Tuberculosis has declined in Japan for 50 years, however it is more prevalent than other developed countries and speed of decline is much slower recently in Japan than in European countries in 1950-80s when the incidence rate was almost the same as that in Japan now. Most of old cases were reactivation and most of young cases were those soon after new infection. Early case detection and treatment and cutting the chain of transmission is necessary for the reduction of young cases. The defaulter rate among smear positive new cases is 3.6% and is higher among non-skilled workers. DOT has not been widely done on outpatient clinic basis but should be considered for those who cannot stay in hospitals.