The most effective way to mitigate TB transmission and activation is to identify and treat LTBI. That is a compelling argument for testing all military personnel for TB before and after every deployment. Table 5.8 summarizes the policies of each branch of the military regarding TSTs and treatment for LTBI.
Available data suggest that prior M. tuberculosis infection and exposure in the theater of operations contribute about equally to the prevalence of LTBI and the risk of disease among US military personnel. The Department of Defense (DOD) estimates that 2.5% of military personnel deployed to southwest and south-central Asia during OEF and OIF acquired new M. tuberculosis infections during deployments (Kilpatrick 2005). In comparison, the prevalence of TST reactivity among young adults entering the Navy in 1997 and 1998 was 3.5% (Smith et al. 2002); among military police who participated in refugee and humanitarian operations in Guantanamo Bay in 1995, it was 3.7% (Kortepeter and Krauss 2001). No case of active TB has been recognized in troops deployed to the Persian Gulf during Operation Desert Shield or Operation Desert Storm (Hyams et al. 1995).