Prevention and treatment measures are stepped up after joint directive from the ministries of education and health The mainland's ministries of health and education have issued a joint directive ordering schools to take preventive measures against tuberculosis outbreaks. The order was made after figures released by the Ministry of Health this week showed a rise in tuberculosis cases on the mainland - 290,882 in the first six months of this year, compared with 274,461 during the same period last year. In all, 372 people have died of the disease in the first half of this year. Authorities were alarmed this year when students at up to five schools in Henan showing symptoms of Sars were found to have tuberculosis, according to a health official. Each school had dozens of infected students, prompting a Ministry of Health investigation. A smaller outbreak was reported in a school in Zhejiang. The directive said: 'Since March, schools in some provinces have had outbreaks of tuberculosis. The outbreaks have attracted intense attention from the state leaders, and authorities are required to step up tuberculosis prevention and treatment measures in schools. 'Students are a special community. Their population intensity is high and there are relatively close contacts between them. Once there are outbreaks, they can become epidemics if they are not contained in time.' The directive also lists tuberculosis among diseases to be tested in compulsory health checks for primary and secondary schools, colleges and universities. The health official said: 'Students have health checks at the beginning of a school year and we discovered that many schools have not included tuberculosis on the list.' 'We were alarmed and we talked to the education authorities to issue the circular before the new school year. 'Students are now required to have X-ray and spit tests in their annual health checks.' The directive said school officials would be held responsible for outbreaks should any negligence be found in the carrying out of precautionary measures and health testing. The health official added that most cases were found in boarding schools in small towns where sanitation was inadequate. 'Most of these students are peasant children from poor areas,' the official said. 'They live in the schools. The food and the living conditions are poor.' But despite the rise in the number of tuberculosis cases, the official said there was no sign of the disease spreading. 'There have always been outbreaks all along. The difference is that many cases were not reported before,' the official said. 'The rise in the figures has more to do with improved transparency in the report of infectious disease. I don't think tuberculosis is getting worse in China.'