TUBERCULOSIS
145. The current policy for the control of tuberculosis, which is the major endemic disease problem facing Hong Kong, must be viewed against the background of the epidemiology and of the economic and social circumstances.
146. By the age of 15, 94.6% of the population show a positive tuberculin test: an average of 12% show radiological evidence of pulmonary disease either arrested, quicscent or active. It is estimated that 2% of the total population bave active tubercular disease,
147. The following table indicates the levels of sensitivity to tuber- culin in three main age groups:
Age group
1--6 years
7—14 yearA
15 + усята
TABLE 5
% positive
34,2%
72.8%
94.6%
148. The existing social conditions of overcrowding and low average încome of a large section of the population have been dictated by the phenomenal influx of refugees. This has given rise to conditions comparable to those existing in industrial communities in the United Kingdom fifty years ago. At that time, without modern forms of therapy available, treatment was by segregation in institutions which ensured adequate rest and nutrition; the optimum provision of beds for the treatment of tuberculosis was considered to be one bed for each death from the disease. This standard applied to Hong Kong today would require 2,302 beds in institutions set aside solely for the care of tuberculosis.
149. To attain any comparable standard has been beyond the physical or staff resources of the Colony during a ten year period when the influx of population has strained all resources to the utmost. However, the advent of antibiotics, chemo-therapeutic remedies and an immunizing vaccine of proved efficacy has made possible an epidemic- logical approach aimed at sterilizing sources of infection, the immuniza- tion of babies and young children during their most vulnerable years and the full use of such hospital beds as are available for cases who can be cured and returned to the community as useful citizens,
150. Since 1952, the measures developed for the control of tuber- culosis have consisted of ambulatory chemotherapy, the vaccination of newborn babies with B.C.G, and the provision of hospital facilities for
the medical and surgical rehabilitation of patients judged to be curable. During this time the number of cases receiving ambulant chemotherapy has risen from 668 in 1952 to 20,678 in 1958; the percentage of new- born infants receiving B.C.G. vaccination has risen from 4.5% to 47% and hospital beds for the treatment of tuberculosis have increased from 573 to 1.444. Economic and social conditions have remained sub- stantially the same. Nonetheless the death rate from tuberculosis has continued its downward trend and the magnitude of this trend appears to indicate that the control measures are meeting with some degree of success.
TABLE T
Year
Eximated Population
Death rate
per 100,000
TUBERCULOSIS
Percentage o total dearfis
Percentage of ruberculosły deaths below 3 years
1946 ..
1,800,000
108.9
14.6
1949
1.657.000
140.6
16.0
34,2
1950
2,265,000
144,0
17.7
38.3
1951
2,013.000
208.0
20.0
34.0
1952
2,250.000
138.8
18.4
34.3
1953
2,250,000
130.6
16.0
36.2
1954
2,277,000
126.3
14.9
31.2
1955
2,340,000
120.0
14.7
28.0
1956
2,440.000
107.0
13.6
25.0
1957
2,583,000
103.6
13.9
21.2
1958
2,748.000
80.8
t1.2
19.6
151. Reference was made in the last Annual Report to the sharp rise in the deaths from tuberculosis recorded during the influenza epidemic occurring in April and May 1957, This resulted in an apparent slowing in the fall in the death rate between 1956 and 1957; the sub- sequent drop in the rate by 20% between 1957 and 1958 may therefore not be as significant as it appears, but it is nonetheless encouraging. Deaths from all forms of tuberculosis in children under five years of age, which can be regarded as an index of the efficacy of control measures, have fallen by 25%; the figure for deaths from pulmonary disease in this age group has remained relatively unchanged, but one must bear in mind that deaths from tuberculosis at this age are notoriously difficult of accurate diagnosis. In tuberculosis (other forms) the fall has been 60%.
152. In patients over five years of age pulmonary disease continues to account for 92% of the total deaths from tuberculosis. The ratio of male to female deaths at all ages over five is two to one but in the forty-five to forty-nine age group this ratio rises to four to one, a feature
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