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 7. Detailed analysis of the changes taking place in mortality from tuberculosis of various ages are presented in Figure 8: it will be observed that, apart from the greatly-improved control of childhood mortality, there has been a postponement, varying from five to ten years, of death from the disease amongst adults.
Morbidity
40.
Notifications of tuberculosis have Auctuated between 12,000 and 15,000 during the past ten years. However, the rate of such notifications per unit of population has shown a steady downward trend, with the exception of 1962 when artificial inflation resulted from the largs number of illegal immigrants entering the Colony during that year. Figure 9 shows the changes which bave taken place in the age and sex- specific morbidity rates (as measured by notifications). It will be seen that there have been marked reductions in incidence of the disease
MORBIDITY PER 100000 IN AGE GROUP
1,300
1000
600
400
300
+
-0
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FOURE 1
TUBERCULOSIS MORBIDITY 1956 A. 1964
(AS MEASURED BY NOTIFICATIONST
J
-
L
15- 15 10 15 AM 45%
AGE GROUP
1964 MALE
1956 MALE
1956 FEMALE
FEMALE
during childhood, that there has been litle change in the vulnerability of young adults between the ages of 15 and 24 and that in the older age-groups there has been, particularly amongst women. only a slight decrease in the morbidity. The relative susceptibility of males, except in childhood, corresponds with the well-documented pattern recorded elsewhere in the world.
Work of the Government Tuberculosis Service
41. The Government Chest Clinics provide ambulatory cherno- therapy services for the great majority of cases of tuberculosis present- ing, hospital admission being reserved for patients requiring specialized surgical or medical treatment. The clinics also provide medical social work and contact tracing and supervisory services and undertake surveys of selected groups, such as Goverment employees and prisoners, in co-operation with the Radiological Service.
42. The size and increasing complexity of the service for the control of tuberculosis is such as to require the separation of its administration from the clinical supervision of cases. Accordingly, one post of Specialist was substituted by a post of Assistant Director, who will be responsible for all public health and administrative aspects of this complex organization while the diagnosis and treatment of cases will continue to be supervised and controlled by a clinical specialist in chest diseases.
43. The gradual decline in numbers of attendances, reported during recent years, was maintained, but was off-set to a certain extent by the high incidence of primary drug resistance which had been demonstrated by research undertaken in conjunction with the British Medical Re- search Council. Results of these investigations indicated that the level of drug resistance in Hong Kong was probably the highest in the world, 40% of the organisms investigated showing a resistance to one or more of the drugs commonly used in ambulatory chemotherapy.
44. A register of resistant cases was started at the main clinics during the year. A total of 946 cases were registered, of which 810 were bacteriologically resistant to at least one drug, and these patients were entered on the waiting list for admission to hospital for treatment with 'second-line' drugs.
45. The work of hospitals dealing with tuberculosis cases is reviewed elsewhere in this report.
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