When a local health department in Virginia learned that a deceased hospital-based nurse had worked for several months with undiagnosed and untreated active tuberculosis, it mounted an extraordinary effort to find, screen, test, and potentially treat numerous contacts. In responding to this challenge, it adapted plans, concepts, and equipment that had been recently developed or acquired for responding to acts of bioterrorism. The improved coordination and integration with community partners and participating agencies, fostered through bioterrorism preparedness planning, were keys to success. Using procedures developed and exercised to distribute prophylactic medication in the Strategic National Stockpile, the health department shifted philosophically from a program-specific response to a more integrated approach. Implementation of this mass tuberculosis-screening program was based on the principles of the Incident Command System (ICS). Owing to the efficiency of the operation, more than 2,500 people were quickly screened, and the rate of return for skin test readings was 91.6%, ranking it extremely high compared to the benchmarks. Overall, 5.9% of those tested were found to be infected with tuberculosis, and no cases of active tuberculosis were identified. This outcome demonstrated public health's improved ability to react, as a result of bioterrorism preparedness activities, to "traditional" public health mass events and non-bioterrorism emergencies.
During U.S. Marine Corps Reserve summer 2-week active duty for training periods, 6,482 people were tested for human immunodeficiency virus (HIV). Testing at an initial exercise, Solar Flare, trained a cadre of contact teams to, in turn, train other personnel in phlebotomy and the HIV protocol at three other exercises (141 Navy Reserve and Inspector-Instructor hospital corpsmen were trained). Corpsmen could be trained with an indoctrination of 120 minutes and a mean of 15 phlebotomies. After 50 phlebotomies, the administration, identification, and labeling process plus phlebotomy could be completed in 90 seconds. HIV testing during military exercises is both good for training and cost-effective.
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