[Treatment and isolation of non-adherent and/or infectious tuberculosis patients under the infectious diseases control law].

OBJECTIVES

To clarify the present situation regarding isolation of tuberculosis (TB) patients who do not comply with hospital treatment or adhere to treatment.

METHODS

A mailed questionnaire survey to 252 hospitals having tuberculosis beds.

RESULTS

Answers were returned from 160 hospitals. Answers from 146 hospitals, excluding 14 that had closed their TB wards, were analyzed. Experiences of defaulters were reported from 35 hospitals. Seven of these defaulting patients were homeless, 4 were foreign-born, and 2 had other problems, but for 15 cases no problem was known. Fourteen hospitals reported that the burden of medical fee payment was one of the causes of defaulting. Defaulting occurred in hospitals even having close cooperation with public health centers over DOTS. For chronic excretors under long-term hospitalization, 31 (20.4%) hospitals allow home isolation, whereas 78 (51.3 %) refuse discharge from the TB ward even for a short period. However, 69 (45.4%) answered that home isolation could be allowed under certain conditions. Only 17 (11.2%) think that current TB hospitals are appropriate for long-term hospitalization, and 63 (41.4%) feel that the improvement of the facilities for that purpose is needed. Seventy-two (48.3%) hospitals answered that confinement under detention should be mandatory, while 70 were against it.

CONCLUSION

Since 2007 hospital treatment of tuberculosis patients has been mandatory under the Infectious Diseases Control Law in Japan, but this study revealed that there are patients who leave the hospital in violation of the law. There is also a problem of non-infectious but non-compliant patients who are discharged for ambulatory treatment being likely to default and develop relapse. Because these patients are likely to develop M(X)DR-TB and may threaten the community, certain effective legal actions including hospitalization under detention should be imposed on them. At the same time, for chronic excretors with XDR-TB, home isolation should be allowed from the point of view of human rights, under clear conditions for infection prevention, together with the provision of a financial subsidy.