TB or Not TB


There’s a health topic that has been buzzing around the São Paulo international mom crowd – whether or not to get our kids (and ourselves) a tuberculosis vaccination.

When we first arrived, my daughter’s pediatrician went through her vaccination data and gave it the thumbs up. Since she spent her first couple years in the U.S. where pediatricians no longer prescribe the vaccination, she had not received a TB shot. And I thought nothing of it.

But as of late, both in the U.S. and in Brazil, there has been a lot of illness in the air. Recently, a friend’s Brazilian doctor told her that she definitely needed to get her two children a tuberculosis vaccination. And one for herself. Hmmm… so what to do?

There is a pretty good argument on both sides.

Pro TB shot:

1. Tuberculosis is a nasty, nasty disease.

2. Treatment is difficult and can take months

3. Like 6 to 9 months.

Anti TB shot:

1. The risks are very low, at least for my child, according to our pediatrician.

2. The shot is very painful.

3. The shot can leave a scar.

4. The vaccination can generate a false positive for TB.

5. In a developed society (which I consider at least São Paulo city proper to be) it seems rather difficult to get TB. Like you’d have to almost try.

According to the Center for Disease Control, TB is spread “through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. People nearby may breathe in these bacteria and become infected.” So you actually have to get close to someone with TB, close enough for the person to sneeze or sing on you, to catch it. The CDC also explains that TB is NOT spread by shaking someone’s hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes or kissing.

Even if the bacteria does get you, the risk for actually acquiring the disease, according to CDC, are high if you:

  • have HIV infection
  • have other health problems, like diabetes, that make it hard for the body to fight bacteria
  • abuse alcohol or uses illegal drugs
  • were not treated correctly for TB infection in the past

Treatment for latent TB, which means you’ve been exposed to the bacteria but not the disease, is actually optional. In the U.S., it is mostly used to control the spread of the bacteria and in an attempt to eliminate the disease.

However, if you or your child DO acquire the actual TB disease, you’ll wish you’d bothered to get the shot. Treatment lasts six to nine months and involves a lot of pills. If you don’t do it exactly as prescribed, not only might you get sick again, but you could make the bacteria stronger and more resistant. 

The World Health Organization develops a profile for each country with statistics around the disease. The prevalence of TB in Brazil is much higher and the country has a higher TB mortality rate than the U.S. But compared to countries like South Africa or the Philippines, Brazil has it under control.

Today, we had a visit with my daughter’s pediatrician. He reiterated his opinion that she was low risk and the vaccination wasn’t necessary. As I trust him, I’ll go with his view.

But what about you?

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34 Responses to TB or Not TB

  1. I’m n American born in Brazil.. I’m 20 years old and I’ve never had the shot or TB haha.

  2. Hmmmm…what about you BAB? Did you get the shot?

    I interact with so many people, but since none of them sing on me I guess I’m OK. 🙂

    On the other hand, after reading “Mountains Beyond Mountains” TB scared the bejeesus out of me! And the WHO protocol for treatment is often lacking.

  3. That is a good question – I have to ask my mother. But I’m pretty sure I didn’t. I’ll let you know. I hadn’t heard of the book – looks interesting, going to take a look! Thanks!

  4. Andrew Francis says:

    In my opinion vaccines are as close as you can get a free lunch: almost guaranteed protection with almost no negative effects. We opted to give our little one the TB shot. It’s optional in the UK but we go to Brazil on a regular basis and who knows where else she might end up when she gets older.

  5. Caio says:

    The subject of tuberculosis is indeed confusing. Allow me to try to dispel some of the confusion (disclaimer: I have a medical degree from Universidade Estadual de Campinas and will begin my residency in Nuclear Medicine in March):

    The TB shot is a controversial subject. In many countries; it is mandatory for infants at birth, like here. It does NOT prevent the infection from the bacteria or even the development of the disease. What it does is prevent severe forms of the disease, such as meningitis, kidney and bone infection. It’s effect only last throughout infancy and early childhood, usually 2 to 5 years. Numerous studies have shown it has NO effect in older children, adolescents and adults, so BAB, you and your friends need not worry, nor does your daughter. In fact, the United States and the Netherlands are the only two countries in the world to never have used this vaccine consistently, due to its dubious efficacy; even when the prevalence of TB was high there.

    The tuberculin test (TB skin test) cannot tell the difference between past infection and present infection, which is why the treatment of latent TB is optional. The vaccine’s influence on the test varies between individuals. We only consider it a possibility in the first 2 years after the vaccine, however some people maintain a strong reaction for life. The CDC has recently approved a blood test called QUANTIFERON™GOLD, which can tell the difference between the vaccine reaction and the actual infection.

    Only people with active tuberculosis can transmit it, those with the latent form cannot. People considered at risk for infection are “close contacts” of active cases. The medical definition of that is one who shares the same enclosed space (work or home) with an active, untreated case for at least 200 (non-consecutive) hours.

    Of all the people infected with the bacteria only 10% will develop the disease. The other 90% will either have the latent form or destroy the bacteria. In any case, the greater risk of developing the disease arises not from the bacteria itself, but from factors which damage the immune system, such as HIV or poor living conditions and malnutrition. It bears to remember TB has a marked preference for low income populations. Therefore, living a healthy lifestyle is the real key. That’s why first world countries without the vaccine (US, Europe, Australia) maintain a low prevalence of TB, and countries with widespread immunization and a large segment of the population below the poverty line like Brazil have not yet erradicated TB.

    I hope to have clarified the subject.

  6. Erin Halm says:

    Both my kids got the vaccine here in Brazil at the recommendation of our family doctor. I haven´t gotten it, but I should. Seriously, who wants TB?

  7. Ray says:

    The pro TB shot arguments totally won me. I would get it on me and the child.
    As it was well pointed out on another comment, who knows where you might end up, not to mention that all it takes is a person who has been exposed to TB in God knows where might bring it to you or your daughter.

    Good post BAB



  8. scrubgrub says:

    We didn’t do it for our son, and I still stand by that idea. My father, much later in life, had to go through the whole rigors of some pretty strong TB medicine as a “precaution” because he showed as “possibly having TB” and they had to make sure he didn’t have it at all. It’s great they can discern now, but seriously it’s a pain to be “positive” your whole life. I think if you weren’t living in Sao Paulo, and your daughter was still very small, then maybe consider it. But she’s older and less susceptible to getting a seriously dangerous form of TB, you are in Sao Paulo and not letting many sick people come up and kiss your adorable daughter right? 😉

  9. scrubgrub says:

    They are good, my husband is actually flying back from a trip to Brazil over the past week. And I’ve met quite the community of Brazilians right here, so kind of best of both worlds. scrubgrub.wordpress.com is my US blog.

  10. Leisa says:

    Thank you, thank you for sharing such important information. I would seriously consider, along with my pediatrician and move forward with a TB shot. For me, the reasons to do it far outweigh reasons not to.

  11. Samia says:

    It’s a complicated topic. I’d get the shot. Being born and raised in Brazil I’ve gotten all the vaccines under the sun, so maybe I’m biased, but I’d rather prevent something that’s preventable than risk it.
    Speaking of TB alone, I learned a couple of months ago that the baby, now 5-year-old, who I took care of in Chicago was diagnosed with TB, and is now undergoing 9 months of treatment. They don’t know how he got the bacteria, nobody else in his family has it. I was surprised by the diagnosis because I honestly thought TB was extinct, at least in certain areas. So, I think it’s worth the shot (serious, pun not intended).

  12. expatlingo says:

    Just one more data point: we’ve lived in mainland China and are now in Hong Kong and both of my (young) kids have had the TB vaccination. My oldest had her shot when she was only a baby and the dr put in in the side of her foot (so she’d have a scar there rather than her upper arm). My youngest had his at 18 months (when we moved back to Asia) and got it in the upper arm (the blister that develops for a few months would have interfered with his shoe-wearing).

  13. Marina Wildhagen says:

    I’m a Brazilian living in The Netherlands and my child was born in Brazil. We both got the shot, my baby was only two days old when she has gotten hers and she cried for maybe one minute. Her mark is also not bad at all and mine neither. And something curious for you to know, foreigners that move to Holland from a country where TB has been active need to go for two years (every 6 months) to check if they don’t have TB. I had to do that. The only funny thing is that if you’re a Dutch person born in Brazil, or if you’ve lived a long time in Brazil, they don’t ask you to take the tests. Weird, right? Anyway, I’m completely in favor of any type of vaccination as you never know what can happen or where you’re going to end up. I’d go for it if I were you. 😉

    • Thanks! That is really interesting. It’s funny, they wouldn’t allow my Brazilian husband to give blood when he first arrived to go to school. As if he’d been living in the Amazon. Countries are funny.

  14. Corinne Rodrigues says:

    My son was born in Brazil and had the shot, which as Caio points out is not technically a TB vaccine, it protects against serious forms of the disease. Well, we are in Texas on my sabbatical and to register my kid for school he needed a skin test because he lives where there is a prevalence of TB. The fact he had the BVG vaccine was irrelevant. His skin test was positive (which is common with those who had the vaccine) and so he needed to have a chest X-ray to rule out active TB. He was cleared of course and thankfully all of it was free. However, in the future he cannot have a skin test for TB because he has already had one. In short, I found that in the US, having this vaccine was a pain in the butt. However, I do not regret my decision to have my kid vaccinated. We are in Brazil for the long term and one never knows where you will end up. My general opinion about vaccines is better safe than sorry.

  15. skarrlette says:

    Don’t quote me on this, but I think its immune suppressed individuals, old people and infants who have to really worry about TB. Not regular healthy adults and children. Its more of a issue with people that have some underlying immune or other disease.. The tropical medicine specialist I saw said not to bother now that my daughter is 15 months. When I went to him to find and get the recommended vaccinations for Brazil TB was not recommended to me.

  16. N says:

    My three sons,born in Canada, had the shot a few months ago when we arrived here. We live in Rondônia, so I think all vaccines are highly recommended. I was born in Argentina and got the shot as a baby and I believe my husband (from SP) too. We’ve traveled and lived in many places, being exposed to countless viruses too, I guess, so we think best to be immunized rather than have to get treated against a nasty sickness.

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