Tuberculosis Risk and Prevention in Travelers-What about BCG?

Tuberculosis (TB) is one of the most important health problems in many tropical and developing countries, particularly since the advent of the human immuno- deficiency virus (HIV) epidemic. The level of TB transmission is much greater in these countries than in most of western Europe or North America. For example, the annual risk of infection with Mycobacterium tuberculosis is estimated to be 300 times higher in some subSaharan African countries1 than in the Netherlands.2 Travel guidelines and advice vary widely in the emphasis placed on TB and on specific recommendations for prevention. American sources generally advise that use of the bacille Calmette-Guérin (BCG) vaccine in travelers be limited to exceptional circumstances3 while some European authorities advocate broader use.4-6 This article reviews the risk of TB in travelers and possible approaches to its prevention, including the use of BCG vaccination.