[Fight against urban tuberculosis problems and program effects in Osaka City]

In Osaka City, tuberculosis (TB) incidence rate (909.7) was already twice as high as national average in 1950. It had been reduced thereafter but was stagnated above 100 in the 1980's and 90's and it has become the worst in the country. To improve the situation, the 10 year plan of TB control was formulated and practiced since 2001. The plan mainly consists of proper treatment promotion to use 4 drugs including pyrazinamide at initial phase, introduction of DOTS, and expansion of chest X-ray screening among homeless which leads to early case finding. As an effect of plan after 8 years have passed, implementation rate of DOTS virtually reached 80% as targeted. As a result, defaulter and failure rate was reduced from 13.7% to less than 5%. The rate of retreatment cases among homeless patients was reduced from 43% to 17%. Multidrug resistant rate among patients without previous treatment was reduced from 1.1% in 2001-2004 to 0.6% in 2005-2008. And overall TB incidence rate became half (50.6) in 2008 from 100 per 100,000 population before the plan started. Factors contributing to the above success seem to be as follows: formulation of long term control plan with indicators, integration of tuberculosis diagnostic committee, introduction of DOTS, strengthening and expansion of chest X-ray screening for the homeless, and unified implementation of contact examination in congregate settings, etc. Moreover patient management has been discussed in the regular meeting on cohort analysis at all public health offices in the city. When they had any questions on the treatment, they can now communicate with medical staff as necessary. It was indispensable to collaborate with welfare department and coordinate with NPOs to solve problems regarding homeless patients.