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 NAVMEDCOMINST 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 6-month intervals.
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 requirements.
The current drug of choice for TB chemoprophylaxis 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 (NAVMEDCOMINST 6300.2).
Requirements for routine and special immunizations must be strictly adhered to.
When administering immunizations, it is accepted practice to have a physician nearby. Therefore, 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 preplanning should preclude the routine use of mass administration techniques in routine immunizations. 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 contamination and improper administration. Conscientiousness, 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 effective immunizations.
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. Additional 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