Yamasaki M, Ozasa K, Shimouchi A
Department of Preventive Medicine, Kyoto Prefectural University of Medicine, Japan.
Kekkaku. 1996 Jan;71(1):7-12.
To review how to strengthen tuberculosis program in Hunai-Gun, Kyoto Prefecture, the recent trend of incidence of tuberculosis and 148 index cases with pulmonary tuberculosis newly registered from 1987 to 1992 were analyzed regarding the mode of detection, conditions when consulting medical facilities, risk factors, bacteriological findings, and secondary infections among contacts. 1. The high crude incidence of tuberculosis in Hunai-Gun is explained by the high proportion (19.3%) of the elderly population of 65 years old and over in Hunai-Gun compared with the average (12.6%) in the Prefecture and the high tuberculosis incidence among age group of 70 years old and over in Hunai-Gun compared with the prefectural average. However, the reason of higher incidence of tuberculosis among the elderly in the district was not clear. 2. The proportion of bacillary as well as culture positive cases were higher among patients who were diagnosed by consulting medical facilities than those detected by regular health check. The proportion of bacillary cases without risk factors for tuberculosis among patients who were diagnosed at medical facilities was the highest among those newly attending medical facilities due to complaints related to tuberculosis (group A), followed by those patients regularly attending medical facilities for other diseases but consulting because of additional complaints related to tuberculosis (group B), and lowest among patients regularly attending medical facilities but detected by chance while being examined for other diseases (group C). The severer the diseases stage, the higher the proportion of bacillary cases, however, there were no difference in the proportion of bacillary cases among the above three groups including those with risk factors. It is explained by the fact that the ratio of patients with risk factors was high in group C, which masked the higher proportion of bacillary cases among patients with risk factors. 3. As future activities of public health center on tuberculosis control, it is important to give health education to those with risk factors on the fact that the progression of the disease is faster among them in addition to the increased risk of the disease onset, and advise them to attend regular health check and visit medical facilities when they have any symptom related to tuberculosis. 4. Considering the fact that the risk of secondary infection to contacts is higher among smear positive patients than bacilli negative patients, it is needed to examine all contacts of sputum smear positive patients thoroughly. In addition, it is advisable to follow-up contacts of smear negative but culture positive patients with the similar intensity with those for smear positive patients because their risk of secondary infection to contacts was also higher than bacilli negative patients although it was not statistically significant.
为回顾如何加强京都府宇治郡的结核病防治项目，分析了结核病发病率的近期趋势以及1987年至1992年新登记的148例肺结核指标病例的检测方式、就诊医疗机构时的情况、危险因素、细菌学检查结果以及接触者中的继发感染情况。1. 宇治郡结核病粗发病率较高，原因是宇治郡65岁及以上老年人口比例（19.3%）高于该府平均水平（12.6%），且宇治郡70岁及以上年龄组的结核病发病率高于该府平均水平。然而，该地区老年人结核病发病率较高的原因尚不清楚。2. 通过就诊医疗机构诊断出的患者中，菌阳及培养阳性病例的比例高于通过定期健康检查发现的患者。在因结核病相关症状首次就诊医疗机构的患者（A组）中，无结核病危险因素的菌阳病例比例最高，其次是因其他疾病定期就诊医疗机构但因结核病相关附加症状前来咨询的患者（B组），在因其他疾病定期就诊医疗机构但在检查其他疾病时偶然发现的患者（C组）中最低。疾病阶段越严重，菌阳病例比例越高，然而，上述三组包括有危险因素的患者中菌阳病例比例并无差异。这是因为C组中有危险因素的患者比例较高，掩盖了有危险因素患者中菌阳病例比例较高的情况。3. 作为公共卫生中心未来结核病控制活动，重要的是对有危险因素的人群进行健康教育，告知他们除发病风险增加外，疾病进展在他们中更快，并建议他们定期进行健康检查，出现任何与结核病相关症状时前往医疗机构就诊。4. 考虑到涂片阳性患者的接触者继发感染风险高于涂片阴性患者，有必要对痰涂片阳性患者的所有接触者进行全面检查。此外，对于涂片阴性但培养阳性患者的接触者，建议以与涂片阳性患者接触者类似的强度进行随访，因为尽管其接触者继发感染风险高于涂片阴性患者，但差异无统计学意义。
