TUBERCULOSIS
(See tables 16-22)
31. As stated previously, tuberculosis is the major health problem of Hong Kong, the estimated incidence of 1.5 per cent of adults with active disease still being amongst the highest in the world. The magni- tude of the problem makes it impossible both physically and financially to provide institutional accommodation of the order required for the isolation of all infectious cases. This policy is also important for economic reasons as persons suffering from the disease will be reluctant to seek treatment if prolonged periods of hospitalization with con- sequent loss of income are necessary.
32. The policy for control of the disease has been to protect, by vaccination with B.C.G., those most vulnerable to serious post-primary manifestations, to provide out-patient facilities for the ambulatory treatment of as many tuberculosis patients as possible and to reserve the limited hospital accommodation for patients not responding to ambulatory treatment or in need of surgical intervention. In the execu- tion of this policy there has been a high degree of co-operation between Government and voluntary agencies concerned with the problem, partic- ularly the Hong Kong Anti-Tuberculosis Association. The Government Tuberculosis Service maintains the B.C.G. vaccination and out-patient treatment programmes while the voluntary agencies, aided by sub- stantial Government subventions maintain most of the hospitals. To ensure the maximum co-operation and co-ordination a Committee which includes representatives of all the main organizations engaged in anti-tuberculosis work in Hong Kong meets regularly once every two months under the Chairmanship of the Deputy Director (Health). The formation of this Committee was in accordance with one of the recommendations made by Professor F. HEAF, C.M.G. and Dr. Wallace Fox in their report to Government on the future of the Colony's tuberculosis control programme. The remaining recommendations made in the report were studied by a small group under the Chairmanship of Dr. the Hon. Sir Albert RODRIGUES, Kt., C.B.E. and including representatives of Government, the University of Hong Kong and the Hong Kong Anti-Tuberculosis Association. The report of this group was presented to the Medical Advisory Board in January 1965 and was subsequently submitted to Government. Some of the recommendations are in process of implementation while the remainder are being closely studied.
10
#
Mortality
33. The death rates from all forms of tuberculosis continued the decline shown in past years, and the trends since 1951 are illustrated in Figure 5.
FIGURE 5
TUBERCULOSIS MORTALITY & B.C.G. VACCINATION OF NEW-BORN 1951-1965
(MORTALITY RATES EXPRESSED AS PERCENTAGE OF 1951 RATES)
100
90
*
PERCENTAGE
Ž
30
B.C.G. VACCINATION OF ALL NEW-HORN IN INSTITUTIONS.
TOTAL MORTALITY
INFANTILE MORTALITY
ព
1951 52 53 54 55 56 57 58 59 60 61 62 63 64 65
YEAR
34. Infantile mortality rate from the disease has shown an even more impressive reduction than the overall rate; it is believed that this is attributable, at least in part, to the wide acceptance of vaccination with B.C.G. for newly-born babies and the increasing application of this measure is also demonstrated in Figure 5. The average age at death from tuberculosis has risen from 32 in 1956 to 49 in 1965. Detailed analyses of the changes taking place in mortality from tuber- culosis of various ages are presented in Figure 6.
It