137. Following on this investigation, there occurred the mass entry of illegal immigrants in April and May and between Junc and September over 68,000 of this group applying for registration were submitted to a chest X-ray. This group had a much more average age and sex distri- bution than the previous group of arrivals investigated early in the year and they were more preoccupied with getting work than with medical treatment. Preliminary assessments indicate that in the younger age groups of the illegal immigrants, tuberculosis was less prevalent than in the urban population of Hong Kong, but that in the elderly immi- grants some 15% had active tuberculosis. Also amongst the immigrants $1% of the active disease was resistant to one or more of the drugs in standard use, namely streptomycin, INAH and P.A.S.
138. The major problem now facing the tuberculosis control services is the detection and treatment of pulmonary disease in the elderly, many of whom are suffering from extensive and drug resistant disease.
Work of the Government Tuberculosis Service
139. All cases attending the Government Chest Clinics are given treatment free, irrespective of origin. The increasing volume of work undertaken at the Government Chest Clinics during the past five years is detailed in Table 8.
TABLE &
WORK OF DOVERNMENT CHEST CLINICS 1958-62
1958
1960
39,454 39,008 35,991 12,270 14,406 12,937
1961
796.2
40,046 43,519 15,270 16,541
intention of ultimately rendering them catalase negative', Hospital ad- mission is arranged for those patients whose treatment can be expedited by surgical or other means or who, for medical or very pressing social reasons, require in-patient treatment.
141. There are four full-time Government Chest Clinics which, in addition to normal day-time working, offer one evening diagnostic session each week. Part-time clinics are maintained at twelve other centres and a sessional advisory service is provided at four other centres maintained by voluntary agencies. In addition to these specialized sessions, routine sessions are provided for the daily injections of strep- tomycin at a number of centres, for the convenience of patients who cannot travel regularly to the full-time clinics.
142. Case-finding is not practised on any scale as the available services are already heavily committed to the care of those patients who present with active disease. All Government employees undergo an annual X-ray examination and similar surveys are undertaken, on request, of employees in industrial concerns and private institutions, subject to certain conditions concerning sick-leave and re-employment for persons found suffering from active disease. Otherwise, little case- finding is performed, but this aspect of the control programme will require detailed consideration in the near future. The results of surveys undertaken during the year are shown in Table 9.
TABLE 9
First attendances
Cases of tuberculosis discovered
Total attendances for treatment Under treatment from previous year
803,326 1.655,100 2,001,960 2.204.058 1,901,435
9.132
13,733 16,062
16,433 17.74
Started treatment during the year
11,546
$1,357 12,417
12,381
12.190
Completed treatment
1.049
2,064
3.724
3,776
4.935
Total examined
Failed to attend
3.048
5.391
4.975
4,987
5,371
Clinically re-examined
Admitted to hospital from chest
clinics
Active tuberulosis
1.511
1,587
1,592
889
021
Still on treatment ut end of year
13,733
16,062
16,434 17,714
17.372
Percentage active tuberculosis
X-RAY SURVEYS—1962
Government Conditional
Employees Surveys
Prisoners
39,232 5.311
20,019
3,852
2,009
1,036
408
412
323
1.04
2.06
3.52
140. Treatment at the Chest Clinics is by ambulatory chemotherapy, which includes daily injections of streptomycin six days each weck combined with oral PAS and INAH, for a period of six months. At the end of this period, the oral therapy is continued for a period of up to two years from the start of treatment. Some chronic cases with positive sputum are maintained for long periods on INAH with the
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143. Following the diagnosis of a case of tuberculosis, Tuberculosis Workers visit the patient's home and arrange for the examination of the family and other close household contacts; those under eight years of age are tuberculin tested and those over that age are X-rayed. During the year a total of 17,353 contacts were fully investigated, the findings being detailed in Table 10.
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