The current situations and measures in the future in childhood tuberculosis

We performed a retrospective analysis of 358 patients who were treated for active TB in our hospital from 1976 to 1993. The rate of primary pulmonary tuberculosis was 49.0% and post primary pulmonary tuberculosis was 25.6%. But the rate of tuberculous meningitis and miliary tuberculosis was 7% respectively. Fatal cases of tuberculous meningitis had continued. Seventy-four percent out of 358 patients had a contact history with active tuberculosis. Main source of infection were their father, mother and grandparents. Thirty-two percent of patients had received BCG. Only 12.6% out of the patients under 5 years of age had received BCG. Only nine percent of 23 cases with tuberculous meningitis had received BCG. If the Ministry of Health and Welfare criteria of chemoprophylaxis was indicated rigidly, about 40% of patients who needed chemoprophylaxis in this study would have been overlooked. Indication of chemoprophylaxis should be decided in each patient flexibly. The study of the contact examination showed that two thirds toddler had tuberculosis within two months after detection of source of infection. Thirty percent of the patients in this study were preventable if contact examination and chemoprophylaxis were appropriately done. In the study of drug susceptibility of TB bacilli from 71 patients, 14 strains were resistant to at least one drug. The resistant rate to each drug was higher than adult resistant rate. In order to eliminate childhood TB, the following is necessary: 1) BCG vaccination in the early infancy. 2) prompt and appropriate contact examination and chemoprophylaxis, 3) infection control against drug resistant bacilli.