title: Tuberculosis among nonimmigrant visitors to US Military installations.
abstract: BACKGROUND
  Nonimmigrant visitors are not required to be evaluated for tuberculosis (TB) before entering the country. Little literature exists describing the challenges of TB control among this demographic. This report reviews the challenges in managing TB in this population on U.S. military installations.
  
  
  METHODS
  Six cases were identified from reportable medical event reports. Information was obtained from public health personnel via phone interviews. Verified cases from 2004 to 2011 were included.
  
  
  RESULTS
  Challenges were congruent among locations including: lack of procedures to screen for infection and disease among individuals at time of entry allowing one case to be admitted with acquired immunodeficiency syndrome and another concurrently on treatment for active TB; delays in the diagnosis of active TB as median time from entry to diagnosis was 62 days; and the need to conduct an effective contact investigation as the mean contact index was 77 including 1 secondary case of active TB.
  
  
  CONCLUSIONS
  These cases emphasize the need for screening for TB in visitors from high-risk countries at time of entry, prompt diagnosis and treatment if found, procedures for evaluation of contacts, and interjurisdictional cooperation in large contact investigations. These challenges are common to nonimmigrants in both military and civilian settings.
authors.affiliation: Preventive Medicine Branch, Walter Reed Army Institute of Research, 2460 Linden Lane, Bldg 509, Office 110, Silver Spring, MD 20910, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Aaron
authors.forename: Meletios J
authors.initials: MJ
authors.lastname: Fotinos
authors.forename: Kevin B
authors.initials: KB
authors.lastname: West
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Goodwin
authors.forename: James D
authors.initials: JD
authors.lastname: Mancuso
mesh_terms: D016358:Contact Tracing / Q000379:methods*; D006801:Humans; D008297:Male; D008889:Military Personnel; D014195:Travel; D014376:Tuberculosis / Q000175:diagnosis / Q000208:ethnology*; D014481:United States / Q000453:epidemiology