, childcare settings. This may also include data to support evaluating the need for integrated TB/HIV services including joint clinics. Someone who has had contact with a person with infectious TB but has not been in prolonged, frequent or intense contact. With support they can communicate health messages, assist with contact investigations or testing and offer people support while they are being tested or treated. The aims of contact investigations are to: detect active TB earlier to offer treatment and prevent further transmission, detect latent TB that may benefit from drug treatment. 1.2.2.3 If a neonate has been in close contact with people with smear‑positive pulmonary or laryngeal TB who have not had at least 2 weeks of anti‑TB treatment: Assess for active TB (see sections 1.3.1, 1.3.2 and 1.3.4). This term is used in this guideline to mean groups of adults, young people and children from any ethnic background, regardless of migration status. See the General Medical Council's Good practice in prescribing and managing medicines and devices for further information. Il y a 100 ans, le Niçois Albert Calmette trouvait un vaccin contre la tuberculose. [2012, amended 2016], 1.8.11.3 Local government and clinical commissioning groups should fund accommodation for homeless people diagnosed with active TB who are otherwise ineligible for state‑funded accommodation. If the Mantoux test is inconclusive, refer the person to a TB specialist. Alternatively the chair could be a representative from the local Public Health England health protection team or the TB control board. Equity proofing helps ensure all policies and programmes address the social determinants of health and health inequalities. 1.3.7.2 For people with active TB without central nervous system involvement, offer: isoniazid (with pyridoxine), rifampicin, pyrazinamide and ethambutol for 2 months then, isoniazid (with pyridoxine) and rifampicin for a further 4 months.Modify the treatment regimen according to drug susceptibility testing. Possible imaging techniques [2012, amended 2016], 1.8.6.3 TB case managers and key allied professionals from the TB prevention and control programme should attend cohort review meetings. Numbers receiving directly observed therapy from the start of, or at any point during, treatment (see Public Health England's enhanced TB surveillance data). [2012, amended 2016], Have the resources to provide ongoing TB awareness‑raising activities for professional, community and voluntary (including advocacy) groups that work with populations at high risk of TB (see section 1.1.1). [2006, amended 2016]. Standard and enhanced case management is overseen by a case manager who will usually be a specialist TB nurse or (in low‑incidence areas) a nurse with responsibilities that include TB. [new 2016], 1.4.1.3 If the rapid diagnostic nucleic acid amplification test for the M. tuberculosis complex is positive but rifampicin resistance is not detected, treat as drug‑susceptible TB with the standard regimen (see section 1.3.7). [new 2016], 1.3.1 Diagnosing active TB in all age groups, 1.3.2 Diagnosing pulmonary (including laryngeal) TB in all age groups, 1.3.3 Diagnosing pulmonary (including laryngeal) TB in adults, 1.3.4 Diagnosing pulmonary (including laryngeal) TB in all children and young people, 1.3.5 Diagnosing extrapulmonary TB in all age groups, 1.3.6 Rapid-access radiology and other investigation results - referral to multidisciplinary TB team process, 1.3.7 Managing active TB in all age groups, 1.3.1.1 If TB is a possibility, microbiology staff should consider carrying out TB culture on samples (see recommendations 1.3.2.2 and 1.3.2.3), even if it is not requested. [new 2016]. [new 2016], 1.8.2.7 TB control boards should collaborate with their local and regional partners. [2012, amended 2016], 1.8.7.2 Commissioners should ensure NHS England's safe staffing principles are applied when commissioning TB services[4],[5]. Ils sont positifs. [new 2016]. 1.1.1 Raising and sustaining awareness of TB, 1.1.2 Providing information for the public about TB, 1.1.4 Preventing infection in specific settings, 1.1.1.1 [new 2016]. Ask them to continue wearing it until they have had at least 2 weeks of treatment. attend regular appointments for clinical follow‑up. [2012], 1.8.9.3 Multidisciplinary TB teams should accept self‑referrals to TB clinics by people who suspect they have TB or have recently been in contact with someone with TB. [new 2016], 1.3.4.1 In children aged 15 years or younger with suspected pulmonary TB, offer rapid diagnostic nucleic acid amplification tests for the M. tuberculosis complex (M. tuberculosis, M. bovis, M. africanum). [new 2016]. 1.7.1.6 TB case managers should ensure the health and social care plan (particularly if directly observed therapy is needed) identifies why a person may not attend for diagnostic testing or follow a treatment plan, and how they can be encouraged to do so. [2016]. These materials should be made freely available and designed so that they can be adapted to local needs. This list is not intended to be exhaustive; membership should be determined based on an area's needs, agreements and commissioning arrangements. [2012, amended 2016], 1.1.1.7 Multidisciplinary TB teams and others working with the general public, and with under‑served and other high‑risk groups in particular, should include information on TB with other health‑related messages and existing health promotion programmes tailored to the target group. 1.7.1.7 The health and social care plan should: state who will be observing treatment and where (if the person is having directly observed therapy this should be provided at a location that is convenient and accessible to them, for example, at a methadone clinic) [2012, amended 2016], include actions to take if contact with the person is lost (for example, keeping details of people who might be able to help re‑establish contact) [2012], refer to, and be coordinated with, any other care plan already established for the person [2012], define the support needed to address any unmet health and social care needs (for example, support to gain housing or other benefits, or to help them access other health or social care services) [2012, amended 2016], include a commitment from the person to complete their TB treatment [2012, amended 2016], be supported by frequent contact with any key workers who work with the person. Public Health England lists high‑incidence countries and areas of the UK on its website. [2016], 1.5.1.13 Offer people advice on simple respiratory hygiene measures. [2012, amended 2016], 1.2.3.6 Substance misuse services and prison health services should incorporate interferon‑gamma release assay testing with screening for hepatitis B and C, and HIV testing. Board members are likely to include the voluntary sector, housing representatives, TB specialists and other clinicians, consultants in communicable disease control or health protection, peer supporter and advocate groups, clinical commissioning groups, executive officers, local government commissioners and an independent chair. [2012], Can provide rapid access TB clinics for all cases, including under‑served groups. Discuss the possible benefits and risks with the person and their family members or carers, as appropriate, so that they can make an informed decision. [2012, amended 2016], 1.8.5.3 Commissioners of TB prevention and control programmes should ensure services reflect the needs of their area, identified by needs assessment. Contact tracing should not be delayed until notification. Biopsy from site of disease, such as endometrial curettings or renal biopsy. [2012], 1.7.3.8 Multidisciplinary TB teams should ensure directly observed therapy is arranged for prisoners or detainees being treated for TB after their release. Nous vous invitons à réessayer ultérieurement.