affected is a slow process, despite the very considerable efforts of the Health staff of the New Territories.
TUBERCULOSIS
117. Mention was made in the Report for 1962-63 of the visit of Professor F. HɛAF, C.M.G., the Adviser on Tuberculosis to the Secretary of State for the Colonies und of Dr. Wallace Fox of the Medical Research Council Tuberculosis Research Unit in London. The pattern for the existing Government Tuberculosis Service was determined in 1952 and a review of the organization which has developed over the past 10 years for the control of tuberculosis and the results of the main policy was timely. While the broad principles of the report have been accepted, the detailed recommendations, particularly those concerning research, are still under active consideration by Government,
118. In brief, the policy has been to protect, by vaccination with B.C.G. those most vulnerable to fatal post-primary manifestations of the disease, to provide out-patient facilities for the ambulatory treat- ment of as many tuberculosis patients as possible and to reserve the limited hospital accommodation for the care and treatment of those patients not responding to ambulatory treatment or in need of surgical operations to hasten recovery. With an estimated two per cent incidence of active disease in the adult population it has been physically and finan- cially impossible to provide institutional care of the order required for the isolation of all infectious cases.
119. Full assessment of the results of this policy has not yet been possible. There has been a great reduction in overall mortality from tuberculosis which has been most marked in children. The incidence of the disease in children has also been lessened considerably. In adults, however, there would appear to be only a very gradual decline in inci- dence with comparatively high morbidity rates in various age-groups over 45 years; it is in these age-groups that there is also a high degree of resist- ance to 'first-line' drugs.
Mortality
120. The number of deaths from all forms of tuberculosis continued the decline shown in past years; the mortality pattern since 1951 is shown in Table 12.
Year
1951
1952
1953
TABLE 12
MORTALITY FROM TUBERCulous 1951-63
Tuberculosis deaths as percentage of
Percentage of ruberculosis deaths below $ years
Estimated
Population
Tuberculosis Death Kare
(mid-year)
per 100,000
total deaths
JAG
2,013,000
208.0
20.0
34.0
3,250,000
158.8
18.4
34.3
2.250.000
130.6
16.0
36.2
1954
1935
1956
2.277.000
126.3
14.9
31.2
...
2,340,000
120.0
14.7
28.0
ING
2.440.000
107.0
13.6
25.0
1957
2,583,000
103.6
13.9
21.2
1958
JAI
2,748,000
83.8
11.2
19.6
1959
2,857,000
75.2
10.7
19.2
1960
2,981,000
69.9
10,8
10.5
1961
3,177,700
60.0
10.2
113
1962
3,400,300
55,3
9.25
5.74
1963
3,592, 100
49.05
8.9
5.50
121. The infant mortality rate from tuberculosis has continued to fall rapidly and in 1963 the rate was 0.16 deaths per 1,000 live births, which represents only 5.6% of the figure ten years ago. This is attributable to the wide acceptance of vaccination with B.C.G, for newly-born babies; in 1963, 83.44% of all new-borns received this vaccine compared with 4.32% in 1952.
122. The average age at death again rose slightly to a figure of 47 years.
Morbidity
123. Notifications of tuberculosis have fluctuated between 12,000 and 15,000 per year during the past ten years. The rate of notification has, however, continued a steady downward trend since 1955, except for the 1962 figure which was artificially inflated by the large number of illegal immigrants entering during that year. The rate for 1963 was 363 notifications per 100,000. Details of notifications according to origin are shown in Table 13.
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