For patients having a
Tuberculosis Examination

Tokyo Metropolitan Government
Bureau of Social Welfare and Public Health
英語What is Tuberculosis?
Tuberculosis (TB) is a disease caused when tuberculosis bacteria
enter the body. When anyone with TB coughs or sneezes, thebacteria are dispersed into the air. Anyone breathing in theseairborne bacteria may be infected.
In the early stages of TB, the symptoms are coughing, phlegm,
and fever and similar to the common cold. Therefore, it may takesome time before a diagnosis of TB can be made. If your cough lasts
for more than two weeks, visit a medical institution such as ahospital, clinic, etc. It does take time to treat TB once it develops,
however, it is no longer an “incurable disease.” If you are a family
member or a friend of the patient, support him/her because patients
often feel vulnerable.

■

Table of Contents

1

Tuberculosis is not a “Disease of the Past” ................... 3

2

Infected with Tuberculosis is Different from Onset ........ 4

3

Why is an Exposed Person Examination Necessary? ... 5

4

What Tests are Conducted in an Exposed Person
Examination? ................................................................. 6

5

What is Latent Tuberculosis Infection? .......................... 7

6What is a Chest X-Ray Examination? ............................ 8

7To Cure Tuberculosis .................................................... 98Care offered to Patients ............................................... 10

9Roles of HOKENJO (Public Health Center) .................. 11

10 Health Examination Records ........................................ 12
List of HOKENJO (Public Health Center) ..................... 13
Checkup Card............................................................... 14
Notes ............................................................................ 16Tuberculosis is not a “Diseaseof the Past”
Even today, annually about 18,000 people develop TB nationwide
and in Tokyo about 2,300 people (in 2015). Especially in recent
years, the ratio of elderly patients is increasing, however, in Tokyo,
the ratio of patients in their 20s and 30s is higher than otherprefectures. So even young people need to be aware of the disease.

TB is not adisease only forelderly people.

3

Infected with Tuberculosis isDifferent from Onset
In many cases, the body is resistant and defeats the TB bacteria
when they enter. However, in some cases, the resistance fails andthe bacteria stay inside the body, and this condition is referred to as“infected.” When TB bacteria activate inside the body, a lesion forms
and such symptoms as cough, phlegm, or fever will appear.
However, not every person who is infected will experience active TB.
Only 1 or 2 people out of every 10 infected will develop TB.

Infection

Latent tuberculosis infection
Infected with TB but has not
onset

Tuberculosis
Onset

Infected with the TB bacteria,
but the body shows nosymptoms.

The TB bacteria within
the body are now active.
Medical treatment isrequired.

4

Why is an Exposed Person
Examination Necessary?
To find people with active TB or who are infected with TB at an
early stage, the family and persons in close contact are given an
Exposed Person Examination.
For any exposed person there is a greater chance of infection if
the patient has a high TB bacteria count in their phlegm, or if aperson is in close contact with the patient, such as when talking tothem.
HOKENJO (Public Health Center) draws up types of tests andcarries out the Exposed Person Examination based on the amountof TB bacteria in the patient’s phlegm, the age of the surrounding
persons, and the contact situation.
The examination includes: IGRA exam (QFT and T-SPOTexams); chest X-ray examination; tuberculin skin test, and others.

5What Tests are Conducted in an
Exposed Person Examination?
In the Exposed Person Examination, the types of tests and date
will be decided and carried out based on the patient’s disease
condition, and the age and health condition of the people being
examined, and the characteristics of each test.

1) IGRA examination

A blood sample is taken and examined for tuberculosis infection.
If your immune system is weak, the test results may not be clear.
Even though a person has been infected, for a period of eight weeks
after infection, the test results will not show positive.

2) Tuberculin skin test

Tuberculin is injected and after 48 hours reddening of the skinmeasured.
The test checks for the presence of a TB infection.
This test is conducted generally on preschoolers under six years ofage.
The reaction may be bigger if the child has received a BCG
vaccination.
For a period of eight weeks after infection, the test results will notshow positive.
For infants and others, who have not received a BCG vaccinationand there is a consequent risk of a severe case of TB developing,
LTBI treatment may be started (see the next page) despite anegative test result.

3) Chest X-ray examination

This is a chest x-ray examination to check for the onset oftuberculosis.
Those who do not have the IGRA examination will first take thisexamination.

6What is Latent Tuberculosis
Infection?
Latent tuberculosis infection (LTBI) refers to a state where anindividual is infected with TB bacteria without any TB symptoms, butwith a possibility of developing TB. To prevent the onset of TB, takeIsoniazid (INH) generally for a minimum of six months.
This treatment is subject to the medical expenses public funding
policy.
There are no special lifestyle limitations during the treatment.
However, the onset of TB is often triggered when immunity is low
caused by overwork and stress, diabetes, etc.
In addition, if you do not regularly take medication to suppress theonset of TB, or stop taking it, the onset cannot be prevented andmay cause a risk of creating a drug-resistant TB bacteria.
If you are infected with a drug-resistant TB bacteria, medication
will be changed as needed. Take medication consistently until theend of the course.

7

What is a Chest X-Ray
Examination?
A chest X-ray examination is a test to determine the onset of TB. If
TB has developed, the result shows the condition of the lungs,
including how much lesions have spread.
For many cases, onset can take from six months to two years fromtuberculosis infection.
During the period, HOKENJO (Public Health Center) will schedulechest x-ray examinations as needed.
Attend every scheduled health examination. If you cannot attend,or your workplace, school, or location changes due to relocation etc.,
contact your jurisdiction HOKENJO (Public Health Center).
Caution: if any cough, phlegm, or fever persist for more than twoweeks, visit a medical institution instead of waiting for yourscheduled health examination.

%

Period before the onset of TB

60% of people onset in ayear, and 80% of people
in two yearsmo.
When you are infected with TB, in most cases it develops between six
months to a year after infection, and about 80% will develop TB within
two years.

8To Cure Tuberculosis
In order to cure TB, multiple drugs are combined according to thepatient’s condition. It is very important to diligently take regular
medication for the necessary period which will be more than six
months.
Most patient’s condition will improve and the risk of infecting others
will be reduced in two to four weeks after commencing treatment if
they continue taking medication. However, stopping medication or
taking it irregularly, may worsen the condition, and develop a drugresistant bacteria rendering the medication ineffective.
For a severe condition, medication treatment may last more than
one year or an operation may even be required.
Continuing medication over a long term without forgetting isdifficult for everyone.
HOKENJO (Public Health Center) also offers support to ensure
you take your medication regularly. Let’s complete the treatment
together!

Pyrazinamide

Rifampicin
Isoniazid9Care Offered to Patients
An individual with latent tuberculosis infection shows no symptoms
of TB and is not infectious to other people.
Even for someone who has developed active TB, the degree ofinfectiousness will be reduced within two weeks by taking regular
medication.
When the patient returns to school or work, there is no risk ofinfecting others.
Offer care to the patient.
Many people suffer from social prejudice due to their healthconditions, such as tuberculosis, AIDS, Hansen’s disease, etc. Their
human dignity is not changed by the disease. We must support them,so they can focus on their treatment.

10Roles of HOKENJO (Public HealthCenter)
HOKENJO (Public Health Center) supporting healthy, vibrant lives!
PHC assists TB patients with medication, medical consultations,post-treatment health checkups, and conducts checkups on apatient’s family and friends.
* Please note, public funding partially covers medical expenses for
TB treatment, and you can submit an application to HOKENJO(Public Health Center).
If you have any concerns, contact your PHC.

What is DOTS?
DOTS is an acronym meaning “Directly Observed Treatment, ShortCourse” and a strategy recommended by the World Health Organization(WHO). DOTS has five components:
1) Government commitment
2) Diagnosis by sputum-smear microscopy and follow-up observation
3) Medication given under direct and supportive observation
4) A regular, uninterrupted supply of drugs
5) Recording and reporting of examination results
This strategy was incorporated into Japanese law in 2005, and inparticular, medication is given to patients under direct and supportive
observation to help them with their continuous medication in-take at
hospitals and HOKENJO (Public Health Center).

11Health Examination Records
1

Checkup schedule (test result)
Scheduled date
Y M D

Test

ConductedRemarks
Institution

ResultChest XRay Exam
IGRA Exam

Immediate

Tuberculin
Skin Test

Injection Site
(Left Right Upper Middle Lower)

X

Injection Site
(Left Right Upper Middle Lower)XX(Blister / Necrosisand Hemorrhage)

Other Test
Y M D

Chest XRay Exam
IGRA Exam

2 Mo. Later

Tuberculin
Skin Test

X(Blister / Necrosisand Hemorrhage)

Other Test
6 Mo. Later Y M D
1 Yr. Later Y M D
2 Yr. Later Y M D

2Chest XRay Exam
Chest XRay Exam
Chest XRay ExamFor those undergoing checkups(1) Taking only one checkup is not enough. You must attend all the scheduledcheckups.
(2) If you have a cough, phlegm, chest pain, or slight fever for more than twoweeks, do not wait for your next checkup. Visit a medical institution with thisform. This also applies even after the treatment is over.

3

For doctors at medical institutions
Mr./Ms.
might have been infected with the TB bacteria aroundYM
D, and this patient has been examined according to theschedule above. If there are any signs of tuberculosis, please contact us at thefollowing HOKENJO (Public Health Center).
HOKENJO (Public Health Center):Dept.:
Tel No.:(12)