An Evaluation of the Latent Tuberculosis Control Program in the United States Military at Accession
Abstract
Although the Centers for Disease Control and Prevention (CDC) recommend targeted testing for latent tuberculosis infection (LTBI), the military has continued universal testing for all recruits. Furthermore, it has been suggested that the interferon-gamma release assays (IGRAs) may be more specific and cost-effective than the tuberculin skintest (TST). This dissertation examines the impact of proposed changes in screening policy at accession, including both targeted testing and the use of IGRAs for screening. The epidemiology of tuberculosis TB in the US military is similar to the general population with an incidence that is low and declining. Risk factors for developing activeTB are similar to the general US population. Therefore, effective screening and treatment at time of accession is a critical element of the militarys TB control program. Targeted testing was evaluated in US Army recruits at Fort Jackson using a questionnaire, the TST, both commercially-available IGRAs. Prediction models were developed which demonstrated that targeted testing based on presence of four risk factors could eliminate 91% of testing with a sensitivity of 79% and specificity of 92%.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 15, 2010
- Accession Number
- AD1013417
Entities
People
- James D. Mancuso
Organizations
- Uniformed Services University of the Health Sciences