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Chemoprophylaxis

102. A large proportion of the deaths from tuberculosis in child- hood are caused by acute post-primary disease; this is especially true in the case of tuberculous meningitis. Efficient B.C.G. vaccination offers good protection against the disease at such time of life, but in those children without such protection and who acquire a natural and hence, virulent, infection the possibility of progressive development of the disease is over present. To such cases, discovered by Mantoux testing of home contacts and attenders at Child Health Clinics under the age of three who have not received B.C.G., IN.A.H, is administered for a period of one year.

103. This is a measure which is applicable to a small number of children and during the year only 180 were given this treatment. It is expected that the number will be further reduced as the popularity of infant B.C,G. vaccination increases.

B.C.G. Paccination

104. The B.C.G. vaccination campaign is now incorporated into the general organization of the Tuberculosis Service, with the assistance of certain other branches of the Medical and Health Department such as the School Health and Maternal and Child Health Services. The central B.C.G, office is mainly a supply organization but it is responsible for the examination and vaccination of contacts, surveys of children in certain groups and for the operation of the campaign to offer vaccina- tion to all new-born children. It is in the last-mentioned sphere of activity that the most spectacular results have been achieved and, dus to the central organization of the campaign plus the increasing co- operation of voluntary and private hospitals and doctors and midwives in private practice, the percentage of new-born infants who receive such protection rose during 1960 to the satisfactory figure of 71.5 per cent. The progress during the past five years is shown in Table 9,

TABLE 9

B.C.G. VMOCINATION OF NEW-BORN BABIES 1956-60

(within 48 hours of birth)

Year

Percentage Vaccinured

1956

24.21

1957

35.93

1958

46.86

1959

59.53

1960

71.54

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105.

By the end of the year, almost all infants delivered in Govern- ment or Government-assisted institutions were receiving this protection. It is now in the field of private midwifery practice that further advances must be made and a refresher course was organized accordingly, for all private midwives, in the technique and value of B.C.G. vaccination. Attendance and interest were most encouraging and there is already an increase in the number of B.C.G. vaccinations performed by these members of the profession. For new-born babies the vaccine is adminis tered by the multi-puncture method.

106. Vaccination of other groups of children is carried out by the classical intradermal method and is administered to all tuberculin- negative contacts of known cases of tuberculosis. It is also performed on tuberculin-negative children attending School Health and Maternal and Child Health Clinics and at the B.C.G. clinic operated by the Hong Kong Anti-Tuberculosis Association.

107. Reference has already been made to the findings from Maternal and Child Health centres which suggest that exposure to infection amongst the young age groups remains virtually unchanged from that existing eight years ago. Further, home conditions and the number of active cases of tuberculosis amongst adults have not changed materially. It would appear, therefore, that the improvements recorded in morbidity and mortality from tuberculosis amongst young children of five years and under can be attributed to the extent of the B.C.G. vaccination campaign. particularly in the new-born. The prophylactic regime of LN.A.H. for child contacts is administered to so few that it cannot have had any significant impact on the total situation in the 0-5 age group.

Chest Surgical Clinics

108. Chest surgical clinics are held at regular intervals in the Wan Chai Chest Clinic by both the Government Thoracic Specialist and by the Chest Surgeon attached to the Grantham Hospital, while cases are also referred to the Ruttonjee Sanatorium for surgical treatment there. The waiting list was considerably reduced during the year, but there still remains a number of more complicated cases requiring pneumon- ectomy who are harbouring resistant organisms as a result of an un- satisfactory response to ambulatory chemotherapy.

Orthopaedic Clinics

109. Regular sessions for patients suffering from bone and joint tuberculosis are held in a number of Chest Clinics under the combined

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