5 days ago6 min read

The Basics of TB Prevention: What Everyone Should Know

Tuberculosis (TB) is a growing health concern in the UK. Previously, in the 18th and 19th centuries, TB was responsible for 1 in 4 deaths due to a combination of poverty, urbanisation, and squalor.

However, by identifying cases of TB and actively treating them with newly available drugs, cases rapidly dropped. Better living standards and a reduction in poverty also led to a sharp decline in cases. Today, the annual incidence of TB is just 7.8 per 100,000.

Cases fell in the UK from the highest in Western Europe in 2011 until 2019, when there was another increase.

The respiratory disease is concentrated in large urban areas. With strains increasingly resistant to antibiotics, TB prevention by identifying and isolating new cases early, and then promptly treatment multiple effective antibiotics, is of paramount importance. TB vaccination is also important in preventing the most severe forms of TB, such as TB meningitis* in children but is less effective at preventing TB of the lungs.

*a severe form that affects the brain

In this guide:

What is Tuberculosis?
How TB Spreads
The Top Prevention Basics Everyone Should Know
Treatment as Prevention: Reducing TB Spread
Global and Community Efforts in TB Prevention

What is Tuberculosis?

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. It is one of the most common and deadly infectious diseases worldwide, causing 1.5 million people to die in 2020 – 2nd to COVID-19 in that year.

Unlike other respiratory infections, TB does not always cause immediate symptoms. Sometimes, it can lay dormant in your body for years (latent TB) before developing into an active disease. The symptoms of TB depend on the stage of the disease. It begins with lung-focused symptoms (pulmonary TB):

Chronic cough lasting three weeks or more
Coughing up blood or blood-streaked mucus (haemoptysis)
Chest pain or discomfort, especially when breathing or coughing
Shortness of breath

Alongside these pulmonary symptoms, patients often notice:

Persistent fatigue or weakness
Unexplained weight loss
Loss of appetite
Fever, often low-grade and recurring
Night sweats

If TB spreads to other parts of the body (extra-pulmonary TB), symptoms may depend on the affected area, such as:

Lymph nodes: Swelling in the neck, armpits, or groin
Spine: Back pain or stiffness
Kidneys: Blood in the urine
Brain (TB meningitis): Headaches, confusion, seizures
Bones/joints: Pain or swelling in the affected area

Extra-pulmonary TB is most common in people with weakened immune systems. It does not occur in all cases of the disease.

How TB Spreads

Tuberculosis spreads similarly to most respiratory diseases by infected droplets. Patients experience a persistent cough. Every time the individual coughs, sneezes, or even speaks, the bacteria is transmitted through the air. If anyone comes into contact with an infected droplet and inhales them, they can develop TB. If the immune system is healthy and active, an infected person may never contract active TB. The bacteria remain inactive or latent. Around one-quarter of the world’s population has latent TB.

TB is not contracted via casual contact. You cannot transmit TB via handshaking or sharing food. Nor are people with latent TB contagious – unless the disease becomes active.

The Top Prevention Basics Everyone Should Know

Personal Protection Measures

TB prevention is the best option for reducing the prevalence of the condition. The most obvious preventative measures involve personal protection.

These include:

Good Ventilation. Respiratory droplets can linger in the air for some time before settling. In a confined space with little ventilation, this increases the risk of ventilation. Good ventilation lets clear airflow into the space and draws the respiratory droplets outside, where they become inert and non-infectious.
Wearing Masks. The debate surrounding mask efficacy is ongoing. However, with TB, wearing a protective barrier between you and a person with active TB is an important measure in stopping the spreading of the disease.
Practise Good Hygiene. There’s no replacement for hand-washing and other elements of good hygiene. Mycobacterium tuberculosis is equally affected by soap and water or alcohol gel as every other microorganism.

BCG Vaccination

BCG is a vaccine for the prevention of TB. Known as the Bacillus Calmette-Guerin (BCG) vaccine, helps reduce the burden of the disease and is particularly effective in stopping children from developing the most severe forms of disease. Each injection lasts up to 20 years, and it can prevent around 20% of children from getting infected, and among those who become infected, it may prevent up to half from developing the disease.

BCG prevention vaccination is primarily used in babies and young children who are at higher risk of getting TB. It helps reduce the rates of TB meningitis, and to a lesser extent, pulmonary TB.

Other people who can benefit from BCG vaccination include people at risk of TB through their work (e.g., doctors and nurses), people travelling abroad, and adults arriving in the UK from certain countries.

Early Diagnosis and Treatment

Routine screening for TB is part of prevention measures. It is a NICE requirement among people who are high-risk. These include:

People who have been in contact with a person with active TB
People who are immunocompromised such as people living with HIV
People who are new entrants to the UK from a high TB prevalence country
People who are a new NHS employee
People who have evidence of TB scarring on a chest X-ray

Infection Control in Healthcare Settings

TB infection control is extremely important. As a respiratory disease, it easily passes from person to person. Anyone who comes in contact with an infected or potentially infected person must take stringent precautions.

Healthcare settings must quickly identify and isolate individuals with suspected or confirmed infectious TB, particularly pulmonary or laryngeal cases. Patients should be placed in single rooms, with high-risk cases cared for in negative pressure rooms and tested rapidly.

Outpatient visits should be minimised, and aerosol-generating procedures should be conducted only in ventilated, negative-pressure areas. Hospital admissions are limited to clinical need, with discharge considered after two weeks of treatment if infection risk is low.

Inpatients must wear surgical masks outside their rooms and follow respiratory hygiene advice. Visitors to children with suspected TB should be assessed for symptoms and isolated if necessary. Isolation measures can be reduced after two weeks if the patient shows improvement and poses minimal risk. These steps prioritise safety and limit TB transmission.

Treatment as Prevention: Reducing TB Spread

The BCG vaccine cannot treat people with either active or latent TB. However, TB vaccination plays a role in protecting individuals from TB.

The vaccine can lower the chance a person contracts TB or that the TB becomes active - particularly in children As such, it can potentially lower the number of people capable of spreading it as a proportion of the population.

In addition, the vaccine reduces the risk of severe disease and thus reducing harm and long term disability. That being said, people who are infected with TB should follow their prescribed treatment plan. Usually, this means hitting TB with multiple antibiotics to prevent the development of more drug-resistant strains.

Global and Community Efforts in TB Prevention

TB incidence is relatively low in the UK. Globally, however, it’s one of the most important infectious diseases. Global control initiatives, such as the WHO’s End TB Strategy, hope to alleviate the disease burden on affected populations.

The End TB Strategy involves a combination of widespread TB vaccination, increasing public awareness, and supporting government systems. Due to the global nature of the challenge, there is no “one-size-fits-all” approach. Nonetheless, central to the strategy’s success is a high-performance national TB surveillance system that measures TB incidence and mortality. The strategy aims to see an 80% drop in new cases by 2030.

One challenge is the stigma surrounding TB. This prevents individuals from seeking early testing and treatment. Such social stigmatisation forces individuals to hide their condition, further worsening the spread of TB. Only by countering these narratives can efforts to prevent TB truly succeed.

Concerned about the risks of TB? Take control of your health and receive a TB vaccination. The BCG vaccine is a safe and effective tool to protect yourself and your loved ones from TB, especially if you’re in a high-risk group. Don’t wait—prioritise your health and the well-being of those around you.

Book your BCG vaccine today and safeguard your future.

Book Your BCG Vaccine

References

Written and Approved by:

Dr Ravi Gowda

Consultant in Infectious Diseases

MBBS, MRCP(UK), MRCGP, DTM&H, DCH, DRCOG, DFFP