[Start of TB case-registration and case-management system in Japan].

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. Up to surgical treatment era, most TB patients earnestly followed doctor's instruction, however, in chemotherapy era, as most symptoms improved rapidly after the initiation of chemotherapy, patients felt as if they were cured, and it had become difficult to maintain high adherence to treatment. Such behavior was found oftener in patients detected in early stage through mass health examinations. 1947, it was legislated for all doctors to report all diagnosed TB cases to an adjacent health center, and the cases are registered at the health center covering his (her) residence, however, standardized formula of registration was not indicated. In accordance with the progress of TB control program, the number of TB registered cases increased, and the need for standardized registration and case-management had become apparent in mid 1950s, and some preliminary trials had been done. In response to this request, the Ministry of Health and Welfare organized a research group headed by Dr. Misonou K, and the staffs of prefectural health department and enthusiastic staffs working in health centers (HCs), staffs of NIPH (National Institute of Public Health) and RIT (Research Institute of Tuberculosis) to study how to register TB cases, how to collect information and how to improve patients' adherence to treatment. Registration index cards were prepared in each HC arranged alphabetically to avoid double register. The formula of registration card was indicated in Fig. 1 and 2. Small hollows were made in the lower part of the card, and registration card container with 45 metal bars in the bottom as shown in Fig. 3 was prepared. By setting 30 cards dislocating one each hollow as shown in Fig. 3, in one card container with 30 rows, altogether 600 registration cards were stored. In most right part of the card, important information such as activity of the case, treatment status, expected time of next home visit, expiring time of public support for TB treatment, etc. are indicated by different color metal signals. This new system was applied in 216 HCs, about one fourth of all HCs in Japan in 1959, another 200 HCs were added in 1960, and finally from 1961, the new system of registration and case-management started in the whole country after making minor amendments based on experience in 1959 and 1960. Quality of TB case-management improved much after the introduction of new system, and annual statistics not only newly registered TB cases but also on prevalence of active as well as registered cases was available since then, and this was the starting point of TB surveillance system started in 1986.