REFORM OF JAPAN'S NTP AND ITS TECHNICAL PERSPECTIVES The 79th Annual Meeting Special Lecture
The 1951 Tuberculosis Control Law of Japan is now faced with tremendous changes that have occurred during the last 50 years in tuberculosis epidemiology and in the environment in tuberculosis control implementation. The law is also challenged with the shift of the paradigm for the National Tuberculo...
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| Published in | Kekkaku(Tuberculosis) Vol. 79; no. 10; pp. 587 - 604 |
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| Main Author | |
| Format | Journal Article |
| Language | English Japanese |
| Published |
JAPANESE SOCIETY FOR TUBERCULOSIS
15.10.2004
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0022-9776 1884-2410 |
| DOI | 10.11400/kekkaku1923.79.587 |
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| Abstract | The 1951 Tuberculosis Control Law of Japan is now faced with tremendous changes that have occurred during the last 50 years in tuberculosis epidemiology and in the environment in tuberculosis control implementation. The law is also challenged with the shift of the paradigm for the National Tuberculosis (TB) Programme. In order to respond properly to these changes, the Tuberculosis Panel of the Health Science Council of the Ministry of Health, Labor and Welfare submitted its report for the amendment of the law in March 2002. Based on this report, a new Tuberculosis Control Law was passed in Parliament last June, and related decrees of the Cabinet and the Ministry are now being revised in preparation for it's enactment in April 2005. In this special lecture, the main points and framework of the revisions were discussed with the perspective of the development of new technical innovations relevant to each area of the revised TB control legislation. 1. Case detection. There will be a shift from the current “indiscriminate” screening scheme to a selective one regarding periodic mass health examination. Only subjects aged 65 or older will be eligible for the screening, supplemented with selected occupational groups who are considered to be at a higher risk of TB, or may be a danger to others if they develop TB, such as health-care providers and school teachers. In addition, local autonomies are responsible for offering screening to the socio-economic high-risk populations, such as homeless people, slum residents, day laborers, and/or workers in small businesses. This means that the efforts of the autonomies are critical for the new system to be effective. The extraordinary examination will be limited to only the patient's contacts, and will be mandatory for those contacts so they cannot refuse to be examined by the Health Center. The public services used in the contact investigations will be greatly facilitated by such new technologies as DNA fingerprinting of TB bacilli and a new diagnostic of TB infection using wholeblood interferon-gamma determination (QuantiFERON). The quality of clinical diagnosis and monitoring of treatment should also be improved by introducing an external quality assurance system of commercial laboratory services. 2. Chemoprophylaxis. Although not explicitly defined in the new legislation, the expansion and improvement of chemoprophylaxis to cover anyone with any risk of clinical development of TB would have a tremendous effect in Japan, especially since 90% of patients who developed TB were infected tens of years ago. These technical innovations in diagnosis of TB infection will be very helpful. Development of new drug regimens for the preventive treatment is also badly needed. |
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| AbstractList | The 1951 Tuberculosis Control Law of Japan is now faced with tremendous changes that have occurred during the last 50 years in tuberculosis epidemiology and in the environment in tuberculosis control implementation. The law is also challenged with the shift of the paradigm for the National Tuberculosis (TB) Programme. In order to respond properly to these changes, the Tuberculosis Panel of the Health Science Council of the Ministry of Health, Labor and Welfare submitted its report for the amendment of the law in March 2002. Based on this report, a new Tuberculosis Control Law was passed in Parliament last June, and related decrees of the Cabinet and the Ministry are now being revised in preparation for it's enactment in April 2005. In this special lecture, the main points and framework of the revisions were discussed with the perspective of the development of new technical innovations relevant to each area of the revised TB control legislation. 1. Case detection. There will be a shift from the current “indiscriminate” screening scheme to a selective one regarding periodic mass health examination. Only subjects aged 65 or older will be eligible for the screening, supplemented with selected occupational groups who are considered to be at a higher risk of TB, or may be a danger to others if they develop TB, such as health-care providers and school teachers. In addition, local autonomies are responsible for offering screening to the socio-economic high-risk populations, such as homeless people, slum residents, day laborers, and/or workers in small businesses. This means that the efforts of the autonomies are critical for the new system to be effective. The extraordinary examination will be limited to only the patient's contacts, and will be mandatory for those contacts so they cannot refuse to be examined by the Health Center. The public services used in the contact investigations will be greatly facilitated by such new technologies as DNA fingerprinting of TB bacilli and a new diagnostic of TB infection using wholeblood interferon-gamma determination (QuantiFERON). The quality of clinical diagnosis and monitoring of treatment should also be improved by introducing an external quality assurance system of commercial laboratory services. 2. Chemoprophylaxis. Although not explicitly defined in the new legislation, the expansion and improvement of chemoprophylaxis to cover anyone with any risk of clinical development of TB would have a tremendous effect in Japan, especially since 90% of patients who developed TB were infected tens of years ago. These technical innovations in diagnosis of TB infection will be very helpful. Development of new drug regimens for the preventive treatment is also badly needed. |
| Author | MORI, Toru |
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| Copyright | THE JAPANESE SOCIETY FOR TUBERCULOSIS |
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| References_xml | – reference: 63) 冨岡治明: 新しい抗結核薬開発の展望.結核.2002;77: 573-584. – reference: 37) Andersen P, Munk ME, Pollock JM, et al.: Specific immune-based diagnosis of tuberculosis. Lancet. 2000; 356: 1099-1104. – reference: 52) 青木国雄: 肺癌の疫学における問題点-宿主要因の研究.肺結核と肺癌の関係を中心として.日本臨床.1968;26: 1818-1822. – reference: 2) 厚生科学審議会感染症分科会結核部会: 結核対策の包括的見直しについて (提言), 2002年3月. – reference: 59) Bjartveit K: Mass minature radiophotography in Norway, today and in the future. Scand J Respir Dis. 1972; (suppl) 80: 31-42. – reference: 47) WHO/IUATLD Global Working Group on Antituberculosis Drug Resistance Surveillance: Guidelines for Surveillance of Drug Resistance in Tuberculosis, World Health Organization, International Union against Tuberc, 1977. – reference: 70) Stop TB Partnership: TB and Poverty. TB Resource Library. Version: 31 March, 2003. – reference: 6) 森亨: 沖縄における結核の疫学的分析, 結核.197h46;357-364. – reference: 44) Talbot EA, Burgess DC, Hone NM, et al.: Tuberculosis serodiagnosis in a predominantly HIV-infected population of hospitalized patients with cough, Botswana, 2002. CID. 2004; 39: el-7. – reference: 61) 厚生労働省保健医療局結核感染症課長通知: 結核対策の推進強化について.健感発第0220001号, 平成15年2月21日. – reference: 35) Mori T, Sakatani M, Yamagishi F, et al.: Specific Detection of Tuberculosis Infection with an Interferon-gamma Based Assay Using New Antigens. Am J Respir Crit Care Med. 2004; 170: 59-64. – reference: 67) WHO Communicable Disease Cluster: Fixed-dose combi nation tablets for treatment of tuberculosis. WHO/CDC/ CPC/TB/99. 267. – reference: 65) Stover CK, Warrener P, VanDevanter DR, et al.: A small molecule nitroimidazopyran drug candidate for the treatment of tuberculosis. Nature. 2000; 405: 962-966. – reference: 41) 長坂裕二: ベトナム従業員集団での患者発生へのQFTの応用.第62回日本公衆衛生学会総会自由集会 (結核集団感染).2003年10月 (京都). – reference: 57) Li CM, Campbell CM, Kumararatne DS, et al.: Association of a polymorphism in the P2X7 gene with tuberculosis in a Gambian population. JID. 2002; 186: 1458-1462. – reference: 20) 吉山崇: 結核患者発見の向上に関する研究.厚生科学研究費補助金新興・再興感染症研究事業「再興感染症としての結核対策確立のための研究」 (主任研究者森亨) 平成12年度分担研究報告.2001;74-77. – reference: 36) Streeton JA, Desem N, Jones SL: Sensitivity and specificity of a gamma interferon blood test for tuberculosis infection. International J Tuberculosis Lung Dis. 1998; 2: 443-450. – reference: 12) Anonymous: First US Tuberculosis vaccine trial in 60 years begins. NIH News. National Institute of Health, January 26, 2004. – reference: 24) Davidow AL, Mangura BT, Wolman MS, et al.: Workplace contact investigations in the United States. Int J Tuberc Lung Dis. 2003; 7 (suppl): s446-452. – reference: 28) 沖縄県結核サーベイランス検討委員会: 沖縄県の結核患者管理における結核菌遺伝子型同定の有用性.日本公衆衛生雑誌.2003;50: 339-348. – reference: 29) Braden CR, Templeton GL, Cave MD, et al.: Interpretation of restriction fragment length polymorphism analysis of Mycobacterium tuberculosis isolates from a state with a large rural population. J Infect Dis. 1997; 175: 1446-1452. – reference: 33) Kulaga S, Behr M, Nguyen D, et al.: Diversity of Mycobac terium tuberculosis Isolates in an Immigrant Population: Evidence against a Founder Effect. Am J Epidemiol. 2004; 159 (5): 507-513. – reference: 1) 厚生省: 結核緊急事態宣言, 1999年7月26日. – reference: 5) Mori T: Role of tuberculosis control technologies in health transition of the productive population. In: High Technolo gy. Population Wealth and Health. 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