Enclosure (2) to COMDTINST 6220.9A
AMIO are not historically at increased risk for TB exposure. The following exposure situations
may warrant performing a TST on Coast Guard personnel.
(1) Prolonged face-to-face contact (without the use of a N-95 respirator) with one or more alien
migrants known or suspected of having active TB disease (e.g., excessive coughing and/or
coughing up blood); and
(2) Exposure to one or more alien migrants known or suspected of having active TB disease
(e.g., excessive coughing and/or coughing up blood) in a confined environment (e.g., vessel
hold) rather than in an open area (e.g., weather deck). Reference (d) provides additional
guidance on TB screening.
c) Case Recognition. In order to prevent further spread of TB disease, it is important to know how
to recognize individuals with suspected active TB disease. The circumstances common to most
boardings, inspections or AMIO may limit the ability to effectively differentiate individuals with
TB disease from individuals with other respiratory disorders. The purpose of identifying
individuals with suspected TB disease is to promptly institute measures to minimize the risk of
transmission while these individuals are under Coast Guard control, and to ensure access to
diagnosis and treatment when possible.
(1) The primary method of identifying individuals with suspected active TB disease in the field
is by taking a good medical history and physical examination. Individuals with the
following reported signs and/or symptoms should be suspected of having active TB disease:
i. Excessive coughing;
ii. Coughing up blood (blood tinged sputum);
iii. Apparent weight loss;
iv. Fatigue;
v. Night sweats; and /or
vi. Fever.
(2) Once identified as potentially having active TB, migrants should be isolated from non-
diseased persons, if possible, and have limited contact with others to minimize the risk of
disease transmission.
(3) Coast Guard personnel can consider placing surgical masks on individuals suspected of
having active TB; however, this is often not tolerated by ill persons, may be difficult to