R 111932Z JUL 07 ZUI ASN-A00192000021 ZYB
FM COMDT COGARD WASHINGTON DC//CG-11//
TO ALCOAST
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UNCLAS //N06300//
ALCOAST 334/07
COMDTNOTE 6300
SUBJ: TUBERCULOSIS AWARENESS AND PREVENTION FOR COAST GUARD
PERSONNEL
A. MEDICAL MANUAL, COMDTINST M6000.1 (SERIES)
B. PUBLIC HEALTH AND DISEASE CONCERNS RELATED TO COAST GUARD
OPERATIONS, COMDTINST 6220.9A
C. COAST GUARD RESPONSE TO QUARANTINABLE COMMUNICABLE DISEASE
OUTBREAKS OF OPERATIONAL SIGNIFICANCE, COMDTINST 6220.11 (FOUO)
1. RECENT MEDIA EVENTS HAVE FOCUSED ON MULTI-DRUG RESISTANT
TUBERCULOSIS (MDR-TB) AND EXTENSIVELY MULTI-DRUG RESISTANT
TUBERCULOSIS (XDR-TB).  MDR-TB AND XDR-TB ARE SPECIFIC FORMS OF
TUBERCULOSIS (TB) THAT ARE RESISTANT TO CERTAIN TB DRUGS.  THERE IS
NO DIFFERENCE BETWEEN THE SPEED OF TRANSMISSION OF MDR-TB, XDR-TB
AND ANY OTHER TYPE OF TB.
2.  TRANSMISSION OF TB GENERALLY REQUIRES PROLONGED INTIMATE
CONTACT IN ENCLOSED SPACES WITH AN INFECTIOUS PERSON.  THE SPREAD
OF TB BACTERIA DEPENDS ON SEVERAL FACTORS INCLUDING THE NUMBER AND
CONCENTRATION OF POTENTIALLY INFECTIOUS PEOPLE IN ANY ONE SPACE.
THE RISK OF BECOMING INFECTED INCREASES WITH TIME SPENT IN THE SAME
SPACES AS THE INFECTIOUS CASE.  THE RISK OF SPREAD INCREASES WHERE
THERE IS A HIGH CONCENTRATION OF TB BACTERIA, WHICH CAN OCCUR IN
CLOSED ENVIRONMENTS LIKE OVERCROWDED HOUSES, HOSPITALS OR PRISONS.
THE RISK WILL BE FURTHER INCREASED IF VENTILATION IS POOR.
3. IN VIRTUALLY ALL TACTICAL SITUATIONS ENCOUNTERED BY COAST GUARD
PERSONNEL, TB IS NOT EASILY TRANSMITTED.  COAST GUARD ENCOUNTERS
WITH POTENTIALLY INFECTED PERSONS ARE GENERALLY EITHER IN OPEN AIR,
OR FOR TIME PERIODS TOO SHORT OR AT A DISTANCE TOO FAR TO MAKE
TRANSMISSION LIKELY. BASED ON THE CENTERS FOR DISEASE CONTROL AND
PREVENTION GUIDANCE, COAST GUARD PERSONNEL IN THESE OPERATIONS ARE
CONSIDERED TO BE AT LOW RISK FOR INFECTION WITH TB.  NO CASES OF
ACTIVE TB DISEASE HAVE BEEN REPORTED IN COAST GUARD PERSONNEL SINCE
1994, EVEN WITH AMIO ACTIVITIES INVOLVING COAST GUARD CUTTERS AND
SMALL BOATS.  ALTHOUGH THERE HAVE BEEN COAST GUARD PERSONNEL WHO
HAVE HAD A REACTIVE TUBERCULIN SKIN TEST (TST), MANY OF THESE TESTS
WERE FALSELY POSITIVE BECAUSE THE TST DOES NOT DETECT TRUE
NEGATIVES ACCURATELY IN A LOW RISK ENVIRONMENT.
4.  A POSITIVE TB TEST IN A LOW RISK PERSON IS MOST LIKELY A FALSE
POSITIVE.  HOWEVER ALL PERSONS WITH A POSITIVE TB TEST MUST BE
TREATED WITH MEDICATION.  ALTHOUGH RELATIVELY SAFE THIS MEDICATION
CAN CAUSE LIVER FAILURE AND POTENTIAL DEATH.  THEREFORE TB TESTS
SHOULD ONLY BE PERFORMED IN PERSONS WITH SIGNIFICANT RISK FACTORS.
DUE TO THE LOW RISK IN COAST GUARD OPERATIONS AND IN ACCORDANCE
WITH REFERENCE "A", PERIODIC SCREENING FOR TB VIA THE TST IS NO
LONGER PERFORMED, BUT MAY BE PERFORMED ON A CASE BY CASE BASIS.
5.  REFS "B" AND "C" DESCRIBE APPROPRIATE FORCE HEALTH PROTECTION
MEASURES FOR COAST GUARD PERSONNEL AGAINST TB AND OTHER
COMMUNICABLE DISEASES.  IN ORDER TO REDUCE OR ELIMINATE EXPOSURE TO
A COMMUNICABLE DISEASE SUCH AS TB, COAST GUARD PERSONNEL SHOULD
UTILIZE APPROPRIATE NON-PHARMACOLOGIC COUNTERMEASURES SUCH AS COUGH
AND SNEEZE ETIQUETTE, HAND HYGIENE, SURFACE
DISINFECTION/DECONTAMINATION AND PERSONAL PROTECTIVE EQUIPMENT AS
DESCRIBED IN THESE REFERENCES.
6.  FOR QUESTIONS CONCERNING TB PLEASE CONTACT CDR
DANA.L.THOMAS(AT)USCG.MIL, 202-475-5212 OR
LCDR ERICA.G.SCHWARTZ(AT)USCG.MIL, 202-475-5172.
7.  INTERNET RELEASE IS AUTHORIZED.
8.  RADM MARK TEDESCO, DIRECTOR OF HEALTH AND SAFETY SENDS.
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