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  3. Occupational Health requirements for students and applicants to the Faculty of Medicine and Health

Occupational Health requirements for students and applicants to the Faculty of Medicine and Health

Mantoux and BCG information

A nurse holding a needle to someone's arm

Introduction
Please read this carefully as it provides essential information on the Mantoux test and the Bacillus Calmette-Guérin (BCG) vaccine for healthcare students. Understanding this information is crucial for making an informed decision on accepting, or declining, the BCG vaccination. 

What is the Mantoux Test? The Mantoux test is a skin test used to determine if an individual has been exposed to Mycobacterium tuberculosis, the bacteria that cause tuberculosis (TB). It is essential for identifying latent TB infection before administering the Bacillus Calmette-Guérin (BCG) vaccine. The test involves injecting a small amount of purified protein derivative (PPD) tuberculin into the skin.

Who Needs the Mantoux Test?

  • Individuals without prior BCG vaccination who are at risk of TB exposure.
  • Healthcare workers, particularly those in high-risk settings.

Why is the Mantoux Test Necessary before BCG Vaccination?

  • A positive Mantoux test may indicate prior exposure to TB, requiring further evaluation.
  • Ensures safe administration of the BCG vaccine and prevents unnecessary vaccination.

How is the Test Performed?

  • A small amount of purified protein derivative (PPD) is injected just under the skin of the forearm.
  • A healthcare professional will examine the injection site 48 hours later to assess the skin reaction.
  • The size of any swelling (induration) is measured in millimetres to determine the result.

Possible Side Effects

  • Redness or swelling at the injection site.
  • Itching or mild discomfort.
  • Rarely, severe reactions in individuals with TB infection.

What Happens After the Test?

  • Following a Mantoux test, you will be given a second appointment to attend Occupational Health 48 hours later to have the test read. This second appointment is essential to determine the test results, as waiting longer than 48 hours can invalidate the results and require a repeat test.
  • If the test is negative, you may proceed with BCG vaccination.
  • If the test is positive, further evaluation (e.g., chest X-ray, clinical assessment) is required before considering BCG vaccination.

What can a positive Mantoux Test indicate?

A positive Mantoux Tuberculin Skin Test (TST) generally means that your immune system has reacted to the tuberculin injected under the skin. This reaction suggests Tuberculosis (TB) exposure or infection, but not necessarily active disease.  In this instance a referral will be actioned to the Leeds Chest Clinic Services for further investigation to ascertain if the results are indicative of:

  • Prior BCG vaccination
  • Latent TB infection – suggesting:
    • The person has been infected with Mycobacterium tuberculosis at some point.
    • The bacteria are present in the body but not causing illness.
  • Active Tuberculosis Disease – this is usually accompanied by the symptoms outlined below, and diagnosis requires further tests such as chest x-ray,  sputum test and blood tests (IGRA).
    • Persistent cough
    • Fever/night sweats
    • Weight loss
    • Fatigue

What action will be taken if latent TB is identified?

You will be referred to a specialist TB team (Leeds Chest Clinic Services) for assessment and management.  People with latent TB cannot spread TB to others.  If someone is diagnosed with latent tuberculosis infection, the goal is to prevent it from developing into active TB disease in the future. Once active TB is ruled out appropriate preventative TB treatment will be offered.  This is typically an extended period of antibiotic treatment. Adherence to treatment is important.

BCG Vaccine

Why is BCG Important for Healthcare Workers?

Healthcare workers, particularly those in direct contact with TB patients or handling potentially infectious materials, face a higher risk of contracting TB. BCG vaccination helps:

  • Prevent Tuberculosis: The vaccine helps reduce the risk of developing severe forms of TB, such as TB meningitis and disseminated TB, especially in individuals exposed to TB
  • Protect Vulnerable Patients: By reducing the risk of healthcare workers contracting and spreading TB, the vaccine helps protect vulnerable patients, particularly those with weakened immune systems.

Who Should Receive the BCG Vaccine?

BCG vaccination is generally recommended for healthcare workers who:

  • Are at high risk of exposure to TB (e.g., those working in TB wards, clinics, or laboratory environments).
  • Have not previously received the BCG vaccine
  • Are likely to be exposed to TB during their work in settings with active TB cases

Procedure

  • A single intradermal injection is given in the upper arm.
  • A small, raised blister usually forms at the injection site.
  • A scar typically develops over several weeks.

Possible Side Effects

BCG is generally safe, but like any vaccine, it can cause some side effects. Common side effects include:

  • Local Reactions: Redness, swelling, or a small blister at the injection site.
  • Scar Formation: A small scar is likely to form at the injection site, which is a normal response and indicates the vaccine has worked.
  • Swollen Lymph Nodes: Mild swelling in the lymph nodes near the injection site may occur, which usually resolves on its own.

Serious side effects are rare but can include infection at the injection site or an allergic reaction (anaphylaxis). If you experience severe pain, fever, or any concerning symptoms, please escalate this appropriately and inform the Occupational Health Department as soon as possible.

Contraindications

  • Individuals with a weakened immune system: Those with conditions such as HIV, cancer, or who are on immunosuppressive treatments (including some topical creams) should not receive the BCG vaccine.
  • Pregnant Women: BCG is not recommended during pregnancy, so please inform the Occupational Health Department if you are pregnant or planning to become pregnant.
  • Severe Allergies: Individuals with a history of severe allergic reactions to any components of the BCG vaccine should not receive it.
  • If you have any concerns about receiving the vaccine due to underlying health conditions, please consult with the Occupational Health Department

How Effective is BCG?
The effectiveness of BCG varies based on the form of TB and the region. It is most effective in preventing severe forms of TB in children and less effective in preventing pulmonary TB in adults. It is, however, still an essential preventive measure, especially for healthcare workers in high-risk settings.

What Happens if I Don't Receive the BCG Vaccine?
If you are at high risk of exposure to TB and do not receive the BCG vaccine, you may be at increased risk of contracting TB, which can impact your health and the health of those you care for. You may be required to follow additional precautions.

In any instance you must report any of the following symptoms to Occupational Health immediately:

  • Unexplained weight loss.
  • Loss of appetite.
  • Heavy night sweats.
  • A persistent fever.
  • Fatigue or a general or unusual sense of tiredness
  • Swollen glands or joints
  • Coughing for 3 weeks or longer.
  • Coughing up blood (Haemoptysis).
  • Chest pain.
  • Shortness of breath.

If you decline the BCG vaccination your manager/ programme lead /supervisor will be informed of your decision. Your programme lead will take a view on this matter in terms of the need for a risk assessment considering restriction to practice / area of work.

For further information or concerns, please consult Occupational Health

Email: Ocupationalhealthstudents@leeds.ac.uk

Telephone:  0113 343 2997