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I've heard TB is on the rise - who is at risk?

 If you live in the UK you would have routinely been offered the BCG test and vaccine, usually whilst at school (this applies to both state and private schools) between 12 and 14 years of age. A significant number of people miss out on this for several reasons; either administrative for example if moving house (although school health departments are meticulous in chasing pupils up), or because of illness at the time or because children or parents refuse the test or vaccine.

I would recommend that you have the BCG screening test and vaccine if needed as tuberculosis (TB) is an illness which appears to be making a comeback in this country, partly as a result of our population including immigrants from countries where TB is more common. Although TB is on the increase it is still quite rare (less than 7000 new cases in the year 2000) and is predominantly confined to the major cities (about 40 per cent of all cases are in London). In the UK you are most at risk of developing TB if you :
1 Are a close contact of an infectious case
2 Have lived in places where TB is still common
3 Have an immune system weakened by HIV or other medical conditions
4 Have chronic poor health through lifestyle factors such as homelessness, alcoholism and drug abuse
5 Young children and very elderly people are more at risk

You need to see your GP who will refer you to the chest clinic at the local hospital where the test (see below) and vaccine can be arranged. You are tested before being offered the BCG vaccine to see if you are already immune to TB. This can follow earlier infection, often with a milder strain of TB which might not have caused any obvious symptoms. If you have already has TB infection (or the vaccine) you develop hypersensitivity to Mycobacterium tuberculosis, the bacterium which causes TB in humans.

The screening test consists of a skin test to determine if you immune system recognises TB. The skin test is done in one of two ways. The most common method is the Heaf test after which you return about one week later to show the result. The other method is called the Mantoux test which can be interpreted after three days. Both are safe and involve a small and almost painless injection into the skin of your forearm. The test cannot be done of you have had any live vaccine in the previous four weeks (as this might reduce your response to the test).

You may also be asked to have a chest X ray when you have the skin test or if the skin test is strongly positive.

Because TB can develop some time after exposure if you have been in contact with TB or have a positive result you may be followed up for up to one year with further appointments for screening and are advised to look out for any suspicious symptoms.

If your test is negative this shows you are not immune to TB and need the vaccine. This is given as an injection into the skin itself. Within two to six weeks a small swelling appears at the injection site. This turns into a raised lump or ulcer about 10 mm across which heals in six -12 weeks and may need a dry dressing. Once the skin heals you are left with the characteristic small round scar which is evidence of BCG vaccination for the rest of your life.

We recommend readers seek personal medical attention in appropriate circumstances