TB testing for children arriving from Ukraine

December 2022 update

Advice for primary care for children arriving from Ukraine.

The response to specific mass migration events continues to be updated as the evidence and expert advice evolves. The UK Health Security Agency and NHS England acknowledge that the updates for this specific group (Ukrainian arrivals) differ from the recommendations for Afghan arrivals (under the Afghan Relocations and Assistance Policy programme) and other groups.

We can assure colleagues that these updates have been carefully worked through with subject-matter experts and NHS England. The UK Health Security Agency are working with partners to address wider disparities and complexities relating to TB testing in migrant groups.

A full national review is expected in 2023 and updates will follow.

Tuberculosis service contact information

First floor offices, Building A, Green Court, Truro Business Park, Threemilestone, TR4 9LF

Email the TB team or call 01726 873 420.

There are 4 TB specialist nurses based at the offices.

  • Service lead nurse, call 07786 468 941
  • Specialist nurses, call:
    • 07920 576 535
    • 07747 457 233
    • 07776 636 504

Tuberculosis team

The following information explains the services and introduces the staff involved in the community tuberculosis (TB) nursing service team and how the team can offer advice and support to everyone at the Trust.

The team includes 4 specialist nurses and an administrator.

“We provide treatment and support to people diagnosed with TB. The team manage incident and outbreak investigations and run nurse-led contact tracing and BCG vaccination clinics. Alison added, our role often involves detective work to locate patients and contacts. Working closely with consultants at the acute hospitals and colleagues in Public Health England. It’s a challenging role but always interesting.” Alison Blake, TB Service Lead Nurse

What is TB?

TB is an infection caused by a bacterium (mycobacterium tuberculosis). TB bacteria are released into the air when someone with infectious TB coughs or sneezes.

Pulmonary TB (in the lungs or throat) is the only form of the illness that is infectious, but TB can affect any part of the body.

If left untreated, TB is a life-threatening illness. Even delays in treatment can have a devastating impact on a person’s health. But TB is curable with a special course of antibiotics.

The sooner the illness is diagnosed and treated the better, both in terms of the patient’s health and stopping them from passing it on to others.

Latent or active disease

Not all cases of TB infection result in disease with symptoms. Most healthy people’s immune systems are able to contain the infection in a latent (dormant) phase. Latent infection can progress to active disease if untreated.

People with latent infection cannot infect others.

BCG vaccination

BCG is a risk based vaccination programme with children born in high incidence areas or with parents or grandparents from high incidence areas eligible for vaccination.

If you become aware of an eligible child (who has not previously been vaccinated) please refer to us for assessment.

We also vaccinate people who are at risk of exposure to TB through their work or travel. If you think you need to be protected from tuberculosis, please contact us and we will assess your eligibility for vaccination.

Referrals

The team accept referrals from any source. Patient referrals can be emailed to ;the Tuberculosis team or by calling any of the nurses’ mobile numbers listed at the top of this page.

Video appointments

We provide video appointments using Attend Anywhere. View our video-appointments page.

Coronavirus (COVID-19) and TB

We understand and appreciate that the coronavirus (COVID-19) crisis may be causing you increased anxiety and that you may have questions and concerns regarding your condition.

You should ensure that you follow the latest Government and NHS advice.

TB Alert have provided some useful information that may answer some of your questions and concerns.

The national guidance is that TB services continue to maintain their focus on the early diagnosis of TB and the management and care of people with active TB during this current situation.

Children and neonatal BCG vaccination programmes are continuing.

Links to COVID-19 guidance in at least 36 languages are below.

If you need more information or support, contact our TB team.

My TB experience from patient 1

My TB experience from patient 1

Initial symptoms

Uncharacteristic periods of fatigue, hot sweats and shivers were my first symptoms.

My GP initially suggested I might have flu but later diagnosed a chest infection. My health deteriorated and I was admitted to hospital. I was originally treated for pneumonia. My condition continued to worsen until the respiratory specialist suggested that I should be given the antibiotics that would be used on a TB patient. From then on I began to recover.

Concerns

Initially because I was being treated for an undiagnosed condition, but my health was still deteriorating I did wonder if in fact I would recover.

Secondly, once diagnosed I was concerned I may have passed the disease on to members of the family and other close contacts.

It was only when I started to feel better that I became reassured about recovery.

When I learned that the family members with whom I had been in contact would be tested for TB this helped allay my concerns about infecting others.

Information received

I was given relevant information regarding the disease and its treatment and the risk of infecting others but I supplemented this with information available on the internet.

Having more facts about the condition enabled me understand the treatment and the importance of maintaining a strict regime regarding the taking of the medication.

Most useful aspects of treatment

I found being able to attend regular clinics and having access to a dedicated TB nurse extremely valuable. This gave me comfort in knowing that my treatment was being closely monitored and I had access to someone who could answer any queries I might have.

Advice to others

TB is not the scourge it once was. Modern drugs are effective in beating the disease and in my case enabled me return to normal fitness. So do not panic and follow the guidance given by the TB team.

TB nurse and wider TB team

The TB nurse was very good at informing me of the nature of TB and the conditions under which it is likely to infect others and in organising the testing of family and other close contacts.

She was good at checking I always had an adequate supply of medication and following up any problems I had with the drugs.

The wider team, besides diagnosing the disease initially, proved to be good at monitoring my condition and adjusting the medication to suit the changing circumstances.

Suggested improvements

Once diagnosed I was very happy with the treatment I received.

But in my particular case it was some time before the TB was diagnosed and a subsequent enquiry to my GP about problems I was having with the drugs resulted in an admission that general practice has very little experience and knowledge of TB.

I think in view of the increase in its incidence it would be beneficial to make GPs more aware of the symptoms and make them more likely to consider the possibility that a patient may have contracted TB.

My TB experience patient 2

My TB experience from patient 2

Richard is a 57-year-old man who was diagnosed with TB in October 2020.

He had been in contact with someone who had TB many years before. He had had a stroke a few years earlier which had left him a bit forgetful and so it was decided that the TB nurse would make contact each weekday to observe him taking his TB medication. His treatment lasted 36 weeks.

He was very pleased when his treatment was completed and could return to his normal life.

He reports his TB experiences as:

My initial symptoms were coughing, night sweats, chills and tiredness. I had these for about 3 weeks before seeking any help but was diagnosed quite quickly which meant I did not spread it to my loved ones.

Throughout treatment he gained weight, his cough improved, he was able to walk to the shops again and he returned to feeling well.

His advice and comments were:

  • Stick with the medication, listen to the nurses, and try and be as positive as you can.
  • It’s a real positive that TB is curable.
  • The TB team are a lovely, compassionate, caring and professional body of nurses.

End of latent TB treatment information

Now that you have successfully completed treatment for latent TB infection, here are some questions and answers you may find useful.

  1. Do I need another Quantiferon blood test or further investigations to make sure I am now free of TB?

    No further investigations are required Once an individual has been exposed to TB, their Quantiferon blood test result is likely to remain positive. If you are offered another Quantiferon blood test as part of contact tracing or an occupational health assessment, you should inform them that you have previously been treated for latent TB.

    We recommend keeping your treatment completion letter to provide as evidence of this. It is important you still attend for TB assessment and screening investigations.
     
  2. Now I have been treated for latent TB, is it possible for me to be infected again

    Yes, if you have another exposure to someone with infectious TB it is possible you will be infected again. It is important you attend for assessment and investigations if identified as a close contact.
     
  3. Is it possible the treatment might not have worked, and I will still develop active TB in the future?

    Treatment for latent TB infection is effective in preventing progression to active TB disease if medication has been taken as directed. However, you should remain vigilant for symptoms of active TB and seek medical review immediately if symptoms develop.
     
  4. What are the symptoms of active TB?

    A cough for 3 weeks or more, weight loss, fever, night sweats, tiredness, loss of appetite. Do not wait for all symptoms to develop. If you have 3 symptoms, contact the TB nurse or GP.
     
  5. Can I now have a BCG vaccination?

    No, BCG vaccination is not recommended for individuals with a history of TB infection (active or latent).

Children's tuberculosis service

Bug busting boy

Hi, my name is Bug Busting Boy. I am going to help you to learn about tuberculosis (TB) in children, what it does and how we can beat it. You are a superhero.

What is TB?

TB is a bug (bacteria) that can live in different parts of your body but mainly your lungs. Your lungs are in your chest and are what you use to breathe, so are important.

If they get a TB bug in them, they do not work as well and make it more difficult for you to do things, like running around and playing with your friends, so it is important that we get rid of them so you can enjoy doing the things you like.

TB can be active (awake). This can make you poorly, or it can be inside you but be asleep (latent), so you do not even know it is there. If it is asleep it could wake up and make you ill, so we want to get rid of it. We need to bust it out of you!

How can TB make you feel?

  • Tired.
  • Hot and sweaty.
  • Make you cough.
  • Make you lose weight and not have as much energy.
  • Sometimes it makes you not very hungry even for your favourite food.

Once you start taking the medication you will start to feel better very quickly.

How can we treat (bust) TB?

With special medicines that you must take every day! There are a few different medicines. You need them all to get rid of the TB bugs, so it is important that you take them all when an adult gives them to you.

It is best to take them when you wake up before breakfast. Sometimes people might need to take them with a biscuit, so it does not make their tummy sore.

The medicines have special powers and make your wee turn bright orange, and if you cry your tears will be bright orange too. This only happens while we are busting the bugs and when you stop taking the medicines the special powers will go too.

Because you must take them for a while, I have made you a chart so you can tick off each day so you can see when you are close to busting the bugs and getting rid of them. Your TB nurse will visit you regularly and might have a few surprises along the way!

Will people know I have TB?

If your TB Is active and awake, we might have to check some of the people you spend time with. This is to make sure that they have not got it and given it to you, or that you have not given it to them. If we speak to your classmates at school and you do not want them to know you have TB, we will not tell them.

If your TB is latent (asleep), then we will not need to tell or test any of your friends, and because you take your medications in the morning, if you do not want to tell them you do not have to.

It might seem scary and really annoying to have the TB bug but if you take the medicines, it will soon be gone.

Preparing your child for the clinic appointment

Before the clinic appointment

Prepare your child by talking about the BCG immunisation. Use a matter-of-fact approach, and describe what will happen, why the vaccine is given and how it will feel. Tell the child about the immunisation at least 1 day before. It helps them to plan how they will cope with it.

Answer your child’s questions honestly. Be straight forward when answering your child’s concerns such as:

  • What will happen? Answer: You will get a medicine called BCG given in the arm with a small needle.
  • Will it hurt? Answer: There may be a sting and some pressure that will last for a few seconds.
  • Why is the BCG given? Answer: To keep you healthy.

Do not give false reassurance and do not apologise. For example, do not say that ‘it will not t hurt’ or that you are sorry, as it may make your child think that the injection will be worse than it is.

Allow plenty of time to get to the appointment and park. If you are stressed, your child may also feel stressed.

When at the appointment

Sit the child on your lap and cuddle firmly in an upright seated position. Tell them to relax their arm and hold it still. The nurse will advise you of the best way to do this. Being held close to you will keep your child calm and helps to keep your child’s legs and arms still so that the injection can be given safely.

Be calm when your child receives the needle. Speak in an even, soft tone because the child is more likely to be calm if you are relaxed.

Ask your child to take a deep breath during the immunisation by having them blow out a pretend candle slowly. This helps the child to relax and takes the focus away from the procedure. Distracting with a favourite toy or book or talking about something else is also useful.

It is important that the child’s arm remains still during the procedure because the immunisation is slightly different to most injections with just the point of the needle inserted under the skin to a depth of 1 mm to 3 mm. It is easy for the needle to be dislodged if the arm is moved and it also takes a little longer to complete.

Recognise that the child has done well after the immunisation by praising and perhaps giving a small reward to reinforce their good behaviour.

Be prepared to wait 15 to 20 minutes after the injection and report any concerns to the nurse.

If you have more than 1 child to be vaccinated

Where possible, having 2 adults attend the appointment allows each child to be vaccinated separately. This helps to reduce stress in the children and parent.

Tuberculosis resources

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TB information in other languages

Bulgarian TB information

Czech TB information

Latvian TB information

Lithuanian TB information

Polish TB information

Portuguese TB information

Romanian TB information

Russian TB information

Slovak TB information

Sudanese Arabic TB information

Ukrainian TB information