Rash of TB Cases Worries Officials

By Suvendrini Kakuchi, IPS, 9 August 1999

TOKYO, Aug 9 (IPS)—Japan is grappling with a sudden tuberculosis alert, following an alarming rise in the number of patients detected with new strains of the life-threatening disease.

Toru Mori, director of the Japan Anti-Tuberculosis Association's TB Research Institute and a leading authority on the disease, says the recent increase in cases shows a strain of bacteria that has become resistant to all known drugs.

When that happens, treatment is futile. There's nothing to do but wait for death. What's even more terrifying is that by the time a patient starts showing symptoms, drugs don't have any effect, he told ‘Shukan Gendai’, a well-know news magazine last month.

The government declared a state of emergency two weeks ago as the national TB rate rose for the first time in 42 years in this country of 127 million people.

The Ministry of Health and Welfare also reported that the incidence of infection is 33 per 100,000 people, far higher than the 10 or less per 100,000 people in the United States or Europe.

The World Health Organisation (WHO) has warned that TB remains a top killer in the world, and has urged governments to strike back through better preventive care.

Though TB is often associated with poor developing countries, experts have warned against complacency because of the threat of new strains of diseases thought to have been largely defeated by better quality of life and advances in medicine.

At least 13,900 people have been newly registered as tuberculosis patients so far this year in Japan, and 14 cases of group infection have been confirmed or probed across the nation, according to the Ministry of Health and Welfare.

An official, who declined to be named, said that the actual number of new TB patients is believed to be much higher as the government has not adopted a comprehensive reporting system of the disease.

TB was a widespread disease in the Japan just after World War II but through massive financial investment we thought we had controlled it, he explained. Thus we are not as well prepared as we should be to deal with the sudden increase of cases.

Dr Masatsu Aoki of the Tuberculosis Protection Association, a volunteer organisation, explains that Japan's history and increasing number of elderly are among the factories that have turned the tide against the nation's fight to eradicate TB.

More elderly people are been diagnosed with TB because these people were infected when they were children, he explains.

Japan is already among the most rapidly ageing societies in the world, with more than 20 percent of its population aged 65 years or more by the year 2020.

Tuberculosis was dubbed the national disease in the early fifties, when hundreds of thousands of Japanese were infected and were dying from it.

Poverty that contributed to poor housing and overcrowded cities including lack of protection and vaccines were the major causes for the problem at the time, when more than a 100,000 people died from the disease each year.

However Japan's economic development helped to change the situation in the sixties as the standard of living improved enormously and the government poured in money to offer better treatment.

But the recent increases indicate a pick-up on a year-on-year basis, health experts say.

The government reports that each year TB infects more that 40,000 people in Japan and claims about 2,700 lives.

More than half—56 percent—are people in their sixties, indicating that they were infected when they were children. Doctors point out that TB symptoms appear when the immune system is weakened as in the elderly.

But they also point to the rise in the number of younger people with TB, such as university students and malnourished children in the cities as well as substance abusers.

Nobukatsu Ishikawa of the Anti-TB Association says there are some concerns about the possibility of a massive outbreak among young people as masses of people are forced to travel in crowded trains, or often congregate in airless karaoke boxes, or saunas.

Japan's stressful lifestyle also prevents young people from taking time off from work to treat TB, another reason for the increase among the younger generation.

The media reports that out of the 60,000 patients being treated for TB, about 2,000 carry a strain that does not respond to the known antibiotic treatment.

Dr Hiroyuki Sawa of Gifu Municipal Hospital recalls a case in which a male TB patient in his thirties failed to respond to multiple doses of antibiotics.