X1000306-1960-61_Part01 — Page 17

been exposed to at least one type, and that more than half have, by the same age, developed immunity to all three types.

Tuberculosis

88. Tuberculosis remains the major public health problem of Hoog Kong and although there are indications that control measures are beginning to exert an effect, particularly in regard to the disease in childhood, much remains to be done. The problem is considered in detail elsewhere in this report.

Other Notifiable Infectious Diseases

89. Influenza, which has been notifiable on a voluntary basis since 1957, did not present a problem during 1960. There were few notifica- tions of scarlet fever and whooping cough, and only one case of puer- peral fever was recorded. Reports of ophthalmia neonatorum remained almost unchanged in numbers as compared to the previous year.

Other Communicable diseases which are not notifiable

Tetanus

90. Of 165 cases of tetanus admitted to hospital, 61 occurred in new born children. Most of these cases of tetanus deonatorum, which carry an average fatality rate of sixty four per cent, occur in the children of mothers who, having previously borne a number of infants delivered in institutions, have decided for one reason or another to have the next baby at home. In such cases, assistance by an untrained person, the use of unsterile material and instruments and the common practice of applying ground ginger root to the umbilicus as a styptic, all combine to give a grave risk of tetanus neonatorum.

Food Poisoning

91. Three hundred and fifty six cases of food poisoning were recorded. Of these, forty six were due to coagulase positive staphy- lococci, many of which had developed a resistance to a wide range of antibiotics.

TUBERCULOSIS

92. Tuberculosis continues to present the major public health prob- lem in Hong Kong and there still remains a large volume of un- diagnosed cases in the community. An investigation into the individual deaths notified suggests that less than half of such cases have been recognized prior to death. Furthermore, morbidity, as measured by the

22

number of cases reported annually, has varied very little amongst the adult age-groups during recent years.

93. It is in the prevention of tuberculosis amongst children and in the reduction of mortality at all ages that the control programme has achieved the main successes. Table 6 details the progress over the past five years.

TABLE &

TUBERCULOSIS IN HONG KONG 1956-60

TUBERCULOSIS

Year

Estimared population

Percentage of

Deah Fare

per 100,000

Percentage of total deaths

ruberculoris deaths

below 3 reurs

1956..

2.440,000

107.0

13.6

35.0

1957

1958

2,583,000

103.6

13.9

212

2,748,000

83.9

11.3

19,6

1959 ..

2,857,000

76.2

10.7

19.2

1960.

2.961.000

69.9

10.8

10.5

94. It will be noted that there has been a steady fall in the death rate although the proportion of the total deaths from all causes resulting from tuberculosis has declined only slowly. However, the mortality amongst children under the age of five years has been falling rapidly during recent years.

95. Parallel to the fall in child mortality from tuberculosis, there bas been a marked reduction in the morbidity, as measured by the num- ber of notifications received in spite of the increasing numbers at risk. There is little doubt that there have been improvements in general child health during recent years due to better economic and social conditions; should these have played a great part in the reduction of child tuber- culosis, it would be expected that there would have been some reflection of them in a reduced incidence in adults and this has not happened. A further possibility is a reduced reservoir of infection; this also is not the case. In the year 1952, the percentage of reactors to tuberculin in the age-group 0-6 years was thirty four. In 1960, all children in this age- group attending Maternal and Child Health centres, who gave a definite history of not having received B.C.G. vaccination, were tuberculin-tested and the percentage showing a positive reaction was thirty eight. It is therefore reasonable to assume that the B.C.G. vaccination of new-born babies, along with chemo-prophylaxis, using LN.A.H., in the limited group with tuberculin sensitivity naturally acquired under the age of three years, have been the major factors in effecting this reduction.

23