先進国の結核対策 (総説)

概要

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At the 47th Annual Meeting of the Japanese Society for Tuberculosis, the author gave a special lecture on “Tuberculosis of Asian Countries, easpecially on the Studies Contributed for Establishing Control Policy of the Disease in Developing Countries”. In November 1971, the author was asked again to give a special lecture on “Tuberculosis Control in Developed Countries”. Both lectures were given for the purpose of contributing to the improvement of tuberculosis control program in our country. The trend of tuberculosis mortality in Japan was similar to that of a group of European countries where the recent mortality figures are not very low. The BCG vaccination policy differed considerably among developed countries. In some countries the vaccination on new born babies has been still continued in wide scale, but as a general tendency, school leaving age has become the choice of vaccination time in European countries. In Netherland BCG has never been used except the limited use on army personnels in recent years. In U.S.A. prophylaxis by the use of BCG on non-infected persons was mostly replaced by chemoprophylaxis on selected groups among infected persons. In most of developed countries the mass application of chemoprophylaxis has not been carried into practice. The traditional case-finding program with mass radiophotography for inhabitants became less efficient in accordance with the decrease of tuberculosis morbidity in developed countries, and selective case-finding on high risk group was recommended. The program has already been carried on in some countries, although the way of selection of high risk groups was different according to countries. On the other hand, it was revealed that only a smaller part of new cases was found by mass radiophotography even under high coverage of the program, and a greater part of new cases, especially smear positive cases, were identified by so-called passive case-finding of symptomatics. So the important role of the latter was recognized even in developed countries. As to the treatment, the result of a trial, which was carried out by the author several years ago, was demonstrated. In this trial clinical records of several cases of pulmonary tuberculosis, such as, copies of radiograms of the chest at the start and certain points during treatment, monthly results of sputum examination and the regimen of chemotherapy used, were sent to the tuberculosis specialists in European and North American countries as well as to Japanese specialists, and their answers on questionaries concerning the treatment program of individual cases were collected. There was a marked difference in the opinion between Japanese specialists and those in other countries, especially on the duration of hospitalization and that of streptomycin administration, that is, both were much shorter in the latter than in the former. The integration of tuberculosis control into general medical services was agreed to be appropriate by most of developed countries, but in some countries such integration was consi dered to be a draw back policy of tuberculosis control. Japan is now at a critical point to improve old-fashioned tuberculosis control program, and it would be necessary to learn the trend and changes in the policy of countries with various tuberculosis situation.
日本結核病学会の論文

著者

岩崎龍郎
結核予防会結核研究所

先進国の結核対策 (総説)

スポンサーリンク

概要

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