Implications of emerging isoniazid resistance in Mycobacterium tuberculosis in Korea.

In 1981, the Korean National Institute of Health (KNIH) reported that 17% of all tuberculosis patients had primary resistance to isoniazid while an additional 17% acquired isoniazid resistance during chemotherapy. This 34% isoniazid resistance rate in the Republic of Korea, where an estimated 6-8% of the total population have active tuberculosis, poses significant concerns regarding management of U.S. military health care beneficiaries who develop tuberculosis or have tuberculosis skin test conversion while residing in or after departure from Korea. To address this issue, the prevalence of Korean acquired isoniazid resistance was estimated in U.S. beneficiaries by performing antibiotic sensitivities on all positive cultures from October 1981 through December 1982. Of 42 patient isolates, six were isoniazid resistant (14.3%). When the data was analyzed further, it was determined that as many as 9.5% of those U.S. beneficiaries infected had primary isoniazid resistance. This is higher than the most recent U.S. population-based drug resistance study, in which 6.9% of tuberculosis patients had primary drug resistance. This data comparison points toward the need for judicious management of Korean acquired infections and skin test conversions. Emphasis is on criteria necessary to warrant use of chemotherapeutic agents other than isoniazid to prevent further introduction of resistant organisms into locales where isoniazid resistance is not as prevalent as reported in Korea.

Prevalence of penicillinase-producing Neisseria gonorrheae in Korea.

An almost two-fold increase in the monthly reported case rate for sexually transmitted disease (STD) in U.S. military members assigned in the Republic of Korea in April 1981 prompted an epidemiologic assessment of that population. Inasmuch as previously nonexistent treatment failures for Neisseria gonorrheae were also being reported, a demographic slice of 253 symptomatic military members was surveyed in June and July, 1981, for gonorrhea prevalence and the proportion of this that could be attributed to penicillinase-producing Neisseria gonorrheae (PPNG). Using standard and accepted methods, the gonorrhea prevalence rate in symptomatic military members was found to be 100% while the proportion that could be attributed to PPNG was 43%. In order to compare this to the contact population of local prostitutes, 116 asymptomatic women who presented to local STD clinics for routine, often legally-mandated examinations, were surveyed. The expected lower gonorrhea prevalence rate was 13.9% but the proportion attributed to PPNG was 27.6%. This data was similar to the sudden increase in PPNG experienced by U.S. military forces at Subic Bay in the Philippines in 1979 and reflected the slow but steady migration of this resistance throughout Asia. The long-accepted norm for gonorrhea treatment using penicillin was changed to spectinomycin in the U.S. military population and was being considered for implementation by the Korean official health community. Further organism resistance can be expected, and close monitoring is taking place.

Crew rest and nap-of-the-eart flying.

Nap-of-the-earth flying was conceived by the U.S. Army to evade enemy detection of rotary wing aircraft, requiring the stressful technique of aircraft movement only inches above the ground terrain. The 100st Airborne Division (Airmobile), Fort Campbell, Ky, tested the nap-of-the earth (NOE) concept from 12 June, 1973, to 30 June, 1974, flying 3267.6 h in NOE training. Four aircraft incidents occurred during this training period, with three of these taking place prior to 1 March, 1974. At that point, after 59.2% of the total hours had been flown, NOE pilot training was curtailed from 8 h/d to 4 h/d. Objective and subjective data infer that pilot (crew) rest and the length of the flying day are important factors in the safety of NOE flying.