Challenges in Obtaining Estimates of the Risk of Tuberculosis Infection During Overseas Deployment

James D. Mancuso Division of Tropical Public Health, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Office of Student Affairs, Harvard Medical School, Boston, Massachusetts

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Mia Geurts Division of Tropical Public Health, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Office of Student Affairs, Harvard Medical School, Boston, Massachusetts

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Estimates of the risk of tuberculosis (TB) infection resulting from overseas deployment among U.S. military service members have varied widely, and have been plagued by methodological problems. The purpose of this study was to estimate the incidence of TB infection in the U.S. military resulting from deployment. Three populations were examined: 1) a unit of 2,228 soldiers redeploying from Iraq in 2008, 2) a cohort of 1,978 soldiers followed up over 5 years after basic training at Fort Jackson in 2009, and 3) 6,062 participants in the 2011–2012 National Health and Nutrition Examination Survey (NHANES). The risk of TB infection in the deployed population was low—0.6% (95% confidence interval [CI]: 0.1–2.3%)—and was similar to the non-deployed population. The prevalence of latent TB infection (LTBI) in the U.S. population was not significantly different among deployed and non-deployed veterans and those with no military service. The limitations of these retrospective studies highlight the challenge in obtaining valid estimates of risk using retrospective data and the need for a more definitive study. Similar to civilian long-term travelers, risks for TB infection during deployment are focal in nature, and testing should be targeted to only those at increased risk.

Author Notes

* Address correspondence to James D. Mancuso, Division of Tropical Public Health, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. E-mail: james.mancuso@usuhs.edu

Financial support: The Infectious Disease Clinical Research Program (IDCRP) funded the Fort Jackson portion of this project.

Authors' addresses: James D. Mancuso, Division of Tropical Public Health, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, E-mail: james.mancuso@usuhs.edu. Mia Geurts, Office of Student Affairs, Harvard Medical School, Boston, MA, E-mail: mgeurts@harvard.edu.

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