Tuberculosis in China

Abstract

The population of the People’s Republic of China accounts for a quarter of the inhabitants of the world. As in most other developing countries, tuberculosis continues to be a major health problem and a high prevalence rate represents a very large number of cases. Thus in 1979 there were an estimated 6.9 million subjects with active tuberculosis of whom 1.8 million had sputum positive disease [I]. It would be interesting to learn how China is dealing with this problem, what steps have been taken to control the disease and how effective the control measures have been. Unfortunately few reports on this subject have been published other than in Chinese journals. Notable exceptions were two papers published in Tubercle recently which reported the results of chemotherapy in the rural area of Beijing [2, 31. On a recent journey to China with a delegation of chest physicians, at the invitation of the Chinese Medical Association, I visited centres for respiratory medicine in Beijing, Shenyang, Shanghai and Hanghzou. This provided an opportunity to learn more about what is happening in the field of tuberculosis control there. At the beginning of the century tuberculosis was rampant in China, as it was in other parts of the world. In Peking in 1926 the mortality rate from this disease was 435 per 100 000 population [I]. Thereafter the death rate gradually declined, probably as a result of improvement in socioeconomic conditions, and by 1938 in Peking the mortality had fallen to 259 per 100 000. In 1933 the Chinese Anti-Tuberculosis Association was formed and preventative measures were introduced, notably the pasteurisation of milk and BCG vaccination of children. This activity was interrupted between 1938 and 1948 by the Sino-Japanese war. Then in 1949 the People’s Republic of China was founded, a National Health Service was formed and a National Tuberculosis Programme was started. The most important features of this programme were universal BCG vaccination of infants, active case finding by means of mass miniature radiography, and when the means became available, the treatment of sputum positive subjects with chemotherapy. BCG vaccir&ion The vaccination of infants with BCG is nationwide. In Beijing and some other centres the rate of vaccination approaches 100 %, but in most provinces it is about 85 %. The aim is to administer the vaccine within a week of birth if possible and at the latest within the first year. Revaccination, with or without prior skin testing, is given to children on entry into primary school (age 7) and again on leaving primary school 6 years later. So by the age of 13 most children will have been vaccinated three times. There is widespread confidence in the