Prevention

The recommendations presented here are intended to inform and contextualize TB-specific IPC interventions and activities within national-level and local-level IPC policies and protocols. Therefore, the target audience includes national and subnational policy-makers, including health system managers for TB, HIV and other disease programmes; IPC services; inpatient and outpatient facilities; IPC and quality assurance programmes; associations of affected groups; managers of congregate settings and penitentiary facilities; and occupational health and other relevant stakeholders.

The objective of these guidelines is to provide updated, evidence-informed recommendations outlining a public health approach to preventing transmission of M. tuberculosis within the clinical and programmatic management of TB, and to support countries in their efforts to strengthen or build reliable, resilient and effective IPC programmes.

These updated guidelines focus on a package of interventions aimed at reducing the risk of M. tuberculosis transmission, and they supersede the 2009 recommendations (7). Overall, the recommendations cover health care and other groups outside the health care system; also, where possible, specific remarks and additional considerations are given, to highlight specific areas or processes required for the implementation of these recommendations within health care facilities and other, non-health care settings such as congregate settings, community settings and households.

With a burden of disease that accounts for more than 10 million new cases per year, of which less than two thirds are reported, tuberculosis (TB) continues to be a major global health threat (1).

These guidelines were developed in accordance with the process described in the WHO handbook for guideline development. ²² Confidence in the certainty of the evidence underpinning the recommendations was ascertained using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The Guideline Development Group, an international group of experts, was convened to advise WHO in this process, to provide input into the scope of these guidelines and to assist the WHO Steering Group in developing the key questions.

Worldwide, tuberculosis (TB) continues to be the most important cause of death from a single infectious microorganism.¹⁴ Although recent decades have witnessed increased efforts in the fight to end TB, fundamental gaps are hampering these efforts, particularly in resource-constrained settings and in settings with a high burden of disease.

These guidelines have been developed to provide updated, evidence-informed recommendations on tuberculosis (TB) infection prevention and control (IPC) in the context of the global targets of the Sustainable Development Goals (SDGs) and the World Health Organization (WHO) End TB Strategy.

General

Antimicrobial resistance (AMR) The loss of effectiveness of any anti-infective medicine, including antiviral, antifungal, antibacterial and antiparasitic medicines.

Grading of Recommendations Assessment, Development and Evaluation (GRADE) An approach to grading in health care that aims to overcome the shortcomings of current grading systems. For further information, see the GRADE website.¹

Table A6.1 proposes a list of variables on which data should be collected for index cases and their contacts in an evaluation of the contacts of a person with TB disease. The data may be collected at various stages of the investigation. Usually, demographic information and much of a person’s medical history is available at the first visit, while other details, such as the results of tests for ruling out TB, confirming infection or starting TPT would be collected at subsequent encounters.