Tuberculosis Cases Surging in Japan

TOKYO (AP) â€” It made perfect medical sense: one member of the household came down with tuberculosis, so everyone who might have been exposed went to the hospital to get tested. <br><br>But this wasn't

Tuesday, November 28th 2000, 12:00 am

By: News On 6

TOKYO (AP) â€” It made perfect medical sense: one member of the household came down with tuberculosis, so everyone who might have been exposed went to the hospital to get tested.

But this wasn't just any household â€” it was the Imperial Household.

The recent screening of the heir to the Chrysanthemum Throne and his wife drove home some troubling health news here: tuberculosis, a disease redolent of poverty and squalor, is making a comeback in affluent Japan.

The number of new tuberculosis patients in Japan jumped in 1999 for the third straight year, and the per capita infection rate â€” 38.1 per 100,000 people â€” was by far the highest among industrialized nations.

The surge has caught Japan's medical establishment off guard.

Health officials are rushing to update prevention programs, hospitals are fretting over the lack of specialists in the disease and experts bemoan the lack of research money. The government declared a tuberculosis state of emergency last year and is in the midst of a national survey of patients.

Several trends are contributing to the spread of TB in Japan, including a rapidly aging population, a weak economy that has aggravated the health problems of the poor and widespread ignorance about the long-forgotten disease.

``People thought tuberculosis was defeated,'' said Toru Mori, director of the Research Institute of Tuberculosis in Tokyo.

The disease is largely associated with the poverty and devastation of Japan just after World War II, but the appearance of TB at the pinnacle of society â€” the Imperial Household â€” has proved that anyone can be at risk.

Crown Prince Naruhito and Princess Masako, who live in a separate palace from the emperor and empress, were tested after an elderly attendant came down with the disease. The couple tested negative, but a second palace employee was hospitalized with tuberculosis on Nov. 16.

Public concern has also mounted about the health of Empress Michiko, who has suffered from a cough for weeks and lost about nine pounds in a one-month period. She recently had medical tests, including X-rays, but palace officials have said there is no evidence she has tuberculosis.

Japan is not the only wealthy country fighting tuberculosis. The disease surged in the United States in the late 1980s, peaking in 1992. Since then, the infection rate has fallen by more than a third.

While many countries attribute higher infection rates to the HIV/AIDS epidemic and an increase in drug-resistant strains of tuberculosis, experts say those are not major ingredients in Japan.

Instead, they point to a different No. 1 factor: the rapidly growing elderly population.

The Japanese are among the world's longest-living populations. Japanese 65 years or older â€” the survivors of the postwar days when tuberculosis was the country's leading cause of death â€” now account for a record 17.3 percent of the population.

Many of those survivors carry the tubercle bacillus. While the disease remains dormant in some 90 percent of its hosts, it can activate and become contagious as the immune system of the carrier declines with age.

That's when trouble begins for the rest of society.

``The biggest cause is that the number of elderly is increasing,'' Mori said. ``They are the sources of infection and they spread the disease to young people.''

The weak economy is also playing a role by pushing unemployment to postwar highs and swelling the ranks of the homeless, creating a growing breeding ground for disease.

That trend is on full display in the western city of Osaka. The infection rate there â€” 113.3 per 100,000 population in 1999, up 9 percent from two years earlier â€” is far and away the nation's highest among large cities and nearly three times the national average.

The Osaka area is the traditional center for Japan's Korean and Chinese minorities and the descendants of the country's feudal underclass, which have long suffered from economic and social disadvantages. The city is also home to the nation's largest migrant labor district â€” another social force that set the stage for today's resurgence.