ABSTRACT
SETTING: In Japan, the incidence of tuberculosis (TB), which had improved continuously from 1951, has shown an upturn since 1997. OBJECTIVE: An Ad-Hoc National Survey was conducted to review the issues of TB control in Japan and to discuss the future direction of change. METHODS: TB registries kept at health centres in all prefectures were reviewed for the year 1998. Vital statistics and BCG vaccination records were reviewed separately. RESULTS: The survey revealed a 34.7% under-estimation of TB deaths in TB registers, and a 11.2% over-estimation of TB cases registered due to a change in diagnosis after registration. For treatment, the four-drug regimen advocated for smear-positive cases was used in only 54.8% of indicated cases, and treatment duration was very long; for example, 18.4% of first-time hospitalised cases over 15 years of age received in-patient care for more than 6 months and 29.8% continued treatment for more than 12 months. Apart from an increasingly elderly population, other factors contributing to an increase in TB included underlying health risk factors for increased susceptibility to TB and socio-economic risk factors for treatment failure. Regarding preventive measures, active case finding by health screening contributed to detection of only 8.7% of new cases aged over 60 years, but BCG vaccination appeared to be preventive among infants under 1 year of age. CONCLUSION: The National Survey revealed a changing profile of TB in Japan and suggested a need to review and revitalise the TB control programme.
