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Japan faces rising health threats from tuberculosis, syphilis

A card from Okayama Prefecture warns people about syphilis and other sexually transmitted diseases.

Cases of syphilis and tuberculosis, commonly considered ailments of the past, have been rising in Japan, posing renewed health threats to the country.

The increase in tuberculosis has been attributed partly to a rise in workers from Southeast Asian countries where the rates of infection are higher than in Japan. Syphilis, meanwhile, has been spreading not just in major cities but in regional areas. Health officials are accordingly putting an effort into detecting infections at an early stage and providing consultation systems.

-- Rise in tuberculosis cases includes non-Japanese patients

At a United Nations conference in June, Indonesian doctor Erlina Burhan stressed the need to develop new drugs to treat tuberculosis. She said the side effects of the current medicines were so severe that several of her patients had taken their own lives.

The number of deaths worldwide from tuberculosis is said to stand at 1.7 million per year, higher than for AIDS or even malaria as a single infectious disease. There are many contributing factors, including a lack of proper health care, poverty, and trouble taking medication. In Indonesia, patients on medication suffer side effects including violent vomiting, joint pain, sleeplessness and depression, and one out of every three people is said to give up on treatment.

At a U.N. General Assembly session to be held in late September, one major theme is the fight against tuberculosis. A declaration is expected to be adopted by top-level officials across the world on steps to combat the disease.

For Japan, tuberculosis is not just someone else's problem. Up until around 1955, it was feared as a disease that could doom the country, but as living conditions improved the number of patients and deaths plummeted. However, an increase in the number of foreign patients has been a concern in recent years.

Of the 16,789 new tuberculosis patients in Japan last year, 1,530, or a little under 10 percent, were born overseas. This figure was 40 percent higher than four years earlier. The number of patients from Indonesia, highlighted by Burhan at the U.N., has been increasing, as has that from Nepal and Vietnam. These countries have relatively high rates of infection.

There are said to be cases in which foreign nationals feel unwell, but do not contact health consultation centers or other medical facilities for fear that they will lose their jobs and be sent home.

Takashi Sawada, a doctor at Minatomachi Medical Center in Yokohama, south of Tokyo, has treated foreign patients. "They've been accepted into Japanese society for economic reasons, but the support system is insufficient," he says. He adds that it is important to prepare a consultation system so that the disease can be detected early and patients can continue with treatment.

At the same time, to prevent tuberculosis patients from entering Japan, the Japanese government has decided to require people from Indonesia, China and some other countries to submit certification that they do not have the disease when they apply for long-term visas. This system will begin as early as the current fiscal year ending in March 2019.

There are also moves to support medical treatment in developing countries to prevent an increase in infections. The Global Health Innovative Technology Fund, a public-private partnership between the Japanese government and pharmaceutical companies and other bodies, is involved in research with overseas partners to develop medicines, vaccines and diagnostic products. It intends to invest 20 billion yen in the R&D over a five-year period starting this fiscal year.

-- Syphilis cases reach highest level in 44 years, spreading to regional areas

People tend to perceive syphilis as a sexually transmitted disease that was prevalent before World War II, but there has in fact been a surge in infections since 2011. In 2017, the number of patients in Japan reached 5,820 -- the highest level in 44 years. As of the end of August this year, 4,221 people were reported to have the disease, more than the 3,446 recorded at the same time last year.

Cases have not only spread in large cities with entertainment districts, but in regional Japan. Even those who have never visited adult entertainment facilities can find themselves at risk of infection, and need to be wary of the disease.

In Okayama Prefecture last year, the number of cases per unit of population was the third highest in the country after Tokyo and Osaka. The reason for the sudden uptick remains unknown, but a survey by the Okayama Municipal Government found that many male patients had used adult entertainment establishments before they were infected, while 26 percent of female patients worked in the adult entertainment industry. There has also been a rise in the number of patients who have nothing to do with the adult entertainment businesses but who have contracted the disease from specific partners.

Hiroko Kanzaki, a doctor operating a dermatology clinic in the city, says that there are cases in which people visit thinking they simply have eczema or an allergy. There are also cases in which people go to an ear and nose specialist due to sudden hearing loss, a symptom of syphilis, but are unable to find the cause of their condition, and first learn they have the disease after receiving a blood test during a comprehensive medical examination.

Takaoki Ishiji, a professor of dermatology at The Jikei University, commented, "People should keep in mind that anyone who is sexually active could have syphilis."

There has been a marked increase in cases among young women in Japan. Over a period of three years, the number of women in their 20s with the disease has risen tenfold. There has also been a rise in the number of babies born with syphilis after being infected through their mothers, with 14 such cases in 2016.

The Ministry of Health, Labor and Welfare plans to analyze routes of infection in detail. If a doctor reports an infection, then the patient will be asked whether they work or have worked in the adult entertainment industry and, for women, whether they are pregnant. Local bodies will also hand out fliers targeting young women, to build awareness of the disease.

(Japanese original by Go Kumagai, Medical Welfare News Department)

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