Tuberculosis (TB)

Tuberculosis (TB) bacteria may infect any organ but most commonly affects the lungs. In 2014, there were 9.6 million active TB cases with 1.5 million deaths, mostly occurring in developing countries where undernourished people stay in crowded accommodation.

TB spreads through air droplets and is associated with extended close contact with a contagious person. Usually infection is prominent in crowded, confined environments such as homeless refuges, health care and correctional facilities.  Transmission has occasionally been reported on international flights. Bovine TB is contracted by consuming unpasteurised dairy products from infected cattle. Milk that has been boiled is safe to drink. The overall risk of TB for travellers is very low. The risk is much higher in those infected with HIV. The greatest risk for progression to disease occurs within the first two years after infection TB bacteria can remain dormant in the body for decades, known as latent TB infection. People with latent TB cannot spread the disease to others.

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Symptoms

Individuals with latent TB infection do not have any symptoms. Active TB disease may cause a persistent cough, fatigue, weight loss, fever, coughing up blood, and night sweats.

Prevention

Vaccination with BCG is routinely given at birth in most developing countries to minimise the risk of severe illness. In Australia, among other at risk groups, BCG is recommended for children less than five years of age who are travelling to reside in countries of high tuberculosis prevalence.

BCG may be considered for specific groups of travellers including missionaries and expatriate aid workers, particularly where they may be exposed to multiple drug resistant TB infection.

Adult travellers at high risk of exposure to TB whilst overseas can be screened using a baseline skin or blood test. These tests are used to establish a person’s immune status before departure. The test may be repeated on return for comparison, particularly if there was possible exposure to TB.

Treatment

Eradication of latent TB infection with oral medication is generally considered for people less than 30 – 35 years of age, but not in older individuals who have a higher risk of serious side effects from treatment.