219. It will be seen that the numbers tuberculin tested have fallen year by year while the numbers vaccinated with B.C.G. have reached a new record annual total as a result of the rise in the number of new born babies vaccinated.
B.C.G. Vaccination of New Born Babies
220. B.C.G. Vaccination of new born babies is carried out by the multipuncture method using 20 mgm/c.c. vaccine. This vaccine is avail- able free to private practitioners, private hospitals, midwives and clinics. B.C.G. Vaccinators attached to the Tuberculosis Service now visit the principal maternity hospitals three times each week instead of twice each week as in previous years. This has necessitated an increase in the establishment of Vaccinators from two to three as it was found that a number of babies were leaving hospital before vaccination could be given. Of the total of 97,834 births known to have occurred during the year 1957, 36% were vaccinated with B.C.G. as compared to 24% in 1956. It is of interest to record that in the small institutions, where the number of births is low, the highest percentage of vaccinations is obtain- ed. It would be reasonable therefore to assume that mothers can be persuaded to have their children vaccinated if trouble and time can be taken so to do.
B.C.G. Vaccination of other Age Groups
221. Vaccination of individuals other than new born children is carried out by the classical intradermal route, using vaccine of a strength of 1 mgm/c.c. The tuberculin test in use is the Mantoux test of five International Tuberculin Units of Purified Protein Derivative, obtained from Copenhagen in bulk, Vaccination of negative reactors is carried out as a routine measure in the Chest Clinics in connexion with tuber- culosis contacts, in the School Health Service and in the Maternal and Child Health Service. A B.C.G. Clinic is also maintained on a full time basis by the Hong Kong Anti-Tuberculosis Association. The total number of persons tuberculin tested by all these organizations during the year was 34,737. Of these 10,074 were subsequently vaccinated, an im- provement on last year's total of vaccinations.
X-ray Surveys
222. General, No general population X-ray surveys were carried out during the year as the facilities for subsequent diagnosis and treatment are already overstrained to such an extent that a limitation of the numbers of these attending for the first time has continued in force throughout the year. Certain special groups were examined.
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223. Government Servants. All Government servants are DOW X-rayed on first appointment and thereafter at annual intervals. This annual examination has been in force for several years and is paying handsome dividends by a reduction of total sick leave, by a considerable annual reduction in the numbers invalided as a result of tuberculosis and by a significant improvement in the prognosis of the cases found. A few individuals are still not regularly examined, but the number is small. The results of surveys during the past few years are :
Total X-rayed
Examined at the clinics Active tuberculosis percentage New active cases
TABLE 19
1953 24,915 2,746
1954 26.255 26.574
1955
1956
1957
27,842
30,231
3,282
3,751
4.347
3.873
0-722
1017
1-272
1-34
1-61
64
101
77
76
64
224. For the first time there has been a fall in the total numbers requiring examination, while the percentage of active cases has further increased. The percentage incidence of new disease remains fairly
constant.
225.
Private Firms and Institutions. Surveys are carried out free of charge provided that a guarantee is obtained which ensures the protection of the patient, with special reference to sick leave with pay and security of tenure of employment. Employees found to be suffering from tuberculosis have complete freedom of choice as to where they obtain treatment.
226. The Tuberculosis Almoner is designated as the officer respon- sible for the contact between private firms wishing to have X-ray surveys of their employees, the Radiological Department, who do the X-ray in connexion with the surveys, and the Chest Clinics who do the clinical assessments and issue the survey reports.
227. The findings for the year, with comparative findings for the previous year are:
TABLE 20
19.50
1957
Total X-ray on 35 mm films
2,870
8.991
Reported normal
2,547
7,617
Clinically examined
322
1.352
Active tuberculosis
30
191
Percentage of active tuberculosis
104%
2.1%
228. The reason for the considerable disparity between the findings
in the two successive years is that during 1956 the smaller total consisted
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