Patients with infectious TB who resist and refuse isolation in wards in Japan, 2022-2024

In Japan, a low-TB-burden country, approximately 4000 cases of sputum smear-positive TB are reported annually and the patients are typically isolated in a TB ward until they become smear-negative. However, there are some patients who resist or refuse isolation. This study aims to characterize these patients.

A descriptive study. A self-administered questionnaire was sent to local health offices about patients registered from April 2022 to March 2024 who resisted or refused isolation.

A total of 71 patients (0.99%) who resisted or refused isolation were identified among 7,186 with smear-positive TB in the study period. In 2022, 22 (31.0%) such cases were reported, whereas there were 49 (69.0%) in 2023. Fifty-seven of these patients (80.3%) were male, with age that peaked in their 70s, 61 (85.9%) were born in Japan, and 28 (39.4%) were unemployed. Tokyo, the capital, reported 13 (18.3%) such cases, followed by Osaka (12, 16.9%) and Saitama (8, 11.3%) prefectures, whereas 24 (51.1%) of 47 prefectures reported none.

Although the number of patients with TB who resisted or refused isolation was small, there should be one or two TB facilities with law enforcement officials readily available to enforce isolation.