BUMEDINST 6224.8B

Question 1

What is the purpose of the TB Control Program?

Answer 1

To provide policy and guidance for controlling tuberculosis (TB) among
Department of the Navy (DON) military personnel and Military Sealift Command (MSC)
civilian mariners (CIVMAR).

Question 2

Name the forms used for medical recording of TB patients.

Answer 2

For medical record and information gathering purposes we provide NAVMED
6224/7, Initial Tuberculosis Exposure Risk Assessment, NAVMED 6224/8, Interim Tuberculosis
Exposure Risk Assessment, and NAVMED 6224/9, Monthly Evaluation for Patients Receiving
Treatment for Latent Tuberculosis Infection.

Question 3

What is the responsibility of the MTFs?

Answer 3

MTFs must continue the annual risk assessment as per CDC and Prevention guidelines or more frequent if there are changes in the TB control program or in the epidemiology of TB.

Question 4

What form is the NAVMED 6224/7 (08-2008)?

Answer 4

Initial Tuberculosis Exposure Risk Assessment

Question 5

What form is the NAVMED 6224/8 (Rev. 03-2011)?

Answer 5

Tuberculosis Exposure Risk Assessment

Question 6

What form is the NAVMED 6224/9 (08-2008)?

Answer 6

Monthly Eval for Patients Receiving Treatment for Latent TB Infections (LTBI).

Question 7

What form is used for the Adult Immunizations Record?

Answer 7

NAVMED 6230/4 (Rev. 10-2007)

Question 8

When should service members begin testing for TB?

Answer 8

TB testing should be started on entry into naval service.

Question 9

Fact of TB?

Answer 9

Personnel diagnosed with Latent TB Infection (LTBI) based on positive skin or blood test and without active disease are not infectious.

Question 10

Individuals with a history of TB, positive Tuberculosis Skin Test (TST), LTBI test or treatment for LTBI must provide what documentation?

Answer 10

Documentation of clinical evals, hospitalizations, diagnoses, and treatments. Copies of pertinent medical records, treatment records, or a physician’s statement on letterhead stationery.

Question 11

What steps should be taken if patient has pertinent medical information about their TB results?

Answer 11

Pertinent information should be transcribed into the medical record.

Question 12

Screening After Receipt of PCS orders to a Commissioned Vessel.

Answer 12

All personnel must be screened for LTBI during operational suitability screening. Screening or testing documented within 6 months prior to reporting aboard a commissioned vessel is acceptable.

Question 13

LTBI Screening At Times Other Than Entry are:

Answer 13

During Periodic Health Assessment (PHA), and individuals answering “yes” to one or more question on the NAVMED 6224/8.

Question 14

How often are Civilian Mariners screened or tested for TB?

Answer 14

CIVMARs will be screened or tested annually during their PHA.

Question 15

T or F: It is no longer required that all personnel have LTBI test results documented within the 6 months prior to sep or retirement?

Answer 15

True

Question 16

What is the approved TST material for the routine Mantoux test?

Answer 16

Tween-80-stabilized intermediate strength PPD (5TU equivalent)

Question 17

What is the preferred product?

Answer 17

Tubersol from Sanofi Pasteur

Question 18

If Tubersol is not available what is the next acceptable product.

Answer 18

Aplisol

Question 19

What information is recorded on the NAVMED 6230/4 and AHLTA?

Answer 19

Date administered, type, strength of tuberculin, manufacturer, lot number, route of administration

Question 20

What time frame must the TST be read within?

Answer 20

48 to 72 hours after PPD administration

Question 21

Measure induration to nearest whole millimeter (mm).

Answer 21

If patient returns after 72 hrs after TST, record results as “Not Read” and apply on opposite forearm

Question 22

If patient doesn’t return at all, enter “Not Read”, patient must be recalled and given another test.

Answer 22

TST test results can be entered into authorized electronic med information systems such as AHLTA, MRRS or SAMS.

Question 23

If there is no induration, record results as “0 mm” or “zero mm”

Answer 23

Another test used if TST test is not available is the QuantifFERON-TB Gold (QFT-G)

Question 24

QFT-G results must be recorded in detail. Date of blood draw, result in specific units, concentration of cytokine measured and lab interpretation (pos, neg, or indeterminate)

Answer 24

TSTs can be administered to persons who received Bacillus Calmette Guerin (BCG) immunization

Question 25

A positive TST reaction in BCG immunized individuals should be regarded as indicative of TB infection.

Answer 25

False negative TST results can occur if administered within a short period after receiving parenteral live-attenuated virus vaccines.

Question 26

A TST may be placed on the SAME DAY parenteral live-attenuated virus vaccines are given or at least 4 weeks later.

Answer 26

TST are both safe and reliable throughout pregnancy.

Question 27

Persons with an increase in reaction sized of 10 mm or more, within a three-year period is considered positive.

Answer 27

LTBI treatment is as followed: isoniazid (INH) 5 mg/kg (300mg max) daily for 9 months to accomplish 270 daily doses within 12 months.

Question 28

Routine lab monitoring is nessessary for those persons whose baseline liver function test are abnormal or at risk for liver disease.

Answer 28

Directly observed therapy (DOT) should be used for patients who are at very high risk for TB and high risk of non-adherence.

Question 29

Patient education and counseling should be documented on the SF 600, “Medical Record Chronological Record of Medical Treatment”

Answer 29

Sugical masks does not provide complete protection from airborne infectious particles.

Question 30

A Medical Event Report (MER) must be submitted for new cases of active TB by the ship/station within 24 hours.

Answer 30

Medical department personnel must wear particulate respirators (N95 minimum) when working in rooms with persons with known or suspected active TB.