Gulf War and Health Volume 5: Infectious Diseases (2007) / Chapter Skim
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.4 Thus, the committee's deliberations covered infectious diseases known to occur in Saudi Arabia, Kuwait, Iraq, Afghanistan, and most countries along their borders (Yemen, Oman, United Arab Emirates, 1Earlier IOM reports in this series present conclusions about long-term adverse health outcomes associated with exposure to depleted uranium, pyridostigmine bromide, sarin, vaccines, insecticides, solvents, propellants, combustion products, and fuels. 2A detailed description of how IOM studies are conducted appears at www.iom.edu/?
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Definition of Long-Term Adverse Health Outcome The committee then developed a set of criteria for determining which infectious diseases to evaluate for strength of association with specific long-term adverse health outcomes. Longterm adverse health outcomes include secondary diseases or conditions (sequelae)
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TB has a long history of activation and transmission in military settings. Moreover, about 2.5% of military personnel deployed to OEF and OIF and given predeployment and postdeployment skin tests for TB converted from negative to positive; that is, these troops acquired new TB infections during deployment.6 Therefore, although the committee found no published reports of active TB cases among the troops in question, conclusions about the long-term adverse health outcomes of TB infection are quite pertinent.
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Assessing the Strength of the Evidence By evaluating the evidence in the published scientific literature, the committee determined the relationships between each of the nine diseases of interest and specific adverse health outcomes that might appear weeks to years after the primary infection. Those relationships are conceived in terms of the strength of association between the primary infection and a specific long-term adverse health outcome.
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o ReA if ReA is manifest within 3 months of the infection; most cases of ReA are manifest within 1 month of the infection. · Active TB and long-term adverse health outcomes due to irreversible tissue damage from severe forms of pulmonary and extrapulmonary TB.
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Inadequate or Insufficient Evidence to Determine Whether an Association Exists The evidence from available studies is of insufficient quantity, quality, or consistency to permit a conclusion regarding the existence of an association between exposure to a specific agent and a specific health outcome in humans. For some potential long-term adverse health outcomes of the nine identified diseases, the evidence of an association is inadequate, insufficient, or both.
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In this report, the committee focused on identifying positive associations between specific infectious diseases and specific long-term adverse health outcomes and did not present the numerous long-term adverse health outcomes for which there is no association. DEPARTMENT OF DEFENSE POLICIES ON TUBERCULIN SKIN TESTING AND PREDEPLOYMENT AND POSTDEPLOYMENT SERUM COLLECTION Each branch of the US military has polices regarding tuberculin skin testing and treatment of latent TB infection (LTBI)
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