Publications by authors named "Tadao Shimao"

Modern National Tuberculosis Program (NTP) of Japan started in 1951 when Tuberculosis (TB) Control Law was legislated, and 3 major components were health examination by tuberculin skin test (TST) and miniature X-ray, BCG vaccination and extensive use of modern TB treatment. As to the treatment program, Japan introduced Public-Private Mix (PPM) from the very beginning, and major reasons why PPM was adopted are (1) TB was then highly prevalent (Table 1), (2) TB sanatoria where many specialists are working are located in remote inconvenient places due to stigma against TB, (3) health centers (HCs) in Japan are working exclusively on prophylactic activities, and minor exceptions are treatment of sexually transmitted diseases and artificial pneumothorax for TB cases, however, as it covers on the average 100,000 population, access is not so easy in rural area, (4) Out-patients clinics mainly operated by general practitioners (GPs) are located throughout Japan, and the access is easy. Methods of TB treatment was developing rapidly in early 1950s, however, in 1952, as shown in Table 2, artificial pneumothorax and peritoneum were still used in many cases, and to fix the dosage of refill air, fluoroscopy was needed.

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We, group of tuberculosis experts, made discussions over how to improve the quality of treatment of multidrug resistant tuberculosis using a newly developed anti-tuberculosis drug, and at the same time, how to prevent the disadvantages of the treated patients and also that of persons who would be infected with newly produced drug-resistant bacilli, by preventing the emergence of resistance to the new drug. A series of proposals are made.

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Purpose: Several reports show smoking as a risk factor of tuberculosis (TB) infection, especially in prisoners, emigrants, the homeless, or people in areas where TB is endemic. These reports mostly used the tuberculin test to detect TB. However, there is no report evaluating smoking as a risk factor of TB infection among people coming into contact with TB with the use of the Interferon-Gamma Release Assays (IGRA) test.

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Co-infection of tuberculosis (TB) and HIV is a serious problem in most developing countries and in industrialized countries, co-infection of TB and HIV is seen mainly among migrant population. In case of Japan, the numbers of both new HIV infection and AIDS cases have been increasing except slight decline in both figures in 2012, however, the epidemiological situation of HIV and AIDS is still one of the lowest in the world, and among index diseases of AIDS, TB is 5th among Japanese. Based on prevalence of radiological TB findings in the national TB prevalence survey in 1968 and the coverage of BCG vaccination, the author speculated that most TB primary infection took place among those with rather high delayed type sensitivity, thus formation of typical primary complex was rather rare and the number of tubercle bacilli in primary complex and post-primary early disseminated lesions were few, and less risk of development of active TB even among HIV infected individuals.

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Setting: The average duration of tuberculosis chemotherapy in Japan increased year by year throughout the 1960's and reached 49 months by 1973. It then began decreasing slowly in the 1970's and more rapidly after the 1980's.

Purpose: To clarify the significant factors contributing to the prefectural variation of changes in the average duration of chemotherapy that occurred from 1973 to 1979.

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Purpose: The indications for treatment for latent tuberculosis infection were revised in 2007 to reflect that any subject with a higher risk of tuberculosis regardless of age should be treated. We worried about the incidence of liver dysfunction due to isoniazid (INH) in patients older than 30 yrs. of age.

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Miniature radiography or radiophotography (RP) was first developed independently by de Abreu M of Brazil and Koga Y of Japan in 1936, and because of its utility, it was used as a tool of mass health examination for TB all over the world soon after its development. The idea of RP is to take a picture of the chest X-ray image on a fluorescent screen set in a dark box, and this idea was materialized through development of a camera with a small F-number. Through application of RP as a tool for mass health examination, many TB cases had been detected, and most of these had been previously unknown cases.

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Traditional food custom of Japan changed after the opening of the country in late 19th century, and habit of eating beef and of drinking milk was introduced, and the control of cattle TB had become one of major topics of veterinary medicine in Japan. Old tuberculin (OT) prepared by Koch R in 1890 initially intended to cure TB, however, it was found ineffective against TB, while local and general reactions after the introduction of OT were found to be useful to detect TB infection, and OT was first applied in veterinary medicine to detect TB infection in cattle. Cattle TB Control Law was legislated in Japan in 1901, and cattle was subjected to health checking including tuberculin test, and TB cattle had to be slaughtered, and TB suspects had to be isolated.

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TB control in Japan started in 1951 through legislation of TB Control Law, consisting of three major components; mass health examination, vaccination and promotion of adequate methods of treatment for TB cases. Mass health examination was first targeted for younger generation below 30 years of age as it was believed that TB was highly prevalent among them, however, it was expanded to cover whole population based on the results of TB Prevalence Survey in 1953 revealing high prevalence of TB in all age groups except children and low awareness of TB cases. Methods of treatment for TB were developing rapidly in late 1950s and early 1960s; initially artificial pneumothorax, then surgical collapse treatment such as thoracoplasty, then pulmonary resection, and finally long term combined use of INH, SM and PAS.

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Chest X-ray examination had been used rather soon after the discovery of X-ray by Rontgen K in 1895 as it was possible to detect chest abnormality by simple radiography. After the discovery of radiophotography independently by Abreu M and Koga Y in 1936, it was applied as a method of mass screening for TB in Japan, and Imamura A made a special lecture on "The mass screening for TB" using radiophotography in 1940 in the Annual Meeting of the Japanese Society for TB. From experiences of mass screening, it was found that there were many cases of TB who do not aware of their own disease, and to know the prevalence of TB, the screening of survey subjects by X-ray examination is indispensable.

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Swine flu epidemic is a current topic, and data relating to Spanish flu pandemic from 1918 to 1920 were presented for your information. Monthly trend of number of deaths due to influenza, acute bronchitis, pneumonia and bronchopneumonia together with PTB, other TB and TB of all forms from 1917 to 1920 was presented in Table 1 and Fig. 1.

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Since the introduction of mass BCG vaccination program, it has become difficult to know how TB primary infection takes place. Based on data before the introduction of mass BCG vaccination, the author tried to overview TB primary infection. Most TB primary infection takes place via lung as shown in Table 1.

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As mentioned in the previous report, PTB mortality by prefecture was printed in the "Statistics Annual", however, the population based on which the rate was calculated was not shown in the "Statistics Annual". In Japan, family register system was introduced in 1872, and every Japanese had to be registered at municipality where their family live. Based on this registry, statistics on registered population by sex and age, and by prefecture was available.

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First "Statistics Annual", which included the population and vital statistics was published in Japan in 1882, and the numbers of death classified by major causes of death were tabulated by sex and age groups and by prefecture. Koch R reported the discovery of tubercle bacilli as the pathogen for TB in 1882, and since the latter half of 1883, the numbers of death due to PTB (Phthisis) were tabulated by prefecture, and by sex and age groups since 1884 annually except for 1885. Based on the population statistics and the numbers of PTB death, PTB (Phthisis) mortality was calculated by sex and age groups, and the results were shown in Table 1.

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Koch R reported the discovery of tubercle bacilli on March 24, 1882, and the numbers of death from phthisis were collected in the vital statistics from the latter half of 1883 in Japan. Tuberculosis death was officially adopted in the Japanese vital statistics from 1899, and there was certain disagreement existed between the numbers of death from TB and phthisis in 1899, the analysis on the trend of TB in Japan was done based on TB death. Trend of TB in Japan in the past 100 years could be divided into five phases.

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Statistics Annual of Japan was first published in 1882, and it covered all aspects of statistics in Japan including demography. Sex- and age-specific population and the population in each prefecture were available, and the number of death classified by major causes of death was also shown. R Koch reported the discovery of tubercle bacilli in 1882, and from the latter half of 1883, the number of death due to pulmonary tuberculosis (phthisis) were collected and tabulated together with the death due to meningitis and apoplexy, and the collection of data on death due to pulmonary tuberculosis had continued until 1906 except 1885.

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Notification of TB cases was introduced since 1947 in Japan, and statistics on notified TB cases by sex and age groups was available since 1949. Sex and age specific TB notification rates per 100,000 from 1949 to 2001 were tabulated together with the number of notified TB cases since 1969.

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In 1951 when TB Control Law was legislated, and the government of Japan started intensive TB programme mainly consisting of mass health examination, BCG vaccination and distribution of appropriate treatment for TB cases, there were about 100,000 beds for TB, similar to the number of then TB deaths, and many TB patients died before admission to sanatoria. Urgent measures were taken to increase beds for TB with a target of 250,000, 2.5 times of then TB death.

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