Pros and Cons of TB Surveillance Strategies for Military Service Personnel

Military risk factors for tuberculosis (TB) infection may be living in crowded confined quarters and deployment to areas which are highly endemic of TB. Soldiers may come in direct contact with the civilian population of the host nation, for example during patrols, in the course of medical aid or in the camp, where they encounter hundreds of civilian employees. TB prevention in occupational risk groups is a measure of occupational protection which can be derived as an employer´s duty from Article 15 of the German Biological Material Regulation. The primary goal of a TB prevention strategy in the military population is to prevent active tuberculosis in military service personnel and to avoid secondary infection in contact persons. A meaningful strategy to this end may be the detection of early TB infection in situations of exposure and treatment of detected cases. Early TB infections can be detected by conversion of a suitable screening test applied before and after deployment (serial testing). Essentially, there are two choices for this purpose, TST (Tuberculin Skin Test) or IGRA (Interferon-y Release Test). IGRA has decisive advantages in terms of higher specificity. It is fully automatable, as far as it concerns the Quantiferon® test, and it is a one-visit-procedure. The pros and cons of various screening strategies have been discussed on the expert meeting „Tuberculosis Surveillance in the Military“ held at Koblenz on 5th July 2007. This meeting has resulted in a consensus recommendation which is published at the end of this article.