Chapter 5: Health staff roles and responsibilities, recording and reporting and BCG vaccination.

A range of different care providers with varying levels of expertise and experience, including primary care staff, general clinicians, and paediatricians, may be involved in managing children with tuberculosis (TB). Clarifying the roles and responsibilities of health care staff for the diagnosis, treatment and prevention of TB in children is important. Roles and responsibilities depend on the relevant level of the health care system (primary, first referral and second referral). All providers of TB care should manage TB patients in conjunction with the National Tuberculosis Programme (NTP). A key aspect of the overall approach to managing children with TB is that they should always be included in the routine NTP recording and reporting system. This means notifying all identified TB cases in children to the NTP, registering them for treatment and recording their treatment outcome. The WHO Expanded Programme on Immunization (EPI) recommends BCG vaccination as soon as possible after birth in countries with a high TB prevalence. Although there have been several reports of disseminated BCG infection in HIV-infected individuals, BCG appears to be safe in the vast majority of cases. Therefore, in countries with a high TB prevalence (irrespective of the HIV prevalence), the benefits of BCG vaccination outweigh the risks and the WHO recommends a policy of routine BCG immunisation for all neonates.