4th National Seminar on TB in Mongolia
TB control experience in Japan
August 1, 2000
Masakazu AOKI
President, Japan Anti-TB Asociation
1. Brief history of tuberculosis in Japan
It is sure that tuberculosis didn't exist in Japan before 4th century, because no human bone having tuberculosis change had been discovered, although many bones of this era were excavated. However, vertebral tbc. changes were confirmed in the bones of human being in the 5th and 6th century, when thousands of technicians had been invited from China and Korea. Tbc. bacilli had been imported with them.
As Japan was agricultural country and there were no so big cities or industry before Edo Era, that tbc. didn't spread so widely in those days. As small scale manufacture and commerce have developed gradually, tbc. had spread slowly in big cities such as Edo (Tokyo) and Naniwa (Osaka) in Edo Era (1601-1868).
Tbc. had spread rapidly in young female according to the development of Industry Revolution (1880-1910) in Meiji Era (1868-1912), because many young, or very young women worked at textile factories which were the first step of industrialization of Japan. Explosive spread of tbc. had occurred throughout the county during the war time (1931-1945) mainly because majority of people were mobilized to factories and/or armed forces. Fig 1 shows the trend of tbc. mortality in Japan.
"Lesson from Japanese experience"
Spread of tbc. is deeply influenced by the socio-economic change. Industrialization and urbanization is going ahead rapidly in Mongolia now. If tbc. control programme is not established confirmly now, there is a possibility that tbc. situation does not improve, but also become worse.
2. Development of tbc. control programme in Japan
1889 The first tbc. sanatorium (Sumanoura Sanatorium) was established.
1917 The first local governmental sanatorium was established.
1919 The previous "Tbc. Control Law" had been enacted.
1938 MOWH has been established.
1939 Foundation of Japan Anti-Tbc Association.
1945 Defeat. The end of the 2nd World War.
1951 The present, modern "Tbc.Control Law" has been enacted.
1953 The first Tbc Prevalence Survey had been carried out.
1961 Tbc control programme has been completely established in this year by the start of the implementation of case-holding system throughout the country.
"Lesson from Japanese experience"
Implementation of BCG vaccination policy, followed by case-finding programme is not so difficult. However, the implementation of effective case-holding (1]establishment of reporting and registration system, 2]to cure the detected cases completely as can as possible, 3]implementation of contact survey, 4]evaluation of the achievement, 5]establishment of surveillance system and so on) is the most difficult, the most expensive, but the effective programme. Never expand case-finding programme without improving case-holding system.
3. Characteristics of NTP in Japan
NTP is established on the basis of existing health and medical infrastructure of the country, so that every county has her own characteristics of NTP. The characteristics of NTP in Japan can be summarized as follows;
1) Integration.
All the clinics and hospitals including private sector can do screening of the symptomatics, and can treat tbc. patients charge free. (By health insurance and governmental expense, although slight charge is to be paid recently becauee of economical depression.)
2) Vertical tbc. control organization with central body
Tbc. control programme is being carried out according to the "Anti-Tbc Law" by the leadership of MOWH. "Division of Tbc. and Infectious Disease Control" in MOWH has the responsibility for planning, budgeting, supervision and so on. Local government of 47 prefectures and 12 big cities have the direct responsibility and are implementing NTP directly with their own Health Centres. There are 673 Health Centres in Japan now.
3) Charge free medication and hospitalization
Medication for all tbc. patients and hospitalization for iufectious tbc. patients was completely charge free previously, but now out-patient should pay 500 yen (about 4.6 US $) per month, and in-patients have to pay 1500 yen (14 US $) per month. 91.3% of smear positive patients were being treated in hospital at first in 1998.
4) Computerized surveillance system
In 1987, computerized tbc. surveillance system has been established connecting central government, local government and health centres throughout the country.
