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Introduction Knowledge of the contemporary epidemiology of hepatitis B virus (HBV) infection among military personnel can inform potential Department of Defense (DoD) screening policy and infection and disease control strategies. Materials and Methods HBV infection status at accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period from 2007 to 2010. A cost model was developed from the perspective of the Department of Defense for a program to integrate HBV infection screening of applicants for military service into the existing screening program of screening new accessions for vaccine-preventable infections. Results The prevalence of chronic HBV infection at accession was 2.3/1,000 (95% CI: 1.4, 3.2); most cases (16/21, 76%) identified after deployment were present at accession. There were 110 military service-related HBV infections identified. Screening accessions who are identified as HBV susceptible with HBV surface antigen followed by HBV surface antigen neutralization for confirmation offered no cost advantage over not screening and resulted in a net annual increase in cost of $5.78 million. However, screening would exclude as many as 514 HBV cases each year from accession. Conclusions Screening for HBV infection at service entry would potentially reduce chronic HBV infection in the force, decrease the threat of transfusion-transmitted HBV infection in the battlefield blood supply, and lead to earlier diagnosis and linkage to care; however, applicant screening is not cost saving. Service-related incident infections indicate a durable threat, the need for improved laboratory-based surveillance tools, and mandate review of immunization policy and practice.

Hans Erik Heier, MD, PhD, MHA*; LTC John Badloe, MD, SBB (ASCP)†;LTC Milos Bohonek, MD, PhD‡; LTC Andrew Cap, MD, PhD, FACP, MC USA§∥¶;Heidi Doughty, MBA FRCP FRCPath**; Jolanta Korsak, MD,PhD††; MAJ Christian Medby, MD*;LTC Roger Mueller Pfaff‡‡; COL Francisco J. Rentas, PhD, SBB (Ret.)§§; GEN Anne Sailliol, MD∥∥ ;LTC Martina Schilha, MD¶¶; Tommy Soderstrom, MD, PhD***

Current policy allows the use of identification cards and tags for transfusion purposes during contingency operations. The purpose of this study was to determine the percentage of soldiers having the wrong blood type on their identification card or dog tag and the effects that these findings could have during wartime. Thirty-four of 923 soldiers (3.7%) demonstrated at least one discrepancy during testing. Of these 34 discrepancies, 22 (2.3%) involved ABO group errors, 10 (1.1%) involved Rh type errors, and 2 (0.2%) involved both ABO group and Rh type errors. These errors could lead to transfusion of the wrong blood type during wartime. The interface of computer systems in the near future may decrease the blood type error rate on identification cards and dog tags. Quality improvement programs to increase the accuracy of the blood type on identification cards and dog tags are suggested.