Tuberculosis as a force health protection threat to the United States military.
Tuberculosis (TB) is a communicable disease that poses a threat to force health protection to the U.S. military. The rate of TB disease in the military is low; however, there are unique challenges for its control in this setting. As a low-risk population, TB testing in the U.S. military can be scaled back from the universal testing approach used previously. Reactivation of latent TB infection (LTBI) present at accession into service is the most important factor leading to TB disease; therefore, its diagnosis and treatment among recruits should be given a high priority. Deployment and overseas military service is an uncommon but important source of TB infection, and rigorous surveillance should be ensured. Case management of TB disease and LTBI can be improved by the use of cohort reviews at the service and installation levels and case finding and delays in the diagnosis of TB disease can be improved by education of providers, as well as increased use of molecular diagnostic tests. Program outcomes can be improved by making LTBI treatment compulsory, offering shorter treatment regimens, and increasing accountability through oversight and evaluation. The diagnosis of LTBI can be improved by implementing targeted testing in all settings and reducing confirmatory interferon-gamma release assay testing.
Armed Forces Health Surveillance Center (AFHSC) and Cherokee Nation Technology Solutions, Inc., 11800 Tech Road, Suite 220, Silver Spring, MD 20904.
Jose L
JL
Sanchez
Mayo Clinic, Division of General Internal Medicine, 200 First Street SW, Rochester, MN 55905.
Joyce L
JL
Sanchez
Armed Forces Health Surveillance Center (AFHSC), 11800 Tech Road, Suite 220, Silver Spring, MD 20904.
Michael J
MJ
Cooper
Armed Forces Health Surveillance Center (AFHSC), 11800 Tech Road, Suite 220, Silver Spring, MD 20904.
Michelle J
MJ
Hiser
Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
James D
JD
Mancuso
D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods*; D008889:Military Personnel; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016273:Occupational Exposure; D011159:Population Surveillance / Q000379:methods*; D012307:Risk Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014481:United States