• 1.

    Mancuso JD, Aaron CL, 2013. Tuberculosis trends in the U.S. Armed Forces, active component, 1998–2012. MSMR 20: 48.

  • 2.

    Office of the Under Secretary for Personnel and Readiness, 2010. Department of Defense Instruction NUMBER 6130.03: Medical Standards for Appointment, Enlistment, or Induction in the Military Services. Washington, DC: Department of Defense.

    • Search Google Scholar
    • Export Citation
  • 3.

    Mancuso JD, Tribble D, Mazurek GH, Li Y, Olsen C, Aronson NE, Geiter L, Goodwin D, Keep LW, 2011. Impact of targeted testing for latent tuberculosis infection using commercially available diagnostics. Clin Infect Dis 53: 234244.

    • Search Google Scholar
    • Export Citation
  • 4.

    Houk VH, Kent DC, Baker JH, Sorensen K, Hanzel GD, 1968. The Byrd study. In-depth analysis of a micro-outbreak of tuberculosis in a closed environment. Arch Environ Health 16: 46.

    • Search Google Scholar
    • Export Citation
  • 5.

    Lamar JE 2nd, Malakooti MA, 2003. Tuberculosis outbreak investigation of a U.S. Navy amphibious ship crew and the Marine expeditionary unit aboard, 1998. Mil Med 168: 523527.

    • Search Google Scholar
    • Export Citation
  • 6.

    Mancuso JD, Tobler SK, Eick AA, Keep LW, 2010. Active tuberculosis and recent overseas deployment in the U.S. military. Am J Prev Med 39: 157163.

    • Search Google Scholar
    • Export Citation
  • 7.

    Cobelens FG, van Deutekom H, Draayer-Jansen IW, Schepp-Beelen AC, van Gerven PJ, van Kessel RP, Mensen ME, 2000. Risk of infection with Mycobacterium tuberculosis in travellers to areas of high tuberculosis endemicity. Lancet 356: 461465.

    • Search Google Scholar
    • Export Citation
  • 8.

    Freeman RJ, Mancuso JD, Riddle MS, Keep LW, 2010. Systematic review and meta-analysis of TST conversion risk in deployed military and long-term civilian travelers. J Travel Med 17: 233242.

    • Search Google Scholar
    • Export Citation
  • 9.

    Mancuso JD, Tobler SK, Keep LW, 2008. Pseudoepidemics of tuberculin skin test conversions in the U.S. Army after recent deployments. Am J Respir Crit Care Med 177: 12851289.

    • Search Google Scholar
    • Export Citation
  • 10.

    Office of the Surgeon General, 2003. The Army Latent Tuberculosis Infection (LTBI) Surveillance and Control Program. Falls Church, VA: Department of the Army.

    • Search Google Scholar
    • Export Citation
  • 11.

    Office of the Surgeon General, 2008. Supplemental Guidance for the Army Latent Tuberculosis Infection (LTBI) Surveillance and Control Program. Falls Church, VA: Department of the Army.

    • Search Google Scholar
    • Export Citation
  • 12.

    Mancuso JD, Mazurek GH, Tribble D, Olsen C, Aroson NE, Geiter L, Goodwin D, Keep LW, 2012. Discordance among commercially available diagnostics for latent tuberculosis infection. Am J Respir Crit Care Med 185: 427434.

    • Search Google Scholar
    • Export Citation
  • 13.

    Bennett DE, Courval JM, Onorato I, Agerton T, Gibson JD, Lambert L, Mcquillan GM, Lewis B, Navin TR, Castro KG, 2008. Prevalence of tuberculosis infection in the United States population: the national health and nutrition examination survey, 1999–2000. Am J Respir Crit Care Med 177: 348355.

    • Search Google Scholar
    • Export Citation
  • 14.

    Diagnostic Standards and Classification of Tuberculosis in Adults and Children, 2000. This official statement of the American Thoracic Society and the Centers for Disease Control and Prevention was adopted by the ATS Board of Directors, July 1999. This statement was endorsed by the Council of the Infectious Disease Society of America, September 1999. Am J Respir Crit Care Med 161: 13761395.

    • Search Google Scholar
    • Export Citation
  • 15.

    Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K, 2010. Updated guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection—United States, 2010. MMWR Recomm Rep 59 (RR-5): 125.

    • Search Google Scholar
    • Export Citation
  • 16.

    Jung P, Banks RH, 2008. Tuberculosis risk in US Peace Corps Volunteers, 1996 to 2005. J Travel Med 15: 8794.

  • 17.

    Kortepeter MG, Krauss MR, 2001. Tuberculosis infection after humanitarian assistance, Guantanamo Bay, 1995. Mil Med 166: 116120.

  • 18.

    Emmons EE, Ljaamo SK, 1999. Active tuberculosis in a deployed field hospital. Mil Med 164: 289292.

  • 19.

    Aaron CL, Mancuso JD, 2014. Development and implementation of a cohort review for latent tuberculosis infection. MSMR 21: 27.

  • 20.

    Long E, 1955. Tuberculosis in the Army of the United States in World War II; An Epidemiological Study with an Evaluation of X-ray Screening. Washington, DC: U.S. Government Printing Office.

    • Search Google Scholar
    • Export Citation
  • 21.

    Centers for Disease Control and Prevention, 2006. Prevention and control of tuberculosis in correctional and detention facilities: recommendations from CDC. Endorsed by the Advisory Council for the Elimination of Tuberculosis, the National Commission on Correctional Health Care, and the American Correctional Association. MMWR Recomm Rep 55 (RR-9): 144.

    • Search Google Scholar
    • Export Citation
  • 22.

    Centers for Disease Control and Prevention, 2000. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep 49 (RR-6): 151.

    • Search Google Scholar
    • Export Citation
  • 23.

    Assistant Secretary of Defense for Health Affairs, 2012. Guideline for Tuberculosis Screening and Testing. Washington, DC: Department of Defense.

    • Search Google Scholar
    • Export Citation
  • 24.

    United States Army Medical Command, 2013. MEDCOM Regulation 40-64: The Tuberculosis Surveillance and Control Program. Department of the Army. Joint Base San Antonio, Fort Sam Houston, TX. Available at: http://www.pdhealth.mil/tuberculosis.asp. Accessed September 8, 2015.

    • Search Google Scholar
    • Export Citation
  • 25.

    Centers for Disease Control and Prevention, 2012. Mantoux Tuberculin Skin Testing Products. Available at: http://www.cdc.gov/TB/education/Mantoux/default.htm. Accessed October 18, 2014.

    • Search Google Scholar
    • Export Citation
  • 26.

    Jensen PA, Lambert LA, Iademarco MF, Ridzon R, 2005. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 54 (RR-17): 1141.

    • Search Google Scholar
    • Export Citation
  • 27.

    Division of Tuberculosis Elimination, 2013. Core Curriculum on Tuberculosis, 6th edition. Atlanta, GA: Centers for Disease Control and Prevention.

    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 173 108 2
PDF Downloads 38 28 0
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

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

View More View Less
  • 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
Restricted access

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.

Save