ABSTRACT
We made a bibliographic search for Japanese and non-Japanese literature on tuberculosis control programs to study the current public health policies for tuberculosis control in Japan especially in regard to cost-effectiveness. Then, we compared the Japanese, strategies for tuberculosis control with those in other countries including the United States, and those recommended by World Health Organization (WHO). The current trend of tuberculosis incidence in the Japanese community demonstrates major differences from the situation that had prompted installation of tuberculosis control measures several decades ago. The tuberculosis control measures should be targeted to the elderly people (over 65 years old) because of the following three aspects. (1) A continuing decline of tuberculosis in the young Japanese population, particularly children who might attain benefits from BCG immunization; (2) The enhancement of the prevalence among the elderly people who are not covered by a uniform national surveillance strategy; (3) Cost-ineffectiveness of Mass Miniature Radiography (MMR) being used as a means to screen for tuberculosis. The cost-effectiveness issue must be considered more seriously, and the WHO recommendations especially in regard with the DOTS (directly-observed treatment, short course) strategy need to be incorporated more effectively into the national program since the incidence of drug resistant tuberculosis in Japan has been recently increasing. Finally, we propose to limit BCG immunization further and to discontinue annual MMR in the young population, and instead to develop effective strategies of both active and passive case finding in the elderly through public and community health services.
ABSTRACT
We made a bibliographic search for Japanese and non-Japanese literature on tuberculosis control programs to study the current public health policies for tuberculosis control in Japan especially in regard to cost-effectiveness. Then, we compared the Japanese strategies for tuberculosis control with those in other countries including the United States, and those recommended by World Health Organization (WHO). The current trend of tuberculosis incidence in the Japanese community demonstrates major differences from the situation that had prompted installation of tuberculosis control measures several decades ago. The tuberculosis control measures should be targeted to the elderly people (over 65 years old) because of the following three aspects. (1) A continuing decline of tuberculosis in the young Japanese population, particularly children who might attain benefits from BCG immunization; (2) The enhancement of the prevalence among the elderly people who are not covered by a uniform national surveillance strategy; (3) Cost-ineffectiveness of Mass Miniature Radiography (MMR) being used as a means to screen for tuberculosis. The cost-effectiveness issue must be considered more seriously, and the WHO recommendations especially in regard with the DOTS (directly-observed treatment, short course) strategy need to be incorporated more effectively into the national program since the incidence of drug resistant tuberculosis in Japan has been recently increasing. Finally, we propose to limit BCG immunization further and to discontinue annual MMR in the young population, and instead to develop effective strategies of both active and passive case finding in the elderly through public and community health services.
Subject(s)
Tuberculosis , JapanABSTRACT
BACKGROUND: Despite the declining tendency of the prevalence of tuberculosis in Korea, pulmonary tuberculosls is still considered to be such an important disease in Korea that tuberculosis patients have been screened by mass miniature radiography(MMR). Although the prevalence of tuberculosis increases with age, screening of it has been done on students and young workers. There hasn't been any study about the prevalence of tuberculosis in adolescents recently. METHODS: MMR were performed on high school freshmen in Seoul from March to September, 1995. Patients with abnormal MMR were further evaluated on history taking and standard chest X-ray. Their results were classified as normal, active tuberculosis, activity-undetermined tuberculosis, healed tuberculosis, and other diseases. The prevalence of active tuberculosis by this screening method was estimated. RESULTS: Among 194,102 high school freshmen,388 were suspected to have pulmonary tuberculosis by MMR. The prevalence of tuberculosis in high school freshmen in Seoul was 0.20%, male 0.18%, female 0.23% by MMR respectively. There was significant difference between the prevalences of both sexes. History taking and standard X-ray was taken for 94 students and among them 68 students were found to have active tuberculosis(72.3% ), 14 normal(14.9% ), 3 other diseases(3.2% ), 9 healed or activity-undetermined tuberculosis(9.6% ). Newly-diagnosed patients in active tuberculosis were 59(82.9% ). There were family history in 31 out of 94 students(33.0%) and 29 out of 68 students(37.1%) with active pulmonary tuberculosis had family history of tuberculosis. CONCLUSIONS: The prevalence of pulmonary tuberculosis in high school freshmen in Seoul was 0.20% by MMR. Positive predicitive value of MMR was 72.3% in follow-up students by standard Chest X-ray. Therefore estimated prevalence of active pulmonary tuberculosis by standard chest X-ray after MMR was 0.14%.