Tuberculosis (TB) is a bacterial infection most commonly spread from person to person through the air by coughing and sneezing. Globally the disease is extremely common with millions of new infections and many deaths occurring yearly. The rate of disease varies widely from country to country, with the highest rates and most deaths occurring in developing regions for example Sub-Saharan Africa and South East Asia.
Most travellers visiting countries with high rates of TB are at low risk of infection. Travellers at higher risk include those visiting friends and relatives, healthcare workers, long-term travellers, and those who have contact with a person who has active infection. Prolonged exposure to infected individuals is usually required for infection to occur.
Most healthy individuals who are infected will never develop active disease as their immune system is able to contain the disease. Those most likely to develop active infection include: young children and persons with underlying health problems (for example HIV, cancer, poorly controlled diabetes, long-term kidney disease and malnutrition).
Although TB may affect any organ it most commonly affects the lungs (pulmonary TB). The disease often occurs without symptoms and when symptoms do occur they depend on the organ affected. Symptoms of pulmonary TB commonly include: fever, night sweats, weight loss and a productive cough. Treatment can be complicated and involves prolonged courses of antibiotics. In recent decades TB has become increasingly resistant to many antibiotics.
Travellers should avoid close contact with individuals known to have infectious pulmonary TB. Those at risk during their work (such as healthcare workers) should take appropriate infection control precautions that may include isolation and barrier nursing procedures.
In the United Kingdom, vaccination against TB (BCG vaccine) forms part of the national immunisation programme and is targeted to high-risk individuals, including some travellers.
TB vaccine is recommended for the following two groups of people travelling for more than three months to a country where the annual incidence of TB is 40/100,000 or greater and/ or where the risk of Multi Drug Resistant -TB (MDR-TB) is high*:
TB vaccine should be offered to those in the following occupational groups, with direct patient contact or contact with infectious materials:
TB vaccine should be considered for some staff working with persons at higher risk of acquiring TB such as prisoners, homeless persons, persons with drug and alcohol misuse and those working with refugees and asylum seekers.
Country-specific information on the risk of TB can be found in our Country Information pages.
Bacillus Calmette-Guerin (BCG Vaccine AJV)
Infants below 12 months:
Children aged 12 months and over and adults: 0.1ml/intra-dermal
* Countries with high rates of MDR-TB: Global tuberculosis report
**A tuberculin skin test is required prior to vaccination for all children from six years of age and may be recommended for some younger children. Full details of tuberculin testing and interpretation can be found in Public Health England guidance.
Vaccination requires intra-dermal injection and should be carried out by healthcare professionals trained in this technique. Live vaccines, such as rotavirus, live attenuated influenza vaccine (LAIV), oral typhoid vaccine, yellow fever, varicella, zoster and MMR can be administered at any time before or after BCG vaccination.
Although immunity may wane over time, reinforcing doses are not recommended. There is no evidence that they would confer additional protection and there is a risk of adverse reactions. There is little evidence of vaccine efficacy in those aged 16 years and older, so vaccination is only recommended for such individuals in special circumstances.