(Vol.76 No.11 November 2001) <1> Kekkaku Vol.76,No.11:679-684,2001 HIV SEROPREVALENCE IN PATIENTS WITH TUBERCULOSIS 1*Hideaki NAGAI, 1Yoshiko KAWABE, 1Naohiro NAGAYAMA, 1Yoshiaki TANAKA, 1Mamoru NISHIYAMA, 1Mayumi SUZUKI, 1Kimihiko MASUDA, 1Motoo BABA, 1Akihiro HORI, 1Atsuhisa TAMURA, 1Shinobu AKAGAWA, 1Kazuko MACHIDA, 1Atsuyuki KURASHIMA, 1Hideki YOTSUMOTO, 1Masashi MORI, and 2Satoshi KIMURA 1*Department of Pulmonary Diseases, National Tokyo Hospital, 2Department of Infection Control and Prevention, Department of Infectious Diseases, Graduate School of Medicine, University of Tokyo The number of patients co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB) in our hospital is increasing year after year. Although most patients were HIV tested because of miliary tuberculosis or extra-pulmonary tuberculosis, some patients were found HIV seropositivity by chance. In order to determine the incidence of HIV seropositivity among TB patients, HIV test- ing was carried out in TB patients for two years from January 1998 with the consent of patients. TB patients who received anti-HIV antibody examination were 164 in 1998, and 149 in 1999 and among them HIV seropositive TB patients were 4 in 1998 and 6 in 1999. The incidence of HIV seropositivity was 3.2% in all TB patients, 28.6% in miliary TB patients, and 1.0% in typical TB patients. The number of patients co-infected with HIV and TB in Tokyo was estimated by using these HIV seropositivity, it was 23 cases/year among miliary TB patients and 16 cases/year among typical TB patients. As there were many HIV-infected persons and many TB patients in Tokyo, it was thought that HIV testing in TB patients was important for the early detection of HIV infection and the early initiation of HIV treatment. Key words:HIV, AIDS, Tuberculosis, Seroprevalence *3-1-1, Takeoka, Kiyose-shi, Tokyo 204-8585 Japan. (Received 14 May 2001/Accepted 8 Aug. 2001) <2> Kekkaku Vol.76,No.11:685-689,2001 RESULTS OF TWO-STEP TUBERCULIN SKIN TEST AGAINST MEDICAL AND NURSING SCHOOL STUDENTS AND TREATMENT ACCORDING TO THE RESULTS OF THE TEST 1*Yoshinobu OHSAKI and 2Akira TAKEI 1*First Department of Medicine, and 2Health Administration Center, Asahikawa Medical College To assess the risk of tuberculosis infection in medical and nursing school students, tuberculin skin tests were carried out in the two-step manner. The second tuberculin skin test was repeated two weeks later excluding those who were strongly positive in the first test. BCG vaccination was done with the consent of students who showed negative reac- tion twice. Medical interview and revaluation of prior routine chest radiogram were made on students who were strongly positive. Prophylactic INH medication was considered to those who are at high risk of tuberculosis. Eight hundred thirty eight students underwent the two-step tuberculin skin test, and among them, 771 students showed the positive reaction on the first test (92.0%) which included 58 weakly positive (6.9%), 347 intermediately positive (41.4%) and 366 strongly positive (43.7%) and 2 not-measurable (0.2%), and 65 students were negative (7.8%). The average size of the erythema was 30.9}18.8mm on the first test and 37.9}20.6mm on the second test. Twenty one students were negative on the second tuberculin skin test, and among them, 15 received BCG vaccination. Out of eight students who were vacci- nated with BCG in 1999 and were followed up in the next year, 6 (75.0%) converted to positive. Strongly positive reaction was seen in 28 students (3.3%) and one of them underwent prophylactic medication of INH according to her family history of exposure to tuberculosis. Key words:Two-step tuberculin skin test, Medical and nursing school students, Tuberculosis prophylaxis *2-1-1-1, Midorigaoka Higashi, Asahikawa-shi, Hokkaido 078-8510 Japan. (Received 27 Apr. 2001/Accepted 20 Aug. 2001) <3> Kekkaku Vol.76,No.11:691-698,2001 THE INTERVENTION AGAINST AN OUTBREAK OF PULMONARY TUBERCULOSIS IN THE DORMITORY OF CONSTRUCTION LABORERS -Connection with Approaches from Public Health, Medical Treatment, Social Welfare, and Labor Management- 1Seiko IBURI, 2*Jiro FUJITA, 3Hiroyasu YAJIMA, 3Hiroshi KAKUDA, 3Michiko SAKAMOTO, and 4Atsuko MATSUMURA 1Community Health and Mental Health Nursing, and 2*First Department of Internal Medicine, Kagawa Medical University, 3Kyoto Prefectural Uji Public Health Center, 4Department of Health and Welfare, Kyoto Prefectural Office An outbreak of pulmonary tuberculosis (TB) in a dormitory of construction laborers took place, and this outbreak was presumed to be caused by the same sourse of infection, based on the results of restriction fragment length polymorphism (RFLP) analysis and other findings. After the first patient was admitted to the hospital with active TB, 18 new other TB patients were discovered by repeated contacts examinations. They were all male and single, and were aged from 41 to 67 years old (mean age 51.7). Among 19 patients, only 4 patients had a health insurance. As these patients lived together in the same dormitory, to prevent infection through close contact in the dormitory, repeated contacts examinations were further performed. In addition, several medical, social, and economical interventions were needed for these patients. It was also required to improve labor conditions in this construction company. It was concluded that comprehensive approaches including public health, medical treatment, social welfare, and labor manage- ment aspects were indispensable to prevent TB among relatively poor laborers. Key words:Outbreak of pulmonary tuberculosis, Construction labor, Contacts examination, RFLP analysis, Health insurance for day laborer *1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa 761- 0793 Japan. (Received 18 Jun. 2001/Accepted 9 Jul. 2001) <4> Kekkaku Vol.76,No.11:699-706,2001 The 76th Annual Meeting Educational Lecture ANTI-TUBERCULOSIS DRUG RESISTANCE IN JAPAN AND IN THE WORLD *Chiyoji ABE *Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association In 1994, the World Health Organization (WHO) and the International Union against Tuberculosis and Lung Disease (IUATLD) launched a global project on anti-tuberculosis drug resistance surveillance. The results from the first 4 years (1994-1997) and the sec- ond 4 years (1996-1999) of the projects were reported in 1998 and 2000, respectively. These surveillance results showed that resistance to anti-tuberculosis drugs is a global problem. The reports also showed that there were several hot spots around the world where prevalence of multidrug resistant tuberculosis (MDR-TB, defined as resistance to at least isoniazid and rifampin) was particularly high and could possibly threaten control programs. The Tuberculosis Research Committee of Japan (Ryoken) has conducted nationwide surveys for drug resistant tuberculosis at 2- or 5-yearly intervals since 1957. The 1997 survey showed that among patients with no prior treatment, resistance to any of the four drugs was found in 10.3%, and the prevalence of primary MDR was 0.8%. The prevalence of drug resistance in the previously treated cases was 42.4% for any of the four drugs and 19.7% for MDR, indicating a high prevalence rate compared with those reported in the global project. Compared with the previous survey in 1992, the current survey shows increased prevalence of drug resistance in both new and re-treatment cases. No significant differences in resistance rates by sex, age group, nationality, district, and/ or accompanying diseases were observed in any of the new or re-treatment cases. Other factors associated with the high prevalence in re-treatment cases remain to be deter- mined. A total of 78 hospitals in various districts of Japan participated the cooperateive study. Each collaborating laboratory sent all the isolated mycobacterial cultures to the Research Institute of Tuberculosis (RIT). In the local laboratories, the absolute concentration method using 1% Ogawa egg slant, its modified methods using a 48-well plate and a 16-well plate, combination of above 2 or 3 methods, and other method were used for drug susceptibility testing, and the proportion method using 1% Ogawa egg slant was used in the RIT. The results in the local laboratories were compared with those in the RIT. There was no significant difference in the concordance rates according to the test drugs among methods for drug susceptibility testing used in the local laboratories. Relatively lower concordance rates were seen in the laboratories using the Microtiter method related to high overestimation rates, compared with those in the laboratories using the standard method and Well-pack method. However, relatively lower concordance rates (less than 90 %) were seen in the laboratories using any of the three methods, indicating that there are variations among facilities. Key words:Drug resistant tuberculosis, Drug susceptibility testing, Global project, Nationwide survey *3-1-24, Matsuyama, Kiyose-shi, Tokyo 204-8533 Japan. (Received 23 Aug. 2001) <5> Kekkaku Vol.76,No.11:707-713,2001 The 76th Annual Meeting Symposium V. MEDICAL TREATMENT SUPPORT TO TUBERCULOUS PATIENTS -From the Standpoint of Community Support- Chairpersons:1*Keiko KOKUBU 2Kimio INUZUKA 1*Fuculty of Nursing and Social Welfare Sciences, Fukui Prefectural University, 2Aichi Prefectural Shinshiro Health Center Symposium Topics & Presenters: 1. The measure of Nagoya-shi:Satori ODAUCHI(Nagoya-shi Nakamura Health Center) 2. The measure of Yokohama-shi: -From the Position of Administration Worker:Kayoko SHINBORI (Yokohama- shi Department of Health) -From the Position of Hospital Worker:Kanemitsu KAWADA (National Sanatoria Minami Yokohama Hospital) -From the Position of Case worker:Masaaki MACHIDA -From the Position of Welfare Worker:Akihiro OOKAWA (Yokohama-shi De- partment of Welfare Kotobuki Home) 3. The measure of Kanagawa Prefectural Health Center:Hisashi HARADA(Kanagawa Prefectural Hatano Health and Welfare Center) Supervisor:Chika SHIRAI (Kobe-shi Health Center) Norio FUJII(Section on Tubercular infection, Ministry of Welfare & Labor) A symposium with "Medical Treatment Support to Tuberculous Patients-From the standpoint of community support" as its theme was held at the 76th Annual Meeting of the Japanese Society for Tuberculous (April 20, 2001). "Once, It is infected with tuberculosis, one have to complete medication with a sensi- tive antituberculosis drug by observing the prescribed dose and duration for successful treatment". For this to be promoted community, it is necessary that (1) to manage patient's medication by medical facilities, (2) to support patient's medication by health center and (3) to support patient's living by welfare offices. Not that each facilities takes such responsibilities alone, but various community must fulfill them continuously in liaison with one another. On what measures should be taken to that end, reports based on practical examples from Nagoya City, Yokohama City and Kanagawa Prefecture have been compiled as follows. 1.It was in-office liaison by conference that supported the DOTS activities of health nurses. 2.It is cooperating, without health, medical treatment, and welfare going out, as follows. (1) A system for hospitals and clinics to carry out DOTS treatment consistently has been kept in good condition. (2) For a patient to take a drug in front of a nurse has become common, causing the patients to be motivated. (3) Assignment of MSW and nurses in charge of DOTS sent from hospitals has make it possible to offer or exchange information smoothly among those concerned. (4) A system for many persons concerned to support patients timely has been kept in good condition. This resulted in an increase in the cure rate of tuberculosis in the areas which have day laborers' lodgings. 3.By DOTS for in-patients, the number of self-discharges has decreased by 1/3, and the treatment completion rate was 94%. 4.In promotion of DOTS for the patients who have health problems other than tubercu- losis, the role MSW plays is great. 5.As conditions for supporting DOTS promotion, it is necessary to create a system by which to stabilize the living of the patient himself, guarantee earnings to support it and dissolve the living problem faced by the patients. 6.Introduction of the "early guidance system for the patients in whom the treatment of tuberculosis" was discontinued has strengthened the liaison between health offices and medical facilities, has led to early detection in persons yet to receive medical treat- ment and resumption of medical treatment, making it possible to deal with problem cases effectively on a priority basis. It has been confirmed that liaison between health, medical service and welfare for com- munity support of the treatment of tuberculous patients who live in that community resulted in improvement of clinical results of tuberculous patients. In this connection, Dr. Shirai advised "For a tuberculous patient to form a habit of taking a drug wherever he lives needs to be recognized as a major subject". He presented the forcible yell. "Any local government office has the homeless. I want you to make efforts so that DOTS be given to all the tuberculous persons. If there is any problem, I am ready to give advice. Key words:DOTS, Community-cooperation, Complete medication, Treatment completion rate *4-1-1, Kenjojima, Matsuoka-cho, Yoshida-gun, Fukui 910-1195 Japan. (Received 10 Aug. 2001)