Medical Department personnel, especially MDRs
aboard ship, must be thoroughly familiar with the
contents of this instruction.
In general, all personnel will be tested at least
annually and more often if circumstances dictate.
Upon discovery of a case of TB in the command,
a Disease Alert Report, MED-6220-3, will be
prepared and submitted under NAVMEDCOM-
INST 6220.2 series. The patients close contacts,
as determined by a medical officer or MDR, will
be located, screened, evaluated, and reported.
When a present or former member of the
command has suspected or confirmed TB,
a contact investigation program must be started.
Each person who has been a close contact of a
known, active, infectious case of TB will be
screened. A Tuberculosis Cent act/Follow-up
Form, NAVMED 6224/1 (Revised 2-84), will be
started and placed in the health record of each
individual affected. Each contact will be initially
tested and subsequently reexamined at 3- and
Report of Tuberculosis Contact Investigation,
MED-6224-9, is submitted to the Commander,
NAVMEDOM, with copies to the area Navy
Environmental and Preventive Medicine Unit and
the Navy Environmental Health Center. This
report is required upon initial study and again at
3- and 6-month intervals.
The Annual Report of Tuberculin Retesting,
Med-6224-8, is prepared by all activities having
Medical Department personnel and submitted
annually by 1 February. Medical Department
personnel shall maintain a tickler system to
ensure compliance with TB control program
The current drug of choice for TB chemo-
prophylaxis is isoniazid. Chemoprophylaxis is
given to all personnel who are new reactors
regardless of age and all previous known reactors
who have never received such a course before,
provided no contraindications exist. Decisions
concerning chemoprophykxis in persons aged 35
and over must be made on an individual basis.
Generally, chemoprophylaxis is indicated for
tuberculin reactors over 35 when the danger of
cent ratting active TB is significant.
There are other requirements for reporting
cases of TB, i.e.,
Disease Alert Report
(NAVMEDCOMINST 6220.2), and Medical
Services and Outpatient Morbidity Report (NAV-
Requirements for routine and special
immunizations must be strictly adhered to.
When administering immunizations, it is
accepted practice to have a physician nearby.
routine immunizations are not
normally administered at sea. The crews of ships
in port will receive immunizations as close as
possible to prescribed schedules. However, such
restrictions do not apply to individual cases in
which there is a clear-cut medical indication
for immediate administration of an immunizing
agent by a competent MDR. Examples include the
administration of appropriate rabies vaccine
and rabies immune globulin after possible
exposure and the administration of tetanus toxoid
if indicated in wound management. In some
circumstances mass immunizations, such as
prophylactic administration of gamma globulin,
will become necessary. The most common method
of mass immunization is through the use of
shot lines. You will undoubtedly remember this
practice from boot camp. Foresight and preplan-
ning should preclude the routine use of mass
administration techniques in routine immuniza-
tions. However, in special situations, such as
administration of influenza virus vaccine, the use
of shot lines is a practical solution to the problem.
When immunizations are administered on a
mass scale, the tendency to shortcut recommended
procedures increases the likelihood of contamina-
tion and improper administration. Conscientious-
ness, attention to detail, and observance of all
recommended precautions and techniques listed
in NAVMED P-5052-15, NAVMEDCOMINST
6230.1 series, and NAVMEDCOM notices in the
6230 series must be practiced to ensure safe and
Quarantine procedures in the Navy are
designed to prevent dissemination of human,
animal, or plant diseases from place to place.
Basic regulations and detailed instructions are
contained in SECNAVINST 6210.2 series. Addi-
tional information in MANMED, chapter 22, and
other published instructions should be consulted.
It is the responsibility of Medical Department
personnel ashore or afloat to be well informed
concerning current naval quarantine regulations
and instructions and to give advice and make
recommendations in matters of quarantine to the