CRITERIA OF HOSPITALIZATION AND DISCHARGE FOR TUBERCULOSIS IN THE WESTERN DEVELOPED COUNTRIES AND COMPARISON WITH THAT OF JAPAN

Abstract

We studied the criteria of hospitalization and discharge in western developed countries, and compared with the criteria of Japan. For 9 regions of USA, New York, Canada, EU, UK, Germany, France, Spain, and Italy we investigated using inter-net search, Pub-Med and other electrical document search webs, official documents expressing opinion on infectiousness after starting chemotherapy and criteria for discontinuing isolation, hospitalization and discharge. In western developed countries, it is the standard opinion that time interval to lose infectiousness after starting chemotherapy is unknown. In many countries there are still remained the hospitalizations for short-term isolation or secure treatment adherence. In criteria for discontinuing isolation or discharge from hospitals, integrated risk of contact with tuberculosis patients (risk of progression to disease when infected and of severe form of tuberculosis such as drug-resistant cases and disseminated or meningitis) is more important determinant than infectiousness itself of tuberculosis patients. In western developed countries, they did not insist on outpatient treatment but adopted flexible policy for hospitalization. In the USA too, inpatient treatment for early treatment phase is frequently seen, and for necessary cases long-term hospitalization is made. The criteria of Japan were thought to focus too strictly on the infectiousness itself of tuberculosis patients.