Report of the Commission of Public Health to the Minister of Public Health / Department of Public Health, Victoria.

  • Victoria. Commission of Public Health.
Date:
[1977]
Catalogue details

Licence: In copyright

Credit: Report of the Commission of Public Health to the Minister of Public Health / Department of Public Health, Victoria. Source: Wellcome Collection.

    9/52 (page 9)
    Tuberculosis Allowance. The Tuberculosis Allowance continues to be paid through the Commonwealth Department of Social Security. Probably the most dramatic change in the tuberculosis situation is shown in figures relating to the number of patients receiving Tuberculosis Allowances for active or potentially active tuber¬ culosis under treatment. The peak figure for payments was in 1951 when 2,039 persons were receiving the Allowance at December 31st. By 1954 the conditions were administered more stringently, but the figure was then 1,453. In 1957 it was 793, and had steadily declined to 67 at the end of 1976. Notification of New Cases and Deaths from Tuberculosis. This is the area where criteria, accuracy of recording, technical changes and/or effort are reflected, and where false deductions are easily made. For instance, in 1948, the notification rate of new cases was 32/105.* Until then there were only a few fixed units for miniature X-ray in use. By 1951-1954, more transportable X-ray units were available, case finding by “searching” was given more opportunity and the new case rate rose to 46-6/105, although almost certainly there was only a small, actual increase in prevalence of tuberculosis associated with the increase of migrants arriving as they had been well screened for tuberculosis before being accepted. The reported rates again steadily declined to 23/105 in 1961, but during 1962, there was a great deal of effort, publicity and public education devoted to tuberculosis prior to the introduction of compulsory chest X-rays in October, 1963. New modern X-ray units were purchased and mounted in caravans. These could be taken to any community throughout Victoria where there was a supply of electricity—virtually the whole population. The notification rates again rapidly increased viz : 1963—28-8/105, 1964—26/105, 1965—24-5/105. Subsequently, tuberculosis control methods remained constant until the end of 1974. A steady decline in notifications occurred through this period, reaching 321, a rate of 8-8/105 in 1974. During 1975 and 1976 methods of applying compulsory chest X-rays were varied—viz. less X-rays were taken on survey, 3 caravans operated instead of 6 as previously and areas were selected for survey rather than serially. In May 1976, the minimum age for compulsory X-ray was raised to 35 years. In 1975, there were 291 new notifications of patients with tuberculosis, a rate of 7-9/105, the lowest recorded in Victoria. However, in 1976, for the first time since 1963, the number of cases increased. There were 311 new cases, a rate of 8 -5/105. This is small, but depressing. The figures for “ Deaths from Tuberculosis ” in Victoria for many years have been too small to provide help in assessing trends, although the notification of the individual can be of value in finding areas of undetected tuberculosis. However, a “ modern miracle ” happened when it is recalled that in 1948, the year Streptomycin became available, there were 677 notifications—a rate of 32-4/105, and 641 deaths from tuberculosis—a rate of 30-6/105. By 1951 new notifications were 1,030—a rate of 44-2/105, and deaths 407—a rate of 18/105 and in 1954 1,046 notifications—46-6/105, and 245 deaths—10/105. In 1975 the rate was 0-88/105 from 32 deaths. It is suggested that the year “ 1974 ” can be used as a baseline for tuberculosis control in Victoria and that statistics in future years continue to be collected as thoroughly as possible so as to recognise trends in tuberculosis prevalence. There is unlikely to be any short term dramatic change, and any adverse trends may well be masked by other factors. Perhaps the earliest significant signs could be an increase in tuberculous meningitis in children (a horrifying thought), or a raised tuber¬ culin positive reactor rate in young children. For this purpose perhaps primary schools should continue to be selected for regular tuberculin surveying. To wait for any significant general rise in recorded notification rates is likely to result in very delayed action. In the meantime, there should be no lessening of standards of tuberculosis screening for persons coming to Australia either before or after their arrival. The incidence of increased risk amongst these groups has been well documented and will continue to influence the active tuberculosis prevalence in this State. Case Register for Active Cases. This was set up in 1962 and has proved a most valuable section in “ medical audit ” of our actual control and methods applied. Statistical information has been collated and used for the preparation of many scientific papers prepared by our own staff, and outside the Department. It has brought certain areas to notice for particular attention and traced patients who have failed to notify their movements and otherwise would have been lost to surveillance. The most names registered were 3,547 in 1967. Since then the number has decreased to 1,637 this year. (* “ /105 ” “ per 100,000 ” .)