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Tuberculosis, a communicable disease that has been commonly linked to poverty and unsanitary living conditions, is making a troubling comeback in Japan. The situation has become so worrisome that the Ministry of Health and Welfare issued a tuberculosis emergency declaration Monday, warning the nation not to take the disease lightly. The ministry urged all government bodies, local authorities, medical institutions and the public to be prepared and take all preventive measures.

The ministry, on its part, has set up a special liaison office consisting of representatives from medical associations, central and local government bodies in order to coordinate strategy and build a nationwide network to carry out TB prevention measures. Specifically, the ministry will turn the various government-run hospitals and sanatoriums into medical centers for the treatment of tuberculosis, particularly those strains that are resistant to drugs.

Behind the flurry of government moves is a steady rise in the incidence of new TB cases in Japan, particularly among elderly people, along with an outbreak of TB in hospitals and schools. Tuberculosis subsided in Japan as living standards and public hygiene made major advances in the 1960s and 1970s. Yet, in the 1980s, the pace of contraction slowed and by 1997, the number of new patients increased by about 200 over the previous year, the first rise in more than 30 years. The ministry reports that each year tuberculosis infects more than 40,000 people in Japan and claims about 2,700 lives. The incidence of infection is 33 per 100,000 people, far higher than the 10 or less per 100,000 people in the United States and Europe.

Of course, tuberculosis remains one of the world’s top killers. Each year, 8 million people around the globe develop TB, and an estimated one-third of the world population is believed to have been infected. The World Health Organization, which believes that the tubercle bacillus is striking back, issued a warning as early as 1993, urging all governments to take preventive action.

Why such a sudden reversal? One big reason is a steady increase in the number of new TB cases among the elderly. In Japan, more than half of new TB patients are over the age of 60, 34 percent in their 70s. Many elderly TB patients had actually been infected in epidemics that struck the country in the early postwar years, and the TB germ overwhelmed the weakened immune system in their old age. The incidence of new TB cases, unfortunately, is also prominent among malnourished youngsters in the cities as well as substance abusers.

In addition, the nation’s medical profession has been caught off-guard. As TB no longer seems to be prevalent, many doctors would inadvertently take the early tuberculosis symptoms, such as coughing, as a common cold or pneumonia, and leave it at that. Hence, the outbreak of infections inside schools, hospitals and old-age homes. In any case, there is a general lack of awareness among the public, who mistakenly believe that TB is a disease of the past. This has been compounded by the tendency of local authorities and medical institutions to shift their priority from TB to the fight against other supposedly more threatening diseases, such as cancer and AIDS.

This is utterly wrong. The brutal fact is that the tubercle bacillus is a very stubborn microorganism. It can stay dormant in the body of TB patients for many years, even after they supposedly recovered from the disease. Once infected, the TB germ does not necessarily show its ugly self, and an infected person may not show any symptoms until they get old and their immune system weakens.

We cannot, therefore, afford to underestimate the threat of tuberculosis. Elderly people with diabetes and young people infected with HIV are particularly vulnerable to tuberculosis and should undertake regular tuberculin tests. Above all, local medical authorities must take effective preventive measures. They should establish a system to track down all people who have come in contact with anyone with TB symptoms, conduct tuberculin tests and, if necessary, give them preventive medication. Medical associations and hospitals should make sure that their medical staff take refresher courses on the basic knowledge of TB and make the right diagnosis.

If tuberculosis is detected early enough, the disease is curable. If nothing is done, the infection could spread to the patient’s loved ones and many other people who, for various reasons, share a room with an infected person. We must brace ourselves for a long fight against tuberculosis and all of us must join the battle.

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