Tuberc Respir Dis.  2007 Jan;62(1):5-10. 10.4046/trd.2007.62.1.5.

Management of Tuberculosis Outbreak in a Small Military Unit Following the Korean National Guideline

• Ji SH
• Kim HJ
• Choi CM

• KMID: 1518483
• DOI: http://doi.org/10.4046/trd.2007.62.1.5

Abstract

BACKGROUND: Korean national guidelines for examining contacts with active pulmonary tuberculosis (TB) are a tuberculin skin test (TST) and chest radiographs. The treatment of a latent TB infection as performed only in those younger than six years of age who test positive for TST. Although there is a high incidence of active TB in young Korean soldiers, the current national guidelines for controlling contacts with active TB in soldiers are insufficient. This study highlights the problems with the Korean guidelines for controlling a TB outbreak in a small military unit. MATERIAL AND METHODS: In December of 2005, there was a tuberculosis outbreak in a military unit with a total of 464 soldiers in Kyung Gi province. The chest radiographs were taken of all the soldiers, and TST were carried out on 408 candidates.
RESULTS
In the first screening of the chest radiographs, two active TB patients were detected. By August of 2006, four additional cases were detected, making a total of six cases after the outbreak. All the patients showed active pulmonary TB or TB pleuritis. When the results of TST in the close contacts and non-close contacts were compared, there was a significant difference in the absolute size of the induration(9.70 +/-7.50mm vs. 6.26 +/-7.02mm, p<0.001) as well as the ratio of patients showing an induration > 10mm (50.0% vs. 32.0%, p<0.001) and 15mm (33.2% vs. 20.9%, p= 0.005).
CONCLUSION
Although the national guidelines for managing a TB outbreak in a military unit were followed, there were continuous instances of new active TB cases. This highlights the need for new guidelines to prevent the spread of TB.

Keyword

Tuberculosis control; Military; Tuberculin skin test; Preventive chemotherapy

MeSH Terms

Humans
Incidence
Mass Screening
Military Personnel*
Pleurisy
Radiography, Thoracic
Skin Tests
Tuberculin
Tuberculosis*
Tuberculosis, Pulmonary
Tuberculin

Reference

1. Guidelines for the control of tuberculosis, 2006. 2006. Korea Centers for Disease Control and Prevention.

2. WHO. International Standards for Tuberculosis Care. 2006. World Health Organization.

3. Shim TS, Koh WJ, Yim JJ, Lew WJ. Diagnosis and treatment of latent tuberculosis infection in korea. Tuberc Respir Dis. 2004. 57:101–108.

4. Annual report on the notified tuberculosis patients in Korea. 2006. Korea Center for Disease Control and Prevention/Korean Institute of Tuberculosis/Korean National Tuberculosis Association.

5. Horsburgh CR Jr. Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med. 2004. 350:2060–2067.

6. DiStasio AJ 2nd, Trump DH. The investigation of a tuberculosis outbreak in the closed environment of a U.S. Navy ship, 1987. Mil Med. 1990. 155:347–351.

7. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med. 2000. 161:S221–S247.

8. Jasmer RM, Nahid P, Hopewell PC. Latent tuberculosis infecion. N Engl J Med. 2002. 347:1860–1866.

9. WHO report: global tuberculosis control surveillance, planning, financing. 2006. World Health Organization.

10. American Thoracic Society. Centers for Disease Control and Prevention. Infectious Diseases Society of America. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: controlling tuberculosis in the United States. Am J Respir Crit Care Med. 2005. 172:1169–1227.

11. Toman's tuberculosis: case detection, treatment, and monitoring. 2004. 2nd ed. World Health Organization.

12. Choi CM, Kang CI, Kim DH, Kim CH, Kim HJ, Lee CH, et al. The role of the TST in the diagnosis of latent tuberculosis infection among military personnel in South Korea. Int J Tuberc Lung Dis. 2006. 10:1342–1346.

13. Lee JY, Shim TS. Diagnosis of mycobacterium tuberculosis infection using ex-vivo interferon-gamma assay. Tuberc Respir Dis. 2006. 60:497–509.

14. Kang CI, Choi CM, Kim DH, Kim CH, Lee DJ, Kim HB, et al. Pulmonary tuberculosis in young Korean soldiers: incidence, drug resistance and treatment outcomes. Int J Tuberc Lung Dis. 2006. 10:970–974.

15. Hong YP, Kim SJ, Lew WJ, Lee EK, Han YC. The seventh nationwide tuberculosis prevalence survey in Korea, 1995. Int J Tuberc Lung Dis. 1998. 2:27–36.