Bumedinst 6224.8B Tuberculosis Control Program (Enclosures 1 And 2)

Front 1

Tuberculosis Testing On Entry Into Naval Services

Back 1

Entry into the military mandates tuberculosis (TB) testing unless otherwise documented. Skin and blood tests are performed to identify individuals with lantent tuberculosis infection (LTBI) caused by "Mycobacterium Tuberculosis" bacteria. Those with history of TB infection must present full medical documentation to include; evaluations, hospitalizations, diegnoses, and treatments.

Front 2

Screening After Receipt of PCS Orders to a Comissioned Vessel

Back 2

All personnel will be screened for LTBI during the Operational Suitability Screening. If positive and using NAVMED 6224/8 for screening should proceed to testing. Screenings and testings should be completed 6 months prior to reporting to a comissioned vessel to be acceptable.

Front 3

LTBI Screening At Times Other Than Entry

Back 3

Active Duty and Reserve personnel while be screened during Periodic Health Assessment (PHA) for LTBI with use of NAVMED 6224/8. CIVMARs are screened or tested for LTBI annually and perform Periodic Physical Examinations per MSC Fleet Surgeon. Tests are only performed in case of risk of TB exposure. Additional screenings may ordered by or for commanders, outbreak investigation, the clinically indicated, and Navy Environmental Preventive Medicine Unit (NAVENPVNTMEDU).

Front 4

Screening for Persons/Units Embarking on a Commissioned Vessel

Back 4

Perform TB screening on all personel prior to or 6 months of arrival.

Front 5

Testing Before Separation From the Navy

Back 5

Not required for separating personal have LTBI 6 months prior to separation.

Front 6

LTBI Testing Guidance
-Tuberculin, Purified Protein Derivative (PPD)-

Back 6

The approved tuberculin skin test material for routine Mantoux test is Tween-80-Stabilized Intermediate Strength PPD. Preferred product is Tubersol from Sanofi Pasteur from Parkedale Pharmaceuticals. If Tubersol unavailable use Aplisol.

Front 7

LTBI Testing Guidance
-Recording Administration-

Back 7

Record Information on...
1. NAVMED 6230/4
2. Adult Immunization Record
3. NAVMED 6230/5
4. Child Immunization Record
Record Electronically in...
1. Armed Forces Health Longitudinal Technology Application (AHLTA)
2. Medical Readiness Reporting System (MRRS)
3. Shipboard Non-Tactical ADP Program (SNAP)
4. Automated Medical System (SAMS)
Include Information...
1. Date Administered
2. Type
3. Strength
4. Manufacturer
5. Lot Number
6. Route

Front 8

LTBI Testing Guidance
-Measurement-

Back 8

PPD must be read in 48 to 72 hours after administration for reaction. Measure TST induration to nearest whole millimeter. If patient returns after 72 hours record as "Not Read" and administer in opposite arm.

Front 9

LTBI Testing Guidance
-Recording Result-

Back 9

Enter TST induration result on NAVMED 6230/4 or 6230/5 then electronically AHLTA, MRRS, or SAMS. If no induration record result as "0 mm" or "zero mm".

Front 10

Blood Assay for M. Tuberculosis (BAMT) Infection

Back 10

1. QuantiFERON-TB Gold (QFT-G) is available as a diagnostic aid for M. tuberculosis infection. Approved to be used in place of TST. A positive QFT-G can be used to evaluate TB before LTBI is diagnosed. A negative QFT-G alone shouldn't exclude M. tuberculosis infection. Record information in medical record. Include blood draw date, specific unit result, concentration of cytokine, and laboratory interpretation.

Front 11

Significant LTBI Conversion Rate

Back 11

Historically through TST results newly-identified LTBI converters is no more than 1 to 2% of Marine Corps and Navy personal. If newly convertors is two times greater than expected baseline conversion rate of the command contact NAVENPVNTMEDU for guidance. If TST is improperly administered or read consider retesting.

Front 12

Special Situations
-Previous Bacillus Calmette Guerin (BCG) Immunization-

Back 12

TST may be administered to those who received BCG. If a positive TST reaction in BCG-immunized occurs regard it as indicative TB infection. Must be evaluated for TB infection prior to receiving treatment for LTBI.

Front 13

Special Situations
-False Negative TST Results-

Back 13

False negatives occur because of specific immunosuppression due to TB infection or disease, general immunosuppression due to immune system compromising conditions or receipt of immunosuppressive medication, or TST administered within a short period of receiving parenteral live-attenuated virus vaccines. TST can be placed the same day as the virus or 4 weeks later.

Front 14

Special Situations
-Pregnancy-

Back 14

TST's are both safe and reliable throughout pregnancy.

Front 15

Special Situations
-TST "Allergy"-

Back 15

If a TST result is consistent with allergic reaction, subsequent TST placement should be deferred until full evaluation by an allergist/immunologist.

Front 16

Special Situations
-Two-Step Procedure-

Back 16

Don't use procedure on recruit, officer accession, or other active duty screenings. Most useful in reducing likelihood of interpreting a boosted response.

Front 17

Special Situations
-Positive TST-

Back 17

Those who are deploying with a positive TST under evaluation should not deploy until completion of evaluation.