Original articleSurveillance of diagnostic and treatment measures in Bavaria, 1974–1976: Results 2 and 5 years after the start of chemotherapy

A central surveillance register for all bacillary pulmonary tuberculosis cases reported in Bavaria (population in excess of 10 million) was established from 1974 to 1976. The aim of the study was to discover the quality and efficiency of health services delivery to the population in the field of tuberculosis under routine conditions, and to find out the relapse rate after cessation of chemotherapy in expatients who were found to be negative 2 years after starting chemotherapy. A total of 7850 German patients with bacillary pulmonary tuberculosis were diagnosed in Bavaria from 1974 to 1976 corresponding to an average annual rate of 25.7 per 100 000 population: 71 % of them were smear-positive and 29 % were positive by culture only. Reactivations formed 25 % of all bacteriologically confirmed cases. Most (71 %) smear-positive new cases were discovered because of symptoms. Of the 5157 cases of bacteriologically confirmed pulmonary tuberculosis reported during 1975 and 1976,4 % died from tuberculosis, 1 % from sequelae of tuberculosis and 9 % from causes other than tuberculosis. A further 3 % of patients had drug side-effects, 3 % were uncooperative, 2 % emigrated or had no permanent address and 1 % had no chemotherapy or no information on treatment. The overall results of treatment were very satisfactory: sputum conversion among 3991 patients in the group with complete treatment was achieved in 97.4 % at 2 years, and in those with incomplete treatment in 96.2 %. The duration of chemotherapy was long, i.e. 19 months or more in two thirds of the patients. The average reactivation rate during the 3rd, 4th and 5th follow-up years was 0.8 % annually; it was higher among males than females and the rate increased with age. Of the 157 patients found to be bacteriologically positive at 2 years after the start of chemotherapy 46 died during the 3-year observation period and 109 were alive at 5 years, 23 of whom were harbouring tubercle bacilli.