結核のサーベイランス (II)

抄録

It is true that the risk of infection is very important index to know the tuberculosis situation in a given community, but it is very difficult to know it in a community having a population of rather small size. There are 859 health centres in all over Japan, and tuberculosis patients are registered to these local health centres. The health centre has the direct responsibility for administration of tuberculosis problems in a given community. As the average population size covered by one health centre is about 100.000, it is important and practical problem in Japan to reveal the ways to make clear how big tuberculosis problem is in the area of such population size.
As a routine work, annual reports including the number of new cases during one year and that of all the registered cases at the end of the year are submitted from health centres to the local and central government. The way of analysis to make clear the tuberculosis problems of the area by evaluation chart (Fig. 1) was introduced and discussed. The evaluation charts are out-puted by mini-computer in the Research Institute of Tuberculosis, J. A. T. A. within a short period, and the feed-back to the local health centres had now started in some prefectures from 1977. As this evaluation chart shows specific problems to be improved of a given health centre, it is considered that this method is one of the useful ways of tuberculosis surveillance at the health centre and/or prefecture level.
Many epidemiological indices showing tuberculosis problem could be calculated from the annual report. As many of them correlated so well with each other (Table 1) that one could estimate tuberculosis situation roughly by the incidence, as a representative one of many indices in Table 1. The way to print out the names of health centres having abnormal incidence and/or other indices to give advises to them has been established already by the Institute, too.
As the variation of diagnostic standard might be rather wide by areas, the importance of smear positive incidence was stressed.
In the field, one might doubt tuberculosis epidemic if the incidence increased than that of the previous year. Comparison of the incidence of 1975 and 1976 revealed that the incidence has decreased 9.4% as an average, but in about one fourth health centres, the incidence had increased than that of the previous year. Informations of incidence of infants, that of more small areas, results of contact surveys and/or the results of tuberculin survey might be much more important than that of the total incidence to detect tuberculosis epidemics.