世界の結核, 日本の結核 TUBERCULOSIS IN THE WORLD, AND IN JAPAN
ある国または地域の結核蔓延状況は,(1) 過去の蔓延状況,(2) 社会・経済的状況,(3) 対策,の3つで決まるが,この結果決められた蔓延状況は,次に強く影響を与え,再び3因子が絡みあって次の状況を作る。こうして「結核蔓延のスパイラル」が形成される。このような視点から世界,日本の蔓延状況を分析した。特に日本については,42年間の各県の罹患率の推移を分析し,47都道府県を,(1) 現在の罹患率が低く,減少が速やかで農村圏にある17県,(2) 過去の影響から高齢者の罹患率が高く,中間的で特徴が少ない18県,(3) 若年者の罹患率が高く,都市結核の様相が著明,あるいは都市結核の様相を示し始めている12県の3群に分けた。世界の結核対策の歴史を振り返ると,(1) 古典的結核対策期(～1963年),(2) 現実的対策期(1964～1990年),(3)DOTS戦略期(1991～1999年),(4) 感染症対策強化期(2000年～)の4期に分けられた。この視点からわが国の対応を見直したが,今後の対策は従来の対策の延長線上にはないと考えられた。今後の対策は,上述の分析のように地域の特性を十分に明らかにし,その特性に応じた対策を強力に進めるべきであると結論した。
Tuberculosis situation in a certain country or area is decided by 1) tuberculosis prevalence of the past during around 40 years, 2) socio-economic situations of the country, and 3) tuberculosis control program. The trend of tuberculosis situation is changing forming " tuberculosis spiral" shown in Fig 1. TB situations of the several countries in the world were discussed to show the factors influencing on them from the standpoint of view mentioned above. The trends of TB epidemiology of the 47 prefectures in Japan were analyzed more deeply. The 47 prefectures were divided into the following 3 groups. The first group consists of rural prefectures where TB incidence is not so high and decreasing rather rapidly. TB was not so prevalent in the past 40 years or more, compared with other prefectures belonging to the other group. The second group is composed of intermediate prevalent prefectures because of rather high prevalence of tuberculosis in the aged, due to the rather high prevalence of tuberculosis in the past. The big cities and prefectures near by are forming the third group. Prevalence of tuberculosis among the young, jobless, homeless, foreign-born and so on is high, and tuberculosis is decreasing slowly. Divergence of tuberculosis epidemiology between these three groups is becoming wider recently. The spiral of tuberculosis, mentioned above, could be observed clearly by the analysis of the trend of tuberculosis in these 42 years in 47 prefectures.<BR>The author is consid ering that tuberculosis control program in the world has developed as follows. After the World War 2nd, classical tuberculosis control program had been carried out in the world (the classical TB control period, 1948-1963), new realistic tuberculosis control program had been launched in 1964 according to the 8th Experts Report of W HO (the realistic TB control period, 1964-1990). However tuberculosis did not decrease as expected, and the simple and clear tuberculosis control program aiming 85 % or more cure rate, later by DOTS strategy (DOTS period, 1991-1999). And to expand and strengthen tuberculosis control program more and more, the Stop TB Partnership has been started in 2000 (the Stop TB period, 2000-). In Japan, tuberculosis control program has been carried out by Anti-Tuberculosis Law enacted in 1951, revising according to the situations. However, remainder of the classical tuberculosis control program, such as high rate of hospitalization, long duration of hospitalization and so on, is still existing. The author concluded that it is important to improve tuberculosis control program according to the epidemiological situation of the area, because tuberculosis situation is different by area to area and will become more profound in the future.
結核 81(10), 623-629, 2006-10-15
JAPANESE SOCIETY FOR TUBERCULOSIS