X1000307-1958-59_Part01 — Page 28

204. The detail of the work done by the Tuberculosis Workers is as follows:

TABLE 14

First visits to patients Revisits

W

Number of contact cards issued Contacts examined as a result

1957 1958 7,766 10,381

4,826 4,874 15.028 16,202 11.403 11,801

205. It is largely through the use of the Tuberculosis Workers that the clinics have been able to deal with the greatly increased volume of work.

B.C.G. Vaccination

206. The value of B.C.G. vaccination as a protective measure is still widely disputed. Much of the controversy arises from differing concepts of tuberculosis control based on varying social circumstances of the populations at risk. In those countries where public health services have been developed to a level that provides of adequate housing. no over-crowding, high standards of nutrition and optimum ratios of hospital beds to population, tuberculosis morbidity and mortality have been reduced to a very low level. Therefore it is argued with consider- able force that to eradicate tuberculosis in is essential that minimal infections, without signs of active diseases, should not be masked by B.C.G. vaccinations; if there is no B.C.G. vaccination, then tuberculin testing is a certain means of detecting potential sources of infection before the disease progresses to the stage of open tuberculosis and these potential sources can thus be detected, segregated and treated. Undoubtedly this is a rational and logical approach within these highly favoured communities,

207. At the other end of the scale there is the underdeveloped and cven primitive community coming into close contact for the first time with tuberculosis and without any immunity or means of providing the services essential to initiate control measures. Here it has been argued, perhaps also with some foroc, that mass B.C.G. vaccination of the total population without Tuberculin Testing is the only economic method of dealing with the situation pending the build-up of health services to the best level attainable.

208. Reference has been made earlier to the environmental back- ground and morbidity statistics against which the problem in Hong Kong must be assessed. The segregation of all open cases of tuberculosis is a practical impossibility within the immediate future. The greatest part of the population has had minimal disease at the age of fifteen years

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and has at least temporarily overcome the infection. In fact 98% of the population is not suffering from infectious tuberculosis; the 2% of active cases, is however a continuing source of danger to the non- immunes. As it is not yet possible to sterilize this source by a complete chemo-therapy cover, any measure of proved efficacy that will protect the younger and most vulnerable age groups must be adopted. Protection thus conferred may at least postpone a natural infection during a period when the body forces are being mobilized to deal with continuing exposures to often massive doses of the Mycobacterium tuberculosis. 209. Accordingly, B.C.G. vaccination of babies by Tuberculosis Service staff within 2-3 days of birth has been adopted as a routine in all large maternity hospitals in the Colony. All other agencies engaged in this work are encouraged to make use of the free supply of B.C.G. vaccine and part of the training of all registered midwives ensures a practical knowledge of the techniques of B.C.G. vaccination. As has been mentioned carlier the tuberculosis mortality rate from all forms of tuberculosis occurring in the 0-5 age group has been reduced by balf over the past six years: social and environmental factors for this age group have not changed significantly and the only new factor introduced has been the use of B.C.G. vaccination.

210. Under the sponsorship of UNICEF. an intensive BCG. vaccination campaign was started in 1952, This campaign continued until 1955 when the Tuberculosis Service took over full responsibility for the routine vaccination of newborn babies. The campaign staff was then absorbed into various units within the Medical and Health Depart- ment and the function of the central B.C.G. office became mainly that of a supply organization with a total staff of five. The B.C.G. vaccine is obtained from the Alabang Laboratories in Manila,

211. The work done since the beginning of the campaign in 1952 is as follows:

TABLE 15

Tuberculin Test Completed Negative

B.C.G, Paccination

New Borns

Grand total vaccinated

Year

Test

vaccinated

vaccinated

1952

176,728

38,173

3,120

41,293

1953

77.422

27,024

4,883

31,907

1954

52.620

15,234

3,050

18,284

1955

58,606

15.775

9,587

25,362

1956

38.523

5,629

23.418

29.047

1957

34.737

10,074

35.149

45.223

1958

29,107

10,390

49,865

60,255

Total

467,743

122,299

129,072

251,371

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"