Tuberculosis contacts and prophylaxis

Every day much energy is expended sorting out the tragedy that is childhood tuberculosis (TB). Given the other challenges faced by our public health services this is energy we can ill afford. It is unlikely that we shall have a more effective TB vaccine available before 2015. In the meantime, many cases of severe and complicated paediatric TB could be prevented by an effective programme of contact screening and chemoprophylaxis. This article looks at the 'what, who and why' of TB contact investigation and TB chemoprophylaxis, including some special cases. We ask why these activities are not happening and what can be done about the situation. Lastly, some proposals for improving the situation are made.