[Tuberculosis annual report 2012 --(2) Childhood and elderly tuberculosis]

In 2012, there were 63 newly notified childhood tuberculosis (TB) patients (patients aged 0-14 years) in Japan, corresponding to a notification rate of 0.38 per 100,000. The annual number of notified childhood TB patients was less than 100 in 2006, since then the numbers and rates (per 100,000 population) decreased steadily. Of the 63 patients with childhood TB notified in 2012, 30 (47.6%) were aged 0-4 years, 12 (19.0%) were aged 5-9 years, and 21 (33.3%) were aged 10-14 years. Thus, the proportion of TB patients aged 0-4 years was the highest among children. In 2012, only one patient of TB meningitis and no patient of miliary TB were reported in children. On the point of case detection, similar to percentages reported in previous years, 22 patients (34.9%) were identified at medical institutions and 32 patients (50.8%) were detected by contact investigation of household members. Since 1999, the notification rates of TB in Japan have been consistently higher among patients aged 85 years and above than among those aged 65-84 years in Japan. The annual rate of reduction in the notification rates of TB patients aged 65 years and above in 2012 (13,307 cases) was 3.3%, compared to 2011 (13,756 cases). The proportion of TB patients aged 65 years and above has consistently increased, reaching up to 62.5% in 2012; notably, the proportion of TB patients aged 80 years and above has increased to 34.0%. The proportion of bacteriologically positive TB patients among pulmonary TB (PTB) patients was higher among those aged 65 years and above than among those aged 15-64 years. The proportion of PTB patients with only non-respiratory symptoms increased with age, reaching 27.6% among those aged 85 years and above. The proportion of TB patients associated with patient delay of two months or longer was lower among the patients aged 65 years and above than among those aged 15-64 years (14.5% vs. 26.7%), whereas the proportion of TB patients associated with doctor delay of one month or longer was slightly higher among patients aged 65 years and above than among those aged 15-64 years (22.9% vs. 20.2%). Of the newly notified TB patients aged 65 years and above in 2011 whose treatment outcomes were available at the time of reporting, 31.3% died within a year after the initiation of TB treatment; of these, 18.4% died within three months. The proportion of deaths within three months after the initiation of TB treatment among patients aged 65 years and above increased substantially with age from 8.1% in the 65-69 years age group to 31.9% in the 90 years and above age group.