International Tuberculosis Information Centre (ITIC)

@It was established in 1992 in order to collect information on tuberculosisepidemiology and on tuberculosis control programme from the countries inthe world, analyze and feedback them. In ITIC computerized database systemand library of references are maintained. Regarding information for theWestern Pacific Region where Japan is a member country, ITIC has been collaborating with Regional Office for the Western Pacific, WHO.

As feedback activities, ITIC has information service through publications,such as Tuberculosis Statistics in the World and Epidemiological Reviewof Tuberculosis in the Western Pacific Region, and through providing information to inquiry.

The Computerized Tuberculosis Surveillance System in Japan

The computerized tuberculosis surveillance have been carried out since 1987in Japan. The surveillance system consists of a three-phase structure,the health center level, the local government level, and the Ministry ofHealth and Welfare (MOHW).

MOHW is technically strongly supported by the Research Institute of Tuberculosis (RIT), Japan Anti-Tuberculosis Association (JATA), as can be seen in the Figure.

As of 1994, there are 844 health centers, 47 prefectures and 12 Metropolitan Cities as local government in Japan.

The individual data consist of the items such as sex, age, occupation ofthe patient, present bacteriology and X-ray findings and those at the timeof registration, chemotherapeutic regimen, date of negative conversion andso on, which are recorded at each health center by the clerk, public healthnurse or someone else. The individual data on the newly registered in thecourse of a month are to be accessed and sent to the local government by10th of the following month, on-line. The local government should send the individual data to MOHW before 15th, on-line.

The results of the analysis are sent back to the local health center throughlocal government up to 20th on-line. Results are distributed to the publicthrough the monthly official journal of the Japanese Society for Tuberculosis, "Kekkaku".

The results of the analysis of the registered patients are published as"Tuberculosis Year Book". A total of 50 tables including thedistribution of patient's, doctor's and total delay, of initial chemotherapeutic regimen, and of the duration of hospitalization; chemotherapy and registration; treatment results and so on, are included in the routine analysis at national level.

As the Directors of every health center have the direct responsibility fortuberculosis control measures in the area, the analysis of data collectedat the health center level is very important. For this purpose, 43 programsto be used for analysis are prepared at each health center. Programs forprint-out of special cases such as bacteriologically positive cases forone year or more after registration, registered 5 years earlier or more,and so on, are included. Analysis of the patient's, doctor's and totaldelay, analysis of treatment duration can be also done with the programavailable at the health center.

Further analysis of the collected data is carried out at prefecture levelby the 50 programs already distributed to the local government to supportthe health center activities.

Precise analysis of the collected data is to be conducted at the RIT, JATA.The National Tuberculosis Surveillance Committee is organized by tuberculosis specialists and a committee meeting is to be held at any time if needed.

Tuberculosis case notification in the world

WHO has been collecting information on tuberculosis notification from thecountries in the world. Here you can see tuberculosis case notificationrates (rate: annual number of newly notified cases per 100 ,000 population)in several countries by region, which are derived from Tuberculosis - AGlobal Emergency: Case Notification Update, February 1996, Global Tuberculosis Programme, WHO, Geneva.

We need to understand the following issues when we see data:

  1. Definition of notified tuberculosis cases may be different from countryto country. For instance, notified tuberculosis cases include pulmonarycases but not extrapulmonary cases in some country.
  2. Number of notified cases might be influenced by quality of diagnosisand reporting activities. For instance, cases diagnosed and treated inprivate sector are not included in official statistics in most developingcountries.

Because of nature of these conditions, it should be considered that tuberculosis statistics bases on notification may not precisely reflect actual epidemiological situation of tuberculosis in some occasion. For instance, even if number of tuberculosis shows increase trend, it should be taken into consideration that the increase trend does not necessarily indicate worsening epidemiological situation and that it may just attribute to improvement of diagnosis and reporting activities in some countries. Therefore we call data shown here as case notification rate, not as incidence rate, which usually refers to rate of new cases occurring actually and which is the term used for theoretical discussion.


Updated 96/09/17