Infectious Diseases

Tuberculosis

General Description: Tuberculosis is a bacterial infection of the lungs that may spread to extra-pulmonary sites. In 2007, approximately 13,300 patients were diagnosed with tuberculosis in the U.S., of whom approximately 5,500 were U.S. born. The initial infection is usually not detected and may be only identified as the result of a tuberculin skin test (TST), a BAMT (Blood Assay for Mycobacterium tuberculosis), or as an incidental finding on a chest x-ray. In persons with normal immune systems, approximately 90% of primary infections are walled off and are never symptomatic (latent tuberculosis infection or LTBI). About 10% of infected individuals develop tuberculosis disease, due either to progression of the primary lesion within the first 2 years after infection, or many years after a long dormant period (reactivation disease). Approximately 5% of initial infections are not walled off and spread occurs through the lung and to other organ systems (primary TB disease). The remaining 5% of infections consist of LTBI infections that reactivate. Treatment of LTBI with an appropriate regimen of antibiotics decreases the risk of reactivation and development of active TB disease.

Mode of Transmission: Inhalation via airborne droplets originating in the lungs of an individual with tuberculosis.

Efficiency of Transmission/Attack Rate: In general, infection with tuberculosis is related to the intensity and duration of exposure to an infectious person. Cramped living quarters and institutional settings such as jails or correctional institutions facilitate the person-to-person transmission of the tuberculosis bacteria.

Period of Communicability: The infection can be spread as long as the sputum contains the bacteria. Persons with LTBI (positive tuberculin skin test or TB blood test with no evidence of active disease) are not infectious. Persons with active tuberculosis disease are generally rendered non-infectious within 2 to 4 weeks of starting and consistently taking an effective anti-tuberculosis antibiotic regimen.

Effect on LEO Fitness for Duty: Deciding whether the law enforcement agency should routinely test recruits or officers for tuberculosis is dependent upon the essential job functions, the mission of the agency, and the prevalence of tuberculosis in the community. Tuberculosis in correctional facilities is a serious problem; however, this document focuses on the patrol officer. The exposures of concern include face-to-face contact with persons with active TB infections, transport of infectious persons in patrol vehicles, and remaining on site at or assignment to institutions such as jails and detention facilities.

LEO recruits who are identified as having LTBI may begin their training concurrently with initiation of anti-tuberculosis therapy. LEOs who are identified as having LTBI may continue active duty concurrently with initiation of anti-tuberculosis therapy.

LEOs who are identified as having tuberculosis disease should be considered infectious and excluded from routine patrol duties or work in close quarters such as office environments until they have completed 4 weeks of effective antituberculosis therapy and/or there is an absence of bacteria in the sputum. Since active pulmonary tuberculosis is a quarantinable disease, return to duty should be managed according to local public health agency guidance.

LEO-specific Clinical Studies and Reports: See also Appendix A.
Binswanger IA, O’Brien K, Benton K, et al. Tuberculosis testing in correctional officers: a national random survey of jails in the United States. Int J Tuberc Lung Dis. 2010;14(4):464-70. PMID 20202305

Coolahan LM, Levy MH. The prevalence of tuberculosis infection in New South Wales police recruits, 1987-1990. Med J Aust. 1993;159(6):369-72. PMID 8377685

Cooper-Arnold K, Morse T, Hodgson M, et al. Occupational tuberculosis among deputy sheriffs in Connecticut: a risk model of transmission. Appl Occup Environ Hyg. 1999;14(11):768-76. PMID 10590550

Steenland K, Levine AJ, Sieber K, Schulte P, Aziz D. Incidence of tuberculosis infection among New York State prison employees. Am J Public Health. 1997;87(12):2012-4.