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Viral Hepatitis

69. Notification of this disease remained voluntary. A total of 729 cases was notified in 1972. Most cases were among adolescents and adults, and a higher proportion was found among men. During the year, steps were taken to promote better and more complete reporting and investigation of the disease.

70. Developments in other communicable diseases showed little variation during 1972.

III WORK OF THE HEALTH DIVISION

AREA HEALTH WORK

71. Area health officers worked during the year to maintain satis- factory standards of environmental sanitation and food hygiene. But they also carried out field investigations into the major communicable diseases, and helped to co-ordinate the activities of teams of inocu- lators participating in prophylactic immunization campaigns.

72. Four such campaigns were carried out. They were against poliomyelitis, measles, diphtheria and smallpox. Hong Kong has not had a case of smallpox since June 1952, and the latest drive against the disease, held in February 1973, was intended to remind the public of the need to preserve this record. Moreover, the sudden outbreak of smallpox in the spring of 1973 in Britain, focussed attention on vigi- lance in view of Hong Kong's increasing importance as a crossroads in international travel in this part of the world,

TUBERCULOSIS

73. Tuberculosis remained the major health problem in Hong Kong. The policy for control of the disease continued during the year to be to protect, by vaccination with B.CG., the new-born, who were partic- ularly vulnerable to the fulminating forms of the disease, and primary school entrants and school leavers who could develop active discase later in life. For actual cases of the disease, it has been shown that in a large proportion of cases, oul-patient therapy is at least as good as institutional treatment. In complete contrast to the past, there is now no waiting list for hospital admission for the treatment of tuberculosis. Institutional resources are reserved for those not responding to out- patient therapy, for acutely-ill cases, for those where the diagnosis is in doubt, and for those in need of surgical intervention. In line with

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this policy, there is a high degree of co-operation between the Govern- ment and voluntary agencies concerned with the problem, particularly the Hong Kong Anti-Tuberculosis and Thoracic Diseases Association, the Haven of Hope Sanatorium, and the Tung Wah group of hospitals. The Government chest service maintained the B.C.G. vaccination and our-patient treatment programme, while the voluntary agencies, aided by substantial government subventions, maintained most of the hospitals. 74. To keep pace with rapid changes occurring in the treatment and prevention of tuberculosis, close liaison continued to be maintained with agencies outside Hong Kong. During the year, there was much activity, in collaboration with the Medical Research Council of the United Kingdom, as in ways by which the treatment of tuberculosis could be made more efficient, cheaper, and shorter. Many of the results of numerous current investigations are now being applied in practice. Although these studies are primarily intended to benefit the people of Hong Kong, many of the results have worldwide implica- tions. As it has been shown that the advantages obtained from routine pre-treatment sensitivity testing in newly-registered cases are minimal, routine pre-treatment sensitivity testing, previously thought to be important in view of the high level of drug resistance in Hong Kong, has been abandoned. Reliance is now placed on regular examination of the sputum as the best monitor of response to treatment. That failure to take drugs is an important cause of treatment failure has been clearly demonstrated for the Hong Kong population in one of the recent controlled trials. In view of this, a careful record is kept of altendance for treatment. Whenever a patient defaults, immediate action is taken to call him back either by a home visit or by telephone. The present course of treatment for tuberculosis is long and arduous, averaging some 18 months. A large controlled clinical trial to inves- tigate the possibility of shortening this is underway.

75. There have also been important investigations with regard to B.C.G., particularly in the methods of administration of B.C.G. at birth, when full-time, highly-trained staff are not available. Results of the survey on children born on, or after, 11th July, 1966, and notified as suffering from tuberculosis, are just beginning to become available. In this connection, the collaboration of the Medical Research Council Statistical Research and Services Unit has been obtained. The study on direct B.CG. given to children of school age has been completed, and this indicates that direct B.C.G., except for the new-born, has a small role to play in Hong Kong.

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