Tuberculosis still a problem in N.Z.

Press, 15 November 1977, Page 8

Tuberculosis still a problem in N.Z.

Parliamentary reporter Tuberculosis is being taken too lightly by the general public, according to the Health Department. It is now a ,quarter : century .. . since tuberculosis was controlled with modem drugs. Earlier this year, the Director-General of Health (Dr H. J. H, Hiddleston) said that he regarded the persistence of tuberculosis as “a disgrace.” A report from the department highlights public distinterest—and the continued public danger. Today the vast armoury of vaccines and preventive measures at the disposal of the medical profession is often underused by the public. It is almost as if the successful war waged by modem medicine against the spread of disease has acted as a signal for general disarmament. The sense of urgency when modem drugs and vaccines were first available and the savage effects of certain diseases then were foremost in the mind of the public, now seems to be lacking. As with most diseases for which modern drugs and immunisation techniques exist, a steady drop in the incidence of tuberculosis followed their inception. Whereas in 1943 142 people per 100,000 suffered from this disease in New Zealand, by 1963 this figure was slashed to 35 and by 1976 to 16.6. Improved living conditions, hygiene, public awareness, the quick diagnosis, isolation and treatment of the infected person, and above all modem

drug and immunisation techniques, are significant contributors to the downturn in the disease.

Figures are, however, only an index of general trends and in human terms unnecessary suffering is still imposed on individuals who, through an absence of preventive measures, contract tuberculosis.

There were 608 people with tlie disease last year. The most significant fact to come to light is the high percentage of Maoris and Polynesians: 243 of these were Maoris and 133 Pacific Islanders.

Tuberculosis has long been recognised as a disease linked to environmental conditions. In New Zealand the poor quality of living conditions among a proportion of middle aged and elderly people who live alone lays them open to the disease.

Favourable environmental conditions may, on the other hand, reverse the trends which lead to tuberculosis, and play a major part in treatment and rehabilitation. It was with this in mind that the celebrated romantics made long pilgrimages by sea or sought the elevated regions of the Mediterranean. Vaccination for tuberculosis plays an indispensible although not a prime part in prevention. New Zealand became a leader in the Southern Hemisphere when it adopted BCG vaccination on a mass scale in post-primary school entrants. The immediate benefits of this measure are revealed in the figures relating to the age group 15 to 24 years. The incidence of tuberrmlosis within this group has

dropped 80 per cent in 10 years, to less than four per 10,000. The variables involved in BCG vaccination are many and complex. Simply put, a skin test is performed on all individuals for whom vaccination is contemplated. Those who react positively are screened and observed for positive signs of the disease. Those who fail to react are considered free of the disease and safe to vaccinate.

The procedure involved in vaccination is not, then, merely one of prevention. It relates closely to detection, which is so vital in arresting the spread of the disease within a person and between people.

Tuberculosis is often diagnosed from an early and persistent cough or even by X-ray when symptom less. More advanced symptoms include a wasting fever, sweating at night, impaired breathing, pain in the shoulder or side and blood spitting.

Tuberculosis is a disease which centres, primarily, on the lungs. Bacilli, tiny rodlike structures, amass in the white cells of the blood and tissue, being transported from there to the air sacs of the lungs, or else directly along tlie air passages. The great danger is that they should multiply and spread from there, through the blood system, to such diverse areas of the body as the brain, kidneys, spine and skin.

It is this mobility or facility to spread Which makes the early diagnosis of the disease so vital. Add to this a potential to produce lesions in almost any part of the body and the vital protective role of modem preventive medicine becomes apparent.