Preventing Tuberculosis

Exposure

TB is spread through the air from one person to another. The TB germs are put into the air when a person with TB disease of the lungs or throat coughs, speaks, or sings.

These germs can stay in the air for several hours, depending on the environment. TB germs are more likely to spread in indoor areas or other places with poor air circulation (such as a closed vehicle) than in outdoor areas.

People who breathe in the air become infected with TB. Not everyone infected with TB germs becomes sick. As a result, two TB-related conditions exist:

• Inactive TB and
• Active TB disease

People with active TB disease are most likely to spread TB germs to people they spend time with every day, such as:

• Family members,
• Friends,
• Coworkers, or
• Schoolmates.

Risk factors

Anyone can get TB. But people at higher risk for TB fall into two categories

• People at higher risk of being exposed to TB germs, and
• People at higher risk of developing active TB disease once infected with TB germs.

You have a higher risk of being exposed to TB germs if you

• Were born in or frequently travel to countries where TB is common, including some countries in Asia, Africa, and Latin America
• Live or used to live in large group settings where TB is more common, such as homeless shelters, prisons, or jails
• Recently spent time with someone who has active TB disease
• Work in places where TB is more likely to spread, such as hospitals, homeless shelters, correctional facilities, and nursing homes

You have a higher risk of developing TB disease once infected if you

• Were recently infected with TB germs
• Have a weaker immune system because of certain medications or health conditions such as diabetes, cancer, or HIV.

What to look out for

Active TB disease in the lungs may cause symptoms including:

• A cough that last 3 weeks or longer
• Chest pain
• Coughing up blood or sputum (phlegm)
• Weakness or fatigue
• Weight loss
• Loss of appetite
• Chills
• Fever
• Night sweats

People with inactive TB do not have symptoms of TB disease. However, without treatment, they can develop active TB disease and become sick.

Prevention steps and strategies

If you have inactive TB, treating it is the best way to prevent active TB disease.

Without treatment, people with inactive TB can develop active TB disease.

Some people with weakened immune systems (due to certain medications or health conditions) are at very high risk of developing active TB disease once infected with TB germs. It is very important that they receive treatment for inactive TB to prevent the development of active TB disease.

If you have active TB disease of the lungs or throat, you may need to take steps to prevent spreading TB germs to other people.

If you have TB disease of the lungs or throat, you could be infectious. This means you could spread TB germs to others. You and your health care provider will discuss how to prevent the spread of TB germs to other people.

The most important way you can prevent the spread of TB is to take all medicines exactly as directed by your health care provider.

Keep all your clinic appointments. Your health care provider needs to see how you are doing. This often requires another chest x-ray or a test of the sputum (or phlegm) you may cough up. These tests will show:

• If the TB medicines are working
• If you can still spread TB germs to others

Be sure to tell your health care provider about anything you think is wrong.

If you are in the hospital

If you are sick enough with TB disease to go to a hospital, you may stay in a special room. These rooms use air vents that keep TB germs from spreading to other rooms. People who work in these special rooms must wear a special face mask to protect themselves from TB germs. You must stay in the room so that you will not spread TB germs to other people.

If you are at home

• Take your medicines as directed. This is very important!
• Always cover your mouth with a tissue when you cough or laugh. Put the tissue in a closed bag and throw it away.
• Do not go to work or school until your health care provider tells you it is safe.
  • Separate yourself from others and avoid close contact with anyone.
  • Sleep in a bedroom away from other family members.
• Air out your room often to the outside of the building (if it is not too cold outside).
  • TB germs spread in small, closed spaces where air does not move.
  • Put a fan in your window to blow air to the outside. If you open other windows in the room, the fan also will pull in fresh air. This will reduce the chances that TB germs will stay in the room and infect someone who breathes the air.

Your health care provider will tell you when you can return to work or school or visit with friends.

Health care settings should have infection control plans to minimize the risk for exposure to and spread of TB.

Health care settings, especially those where people have a higher risk for exposure to TB, should have a TB infection control plan. These plans should describe policies and procedures for TB prevention, including:

1. Administrative measures, such as facility risk assessments, health care personnel screening, and education.
2. Environmental controls
3. Respiratory protective equipment

Why prevention is important

Treating inactive TB prevents active TB disease.

If left untreated, 1 in 10 people with inactive TB will get sick with active TB disease. Active TB disease can spread to others and can be deadly.

The risk of developing active TB disease is much higher for people with weakened immune systems or people with diabetes, cancer, or HIV.

More than 80% of people who get sick with active TB disease in the United States each year get sick from untreated inactive TB.

Taking TB medicine as prescribed prevents drug-resistant TB disease.

Sometimes the TB germs are resistant to the medicines used to treat TB disease. This means that the medicine can no longer kill the TB germs.

Drug-resistant TB disease means that the TB germs are resistant to at least one of the most effective TB medicines. Drug-resistant TB disease is difficult and costly to treat.

Some people develop drug-resistant TB disease because they are exposed to drug-resistant TB germs. Drug-resistant TB can also occur when the medicines used to treat TB are misused or mismanaged.

Drug-resistant TB disease is more common in people who:

• Have spent time with someone known to have drug-resistant TB disease.
• Come from areas of the world where drug-resistant TB disease is common.
• Develop TB disease again, after being treated for TB disease in the past.
• Do not take all of their TB medicines.
• Do not take their TB medicines regularly.

The most important way to prevent drug-resistant TB disease is to take all TB medicine exactly as prescribed.

Traveling

TB occurs throughout the world but is much more common in some countries. Most TB disease occurs in countries in sub-Saharan Africa, Eastern Europe, and Asia.

A traveler's chances of exposure to TB germs on a plane are very low.

Travelers planning to work in health care settings

If you are traveling to work in a clinic, hospital, or other health care setting where patients with TB disease are likely to be, consult infection control or occupational health experts.

• Ask about administrative and environmental procedures to prevent exposure to TB germs.
• Consider using personal respiratory protective devices.

Travelers who anticipate possible prolonged exposure to people with TB disease should have a TB blood test or a TB skin test before leaving the United States.

• If the test reaction is negative, repeat the test 8 to 10 weeks after returning to the United States.
• Annual testing may be recommended for people who anticipate repeated or prolonged exposure or an extended stay over a period of years.
• If you have HIV, talk to your health care provider. People with HIV are more likely to have an impaired response to TB tests.

Resources