What is Tuberculosis (TB)?
Tuberculosis (TB) is a chronic bacterial infection caused by a bacterium called
Mycobacterium tuberculosis (M. tuberculosis). TB usually affects the lungs but can affect other parts of the body such as the brain, kidneys, or the spine. If not treated properly, TB disease can be fatal.
Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist - inactive TB, or
LTBI, and
active TB disease.
Latent TB Infection (LTBI)
People with LTBI -
- Are infected with TB bacteria, but do not have active TB disease.
- Do not feel sick or have any symptoms.
- Cannot spread TB to others.
Without treatment, people with LTBI can develop into into active TB disease at any time and become sick.
Active TB Disease
People with active TB disease -
- Are infected with TB bacteria and cannot prevent the TB infection from growing.
- Feel sick and have symptoms.
- May be able to spread TB to others.
Without treatment, active TB disease can be fatal.
For more information, visit
About Tuberculosis (TB) 
.
How TB Spreads
Active TB is spread through airborne transmission. Those with active pulmonary TB spread the
M. tuberculosis bacilli (MTB) through coughing or sneezing, and those nearby can become infected by breathing in the droplets.
Most people who become infected remain in an inactive state, or LTBI. Only 5% to 10% of otherwise healthy people who are infected progress to active TB disease during their lifetimes.
Military TB Reporting Requirements & Screening Programs
The Defense Health Agency (DHA) tracks confirmed active TB cases via the DRSi. TB is an RME and must be reported within 24 hours of diagnosis, per DoD policy. LTBI is not communicable and is not an RME in DRSi.
Active TB disease is a communicable disease that must meet both military and civilian reporting obligations. A Centers for Disease Control and Prevention (CDC) Report of Verified Case of Tuberculosis (RVCT) will be completed for each case of active TB disease. The RVCT will be sent to the supporting county and/or State health department and reported through the DRSi.
Visit the
Communicable Disease Toolkit for more resources on TB reporting requirements.
Service-specific TB screening program information is available.
Prevent the Spread of TB
Early Detection and Treatment
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Regular screenings ensure early detection, which is crucial for effective treatment and preventing further spread.
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Properly treat LTBI to prevent progression to active TB disease.
Exposure & Contact Tracing
If a case of active TB is identified in a setting like a workplace, child development center, or school, contact tracing is often initiated to identify, test, and, if necessary, treat individuals who may have been exposed. Alongside contact tracing, health risk communication ensures the community is informed and understands the situation. The following teams are available at DHA to assist with these efforts:
- Epidemiologists: Provide expertise in disease surveillance, data analysis, and outbreak investigation to identify potential contacts and assess the extent of exposure.
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Health Risk Communication Specialists: Develop and deliver clear, accurate, and culturally sensitive messages to inform the public, address concerns, and promote testing and treatment.
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Local and Regional Public Affairs Teams: Coordinate communication with the media, stakeholders, and the broader community to ensure consistent and accurate messaging about the TB situation and response efforts.
Education and Awareness
Educate the public about how TB spreads, common symptoms, effective control methods, the importance of early diagnosis and adherence to treatment regimens.
Infection Control Measures in Institutional Settings
Establish and maintain TB infection control measures in institutional settings where health care is provided and especially where immunocompromised patients congregate, including hospitals, drug treatment programs, prisons, nursing homes, and homeless shelters.
In addition to CDC guidance, infection control measures should align with Service-specific policies, which provide detailed standards for TB prevention and control in military medical treatment facilities and operational settings.
Address Social and Environmental Determinants
Reduce risk factors for TB infection and disease progression such as poorly ventilated and crowded living conditions, malnutrition, indoor air pollution, smoking, and alcohol misuse.
Travel Considerations
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Advise travelers to avoid exposure to people with active TB disease, especially in crowded and enclosed environments.
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Advise travelers who will be caring for patients, or who will be working in healthcare facilities where people with active TB are likely to be patients, to consult infection control or occupational health experts about—
- Baseline LTBI screening,
- Procedures for obtaining personal respiratory protective devices (e.g., N95 respirators), and
- Recommendations for respirator selection and training.
Bacille-Calmette-Guérin (BCG) Vaccine
The Bacille-Calmette Guérin (BCG) vaccine is not routinely used in the United States but remains in use in countries with high TB prevalence.
Indiviudals from countries that administer BCG may have positive tuberculin skin test (TST) results due to prior vaccination. CDC recommends using interferon-gamma release assay (IGRA) testing to distinguish between true infection and BCG effects. For more information, visit
BCG Vaccine Information .
All people, including those who have received BCG vaccination, must follow recommended TB infection control precautions to the greatest extent possible. Individuals from countries where BCG vaccine is used may not know or recall if they received this vaccine.
Who is at High-Risk?
Those at high-risk for
TB exposure include:
- Healthcare workers
- Individuals living or working in large group settings
- Individuals with certain medical conditions
- Those in close contact with individuals with active TB infection
- Those traveling or deploying to areas where TB is common
Anyone can get TB, but some people with LTBI are more likely to develop active TB disease than others. The risk of
developing active TB disease once infected is highest among:
- Children younger than 5 years
- The elderly
- Those with a weaker immune system from medical conditions such as cancer, HIV, or diabetes
- Those taking certain medications that weaken the immune system
For more information, visit Tuberculosis Risk Factors .
Symptoms and Diagnosis
Symptoms
Symptoms of
active TB disease depend on where in the body the bacteria are growing. Most commonly, active TB disease affects the lungs. Common sites for active TB outside the lungs include the bladder, bones and joints, brain and meninges, genitalia, kidneys, lymph nodes, and pleura.
Active TB disease in the
lungs may cause symptoms such as:
- A cough that lasts 3 weeks or longer
- Chest pain
- Coughing up blood or sputum
Other symptoms of active TB disease include:
- Weakness or fatigue
- Weight loss
- Loss of appetite
- Chills
- Fever
- Night sweats
If untreated, TB can be fatal. Complications may include spinal pain, joint damage, meningitis, liver or kidney problems, and heart disorders.
For more information, visit
Signs and Symptoms of Tuberculosis .
Diagnosis
M. tuberculosis infection can be detected by a positive tuberculin skin test (TST or PPD) or IGRA (e.g., QuantiFERON-TB Gold) 8–10 weeks after exposure.
While clinical criteria can be used to diagnose TB in the absence of microbiologic confirmation,
laboratory testing is essential to—
- Confirm the diagnosis of TB.
- Guide treatment decisions.
- Provide bacterial DNA for molecular epidemiology studies.
IGRA is preferred over the TST in those that have received the BCG vaccine because the vaccine may induce false-positive TST results.
For more information about laboratory testing for TB, visit
Clinical Testing and Diagnosis for Tuberculosis .
TB Treatment
Both LTBI and active TB disease can be treated. Treating LBTI is the best way to prevent progression into active TB disease. Treating active TB disease is the best way to prevent the spread of TB.
For more information, visit
Clinical Treatment of Tuberculosis .
Resources for Healthcare Providers
CDC - Preventing Tuberculosis
CDC - Yellow Book - Tuberculosis
Defense Health Agency Public Health (DHA PH) –
Communicable Disease Toolkit
Military Health System (MHS) –
Armed Forces Reportable Medical Events
Service-Specific Guidance
Department of the Air Force –
Public Health Surveillance , AFMAN 48-105 or visit
Publications and Forms and search for the most recent Public Health Surveillance publication.
Department of the Army -
Army Public Health Program , PAM 40-11
Navy and Marine Corps Force Health Protection Command –
Tuberculosis Prevention and Control
