and out-patient
The Government Chest Service maintained the B.C.G. vaccination treatment programme, while the voluntary agencies, aided by substantial government subventions, maintained most of the hospitals.
70.
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 to ways by which the treatment of tuberculosis could be made more efficient,
and shorter. cheaper,
Many of the results of numerous current investigations are now being applied to practice. Although these studies are primarily intended to benefit the people of Hong Kong, many of the results have worldside implications. 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 attendance for treatment. Whenever a patient defaults, immediate action is taken to call hím 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 investigate the possibility of shortening this is underway and preliminary results are encouraging.
71.
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, July 1, 1966 and notified as suffering from tuberculosis, are just beginning to become available and it should soon be possible to undertake analysis. In this connection, the collaboration of the Medical Research Council Statistical Research and Services Unit has been obtained.
Case Finding
72.
In the past, the many patients attending the chest clinics made large scale case-finding undesirable. With improved facilities and the decrease in the number of patients, case finding must now play a greater role than in the past. A shortened form of chemotherapy, which may be anything between six to nine months' treatment, should become available within the next two years. Thought is now being given as to how this improved therapy should be linked with a more intense case finding campaign. Certainly if everyone with a cough lasting more than two weeks came forward, not many cases of tuberculosis would be overlooked.
Mortality and Morbidity
73.
During the year, there was a gratifying fall in the tuberculosis death rate from 32.2 to 27.7 per 100,000 population. Tuberculosis mortality by age and sex is'shown in Figure 5. During the year, the notification rate fell to 196.0 per 100,000 of the population. Figure 6 shows the age and sex specific notification rates. Tuberculosis is much more common in men than Tuberculosis is now rare women, and is especially common among older men.
under the age of 15, probably due to the high level of B.C.G. administration to the new-born.
16
DEATHS PER 100,000 POPULATION IN AGE GROUP
500
100
50
2
1
0.0
0.6
0.4
0.2
10
15
FIGURE 5
TUBERCULOSIS MORTALITY BY AGE & SEX
1963 & 1973
MALE 1963
1973
&
FEMALE 1963
1973
FR
20
25
30 35 40 45
50
55 60
65
25+
A GE GROUP
17
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