[Evaluation of clinical practice in pulmonology: tuberculosis]

The management of patients affected by tuberculosis raises issues including epidemiology, the identification and treatment of disease or infection, infection control measures, BCG vaccination and national and international strategies against the disease.

BCG vaccination is controversial because of its undesirable effects and the conflicting evidence from trials. It provides partial but undeniable protection; 50% against all forms and 80% against the most severe forms, particularly in children. Vaccination strategies (generalised, selective or not at all) provide different cost/benefits depending on the population involved and its prior vaccination history. This variation in response does not outweigh the ethical and pragmatic considerations underlying the current approach of universal vaccination. The directly observed therapy, short course (DOTS) strategy has been well evaluated notwithstanding the huge potential scope of its global implementation.

A more effective vaccine is one of the possible solutions for eliminating tuberculosis. DOTS could be usefully implemented in France as part of a strategy to eliminate the disease.

BCG vaccination and elements of DOTS are effective interventions for the management of TB.