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This message is posted with the originator's permission. R 111932Z JUL 07 ZUI ASN-A00192000021 ZYB FM COMDT COGARD WASHINGTON DC//CG-11// TO ALCOAST BT 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. BT
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