Tuberculosis Prevention and Control

Tuberculosis (TB) is caused by the bacterium Mycobacterium tuberculosis and most commonly manifests as a respiratory illness. Symptoms can include a cough lasting three weeks or longer, coughing up blood or sputum, night sweats, weakness or fatigue, fever, chills, weight loss, and loss of appetite. TB is a significant public health concern for Navy and Marine Corps personnel. Sailors and Marines commonly operate in areas of the world where there is a high prevalence of TB infection, and close working/living quarters in shipboard and other military environments increase the risk of spreading TB.

Tuberculosis in Department of Navy Beneficiaries: 2018 Report (NMCPHC): NMCPHC tracks TB trends to better understand the impact in Navy and Marine Corps personnel. This report summarizes active TB cases from 2005 to 2017 among DON beneficiaries, including active duty service members, recruits, retirees, and their family members.

• Information for Preventive Medicine Departments
• Information for Healthcare Providers
• Information for Navy and Marine Corps Personnel and Their Families

Information for Preventive Medicine Departments

The Navy’s TB control program, as outlined in BUMEDINST 6224.8C, is based on prevention of active TB disease through early detection and complete treatment of latent TB infection (LTBI). LTBI screening should be conducted at accession and in the following situations: personnel embarking on a commissioned vessel, during the Periodic Health Assessment (PHA), as directed by combatant commanders, as part of a contact or outbreak investigation, if clinically indicated based on history or physical, or as recommended by the cognizant NEPMU.

Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection (CDC): Updated guidelines for targeted tuberculin testing and treatment regimens for persons with LTBI.

Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection - United States, 2010 (CDC): Provides guidance to public health personnel, healthcare providers, and laboratory workers for the use of IGRAs in diagnosing TB infection. FDA-approved IGRAs include the QuantiFERON-TB Gold (QFT), the QuantiFERON-TB Gold Plus (QFT-Plus), and the T-SPOT.TB (T-SPOT).

Pulmonary tuberculosis is a reportable event as defined in the Armed Forces Medical Event Guidelines. Furthermore, TB cases should be reported within 24 hours of identification, per BUMEDINST 6220.12C and NMCPHC-TM 6220.12: Medical Surveillance and Reporting. Navy and Marine Corps units providing patient care should report probable and confirmed cases of TB via Disease Reporting System-internet (DRSi). The report should include travel/deployment history, history of exposure to a confirmed or suspected TB case, potential occupational exposures, evidence of multidrug resistance (if present), and history of tuberculosis vaccine (BCG). Note: LTBI cases without evidence of active disease are not reportable.

Medical Event Reporting (NMCPHC): Policy and guidance for medical event reporting in the Navy and Marine Corps.

DRSi Webpage (NMCPHC): Request an account for the Disease Reporting System internet (DRSi) and access training resources.

Notification of the cognizant NEPMU is required upon discovery of a suspected or confirmed case of active tuberculosis in a service member and upon initiating a contact investigation.

Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis (CDC): Guidelines for investigation of TB exposure and transmission, and prevention of future cases of TB through contact investigations.

TB Contact Investigation Forms:

• NAVMED 6224/7: Initial Tuberculosis Exposure Risk Assessment
• NAVMED 6224/8: Tuberculosis Exposure Risk Assessment
• NAVMED 6224/9: Monthly Evaluation for Patients Receiving Treatment for Latent Tuberculosis Infection

NMCPHC hosts monthly disease surveillance trainings on the last Tuesday of every month that are designed to provide refresher training to local public health staff. Past trainings include “Tuberculosis Contact Investigations” and “Tuberculosis Control Principles.” Contact the DRSi helpdesk for more information, or visit the Monthly Disease Surveillance Training page for the archived training directory.

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Information for Healthcare Providers

Sailors and Marines have the potential to be exposed to people with active TB disease throughout their service. Additionally, specific military living and working environments (e.g., shipboard, training) may have limited air circulation, potentially promoting the spread of TB disease if an active TB patient is present. Navy Medical Departments are key to controlling the spread of tuberculosis in that they work to:

• Promptly detect, treat, and report persons with clinically active TB
• Protect persons in close contact with patients diagnosed with infectious TB
• Prevent TB disease in military personnel and other beneficiaries through targeted testing and effective treatment for LTBI

Navy Medical Department personnel employ a multi-faceted TB control program as described in BUMEDINST 6224.8C that includes screening for personnel who may have been exposed to someone with active TB disease, testing those who screen positive to identify whether the potentially exposed person has LTBI, tracking the treatment of persons with LTBI to completion, early detection and respiratory isolation of persons with active TB disease, and prompt and thorough protection of those persons who may have been exposed to an identified active TB case.

Notification of the cognizant NEPMU is required upon discovery of a suspected or confirmed case of active tuberculosis in a service member and upon initiating a contact investigation.

Latent Tuberculosis Infection: A Guide for Primary Healthcare Providers (CDC): Guidelines for healthcare providers for the screening, diagnosis, and treatment of latent TB infection.

Updated Guidelines for Using Interferon Gamma Release Assays to Detect Mycobacterium tuberculosis Infection - United States, 2010 (CDC): Provides guidance to public health personnel, healthcare providers, and laboratory workers for the use of IGRAs in diagnosing TB infection. FDA-approved IGRAs include the QuantiFERON-TB Gold (QFT), the QuantiFERON-TB Gold Plus (QFT-Plus), and the T-SPOT.TB (T-SPOT).

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Being a Sailor or Marine is not in itself a risk factor for tuberculosis. However, situations imposed by military service may present an increased risk for infection. Sailors and Marines frequently deploy to areas where there is a high prevalence of TB infection, and close working/living quarters can provide an ideal environment for TB to spread effectively and rapidly. Due to this, the Navy has implemented a TB control program to institute measures to significantly reduce the chance of a TB infection spreading to others, should one occur.

Part of this strategy includes TB screening and laboratory testing procedures. Identifying persons with LTBI and providing treatment can reduce the risk for both active disease and subsequent transmission. All Sailors and Marines are laboratory tested for LTBI upon accession. This could be done either using a tuberculin skin test (TST) or a blood test (IGRA). The TST requires the screened individual to return within 48-72 hours for the test to be interpreted, or “read.” These tests only determine whether a person is infected with TB and do not tell whether the person has LTBI or active TB. If one of these tests is positive, additional testing is done to determine whether the person has active TB.

Following accession, screening for tuberculosis risk is then conducted through the Periodic Health Assessment (PHA) which includes questions to evaluate TB risk. Individuals who screen as being at risk for acquiring TB are then tested for TB using the TST or IGRA. TB screening and testing can be performed in other situations, such as:

• Prior to or within 6 months of arriving on a commissioned vessel
• As directed by combatant commanders
• As part of a contact or outbreak investigation
• If clinically indicated by a healthcare provider based on history or physical, or as recommended by the cognizant NEPMU

If a TB case is identified, a contact investigation will be initiated. Exposed service members may be tested (given a TST) and, if positive, may be given treatment for LTBI to prevent active disease and to prevent further TB transmission to others.

Questions and Answers About TB (CDC): Information on the diagnosis and treatment of TB, written for persons without a medical background.

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