[Tuberculosis control and strategy as an urban problem]

Tuberculosis is always an urban problem. There are differences in the severity of pulmonary tuberculosis in relation to socio-economic groups. The percentages of cases shown to be positive by smear microscopy of acid-fast bacilli in their sputum specimens and of cases with cavitary lesions in the lungs were high for the lower socio-economic group. The percentage of cases having had chest X-ray examination within the preceding year was low for the lower socioeconomic group. The Osaka metropolitan area consists of many prefectures and cities. Osaka City is in the center of this great metropolis. Registered cases of each zone had statistically differences about social characteristics. This result was thought to reflect the population of each zone. Cooperative common political will against tuberculosis in this area is needed to promote tuberculosis control. We analyzed the incidence rate in Osaka City in five-year from 1978 to 1997. Until the first half of 1980, the tuberculosis incidence rate in Osaka City had been dropping every year, but the rate of decline has been slowed substantially or even stopped since 1983. The slowdown in the reduction of the tuberculosis incidence rate has occurred not in all wards, but in a few wards and it is a typical phenomenon of the middle-aged in those wards. Such tuberculosis among employees in an insecure position has a growing urban social problem. It is important to establish the cooperation between medical facilities and public health centers within the territory of tuberculosis hospitals in an urban area. The sources of tuberculosis infection in an urban area are quite diverse and complicated. We shall utilize a molecular epidemiologic analysis of Mycobacterium tuberculosis.