日本における結核根絶
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According to the operational definition adopted at Wolfheze Workshop held in March 1991 (Table 1), tuberculosis low incidence countries are defined as those where the incidence of all forms of tuberculosis is less than 1 per 100, 000. The incidence was 41.9 in 1990 in Japan, so that Japan cannot be considered as a low incidence country. Why is the incidence of tuberculosis so high in Japan? What part of population is affected by the tuberculosis disease? To solve these questions and to make clear the mode of development of tuberculosis, a study was carried out.<BR>Fortunately, both the annual risk of tuberculosis infection and the prevalences of persons with healed and/or fibrotic lesion in the lung are known from the results of the National Tuberculosis Prevalence Surveys carried out in 1963 and 1973 as shown in Figures 1 and 2. From these data, the number of newly infected within 5 years and that of remote infections by age group were estimated. The former was divided into BCG vaccinated and non-vaccinated and the latter into persons with fibrotic lesion, with healed foci and without abnormality in the lung. (Table 2)<BR>The rates of development of tuberculosis disease according to the X-ray findings of the lung were observed at the five-years follow-up study of all the examinees at the Prevalence Survey carried out in 1968. The ratio of development of the disease in those with recent infections, remote infections with fibrotic lesion, those with healed foci and those without abnormality was estimated as 20: 10: 2: 1. (Table 3) As the risks of development of the disease vary with age, so that the parameters shown in Table 4 were used for the estimation of the number of new cases.<BR>The results of estimation of the number of new cases by age group in each calendar year are shown in Fig. 3 and Table 5. The fitness of the estimation was fairly good except that of 1975. The author discussed the reasons of under-estimation of new cases among 20-39 years of age in 1990 and those among 40 years of age or more in the text, although it is omitted here. It was estimated that 91.6% of new cases were developed from the persons with remote infection, and only 8.4% of them were developed from those infected during the last 5 years. The patients with disease reactivated from fibrotic lesion occupied 11.4% and those with healed foci 16.4% according to the estimation done in 1990.<BR>The estimation of the number of new cases that will be developed in 2000 was done by the same method. Total number of new cases was estimated as 35, 049 or 26.7 per 100, 000. The results of the calculation showed that 97.7% of new cases are to develope from the persons with remote infection. (Table 7) Although the persons infected within 5 years would be 0.03% of the total population, 3.2% of the patients would occur from them. (Table 8) It was clearly shown that the persons with fibrotic lesion are one of the highest risk groups of tuberculosis. It is not difficult to detect the persons with fibrotic lesion in Japan where Xray examinations are very common, therefore, preventive chemotherapy for those persons has been recommended.<BR>From the results of the estimation of tuberculosis in 2000, the author concluded that active implementation of several tuberculosis control measures as shown in Table 9 would be advised to accelerate the elimination of tuberculosis in Japan. The prevalence of HIV infection is not so high at present, however, it is increasing rapidly as shown in Fig. 5. The author stressed the importance to decrease tuberculosis before the spread of HIV infection in Japan.
- 一般社団法人 日本結核病学会の論文
一般社団法人 日本結核病学会 | 論文
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