ReacciónWith 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). Although the global number of TB deaths fell by 42% between 2000 and 2017, and the annual decline in the global TB incidence rate is currently 1.5% (1), much action is needed to accelerate progress towards achieving global milestones to end TB (2). TB can affect everyone, but specific population groups have a higher risk of acquiring TB infection and progressing to disease once infected; these groups include people living with HIV infection, health workers and others in settings with a high risk of transmission of M. tuberculosis. For instance, global TB data indicate that, in 2017 – out of the 920 000 estimated incident TB cases among people living with HIV – there were an estimated 300 000 deaths¹ from TB in this population. Also, 9299 TB cases among health workers were reported in 60 countries alone, with the notification rate for health careassociated transmission of Mycobacterium tuberculosis being twice as high as the rate in the general adult population. In addition, more than a million incident cases were estimated among children (aged <15 years), reflecting ongoing community transmission.
An increasing challenge to public health and to TB prevention is that of transmission of drug-resistant strains of M. tuberculosis. Initial evidence suggested reduced transmissibility of resistant strains; however, it is now clear that primary transmission of drug-resistant bacteria (as opposed to acquired resistance) is the dominant mechanism sustaining the global transmission of drug-resistant TB (DRTB) cases (3, 4).
Interrupting the cycle of M. tuberculosis transmission is crucial to achieving global targets to end the TB epidemic. Thus, there is a need to implement interventions to rapidly identify source cases, and impede person-to-person transmission by reducing the concentration of infectious particles in the air and the exposure time of susceptible individuals. These principles form the basis for effective infection prevention and control (IPC).
Initial global recommendations on the implementation of IPC for TB were published between 1999 and 2009 (5–7). The demand for these recommendations stemmed from the resurgence of TB and the various drivers fuelling the epidemic, such as the upsurge in HIV infections, concurrent with disrupted health care systems in low- and middle-income countries, the growing incidence of noncommunicable diseases (8, 9) and the emergence of drug-resistant forms of TB. Although the implementation of IPC measures can reduce the risk of M. tuberculosis transmission (10–12), IPC practices are not routinely or systematically implemented, despite their potential benefit and impact, especially in settings with limited resources. Also, there has been little progress in the generation of evidence specific to IPC practices in TB – to date, there are no data available to evaluate the progress in implementing IPC measures globally, including in high TB burden settings.
Since the WHO policy on TB infection control in health care facilities, congregate settings and households was published in 2009 (7), it has been anticipated that the evidence will need to be reassessed and the guidelines updated.
Fuelled also by user needs, the revised guidelines address important gaps for IPC implementation within the clinical and programmatic management of TB (see the Summary of changes table below). These revised guidelines also bring together existing World Health Organization (WHO) recommendations in the context of the overall framework of IPC programmes. Hence, this document incorporates the recommendations from Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level, published by WHO in 2016 (13). The initial development of those core components resulted from requests for support from Member States for strengthening of overall IPC capacity, to achieve resilient health systems, both at the national and at the facility level. Their inclusion in this document provides the basis for adopting specific components that are crucial for the effective functioning of IPC across health care programmes.
¹ TB deaths among HIV-positive patients are classified as HIV in the international classification of diseases system (ICD-10).