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Tuesday, June 4, 2013

Rubella Epidemic continues in Japan

Archive Number: 20130604.1754725
RUBELLA - JAPAN (07): UPDATE
****************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Tue 4 Jun 2013
From: Kentaro Iwata [edited]


[This report is an update and revised version of previous reports by Dr Mugen Ujiie, Tokyo, Japan. - Mod.CP]

A rubella epidemic still continues in Japan. The epidemic was mainly in Tokyo, the capital of Japan, but now has spread to almost all over Japan. According to the National Institute of Infectious Diseases, as of week 21, 2013 [week ending 25 May 2013], Osaka area, on the west side of Japan, exceeded Tokyo in regards to the number of rubella cases. 204 cases of either clinically or laboratory-confirmed rubella cases were reported from Osaka that week, followed by Tokyo (112 cases), Hyogo (85 cases), and Kanagawa (61 cases). 672 cases of rubella were reported on week 21 from all over Japan. As of this week, 8507 cases of rubella were reported in total, which is far more than the total number of rubella cases reported in 2012 (2392). The majority of the patients are males in their 30's, who often missed rubella vaccination (vide infra).

As of [10 May 2013], 5 new cases of congenital rubella syndrome (CRS) have been reported in 2013. In the last decade, 25 cases of CRS were reported in Japan, including those reported this year [2013]. Some municipalities decided to subsidize vaccination fees for those who are at risk. However, Japan's Government has not moved forward to change the current status; it will not subsidize vaccination fees for anybody beyond children on the routine vaccination schedule, nor develop catch-up vaccination program for adolescents or adults at risk.

Generally, rubella is common in the spring to summer. Therefore, the number of patients may continue to rise. Urgent vaccinations against rubella need to be promoted for all of people who have never had rubella before and have not been immunized against it.

The original information sources for this report include:
- National Institute of Infectious disease
http://www0.nih.go.jp/niid/idsc/idwr/diseases/rubella/rubella2013/rube13-21.pdf (partly in Japanese),
http://www.nih.go.jp/niid/en/iasren/2930-inx393-e.html
- Tokyo Metropolitan Infectious Disease Surveillance Center
http://idsc.tokyo-eiken.go.jp/assets/weekly/2013/10e.pdf

Rubella is an acute, viral infection spread via droplets. While the illness is generally mild in children, it has serious consequences in pregnant women, causing fetal death or congenital defects known as congenital rubella syndrome (CRS). When an adult woman is infected with rubella virus early in pregnancy, she has a 90 percent chance of passing the virus on to her fetus. This can cause miscarriage, stillbirth, or severe birth defects known as CRS. Infants with CRS may excrete the virus for a year or more. Children with CRS can suffer hearing impairments, eye and heart defects, and other lifelong disabilities, including autism, diabetes mellitus, and thyroid dysfunction, many of which require costly therapy, surgeries, and other expensive care.

Rubella vaccine is normally included as a component of the MMR (measles, mumps, rubella) triple vaccine administered in early childhood. The rubella component of the MMR triple childhood vaccine is a live [naturally] attenuated strain that has been in use for more than 40 years. A single dose gives more than 95 percent long-lasting immunity, which is similar to that induced by natural infection. Because of the occurrence of aseptic meningitis after injection of MMR in 1980's to early 1990's, which was believed to be caused by the mumps component in MMR, the coverage rate of rubella immunization decreased significantly in Japan, particularly in the male population. The Ministry of Health (back then) was intimidated by scores of lawsuits, and was not willing to encourage vaccination programs since then. Japan still has occasional outbreaks of measles and sporadic cases of bacterial meningitis or Japanese encephalitis. These are believed to be partly due to defective vaccination policy and programs in Japan.

--
Communicated by:
Kentaro Iwata, MD, MSc, FACP, FIDSA
Division of Infectious Diseases Therapeutics
Kobe University Graduate School of Medicine
Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo 650-0017
Japan

[ProMED-mail thanks Kentaro Iwata for provision of this update. It is surprising that under the prevailing circumstances the Japanese government has decided against financing catch-up vaccination. - Mod.CPArchive Number: 20130604.1754725
RUBELLA - JAPAN (07): UPDATE
****************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Tue 4 Jun 2013
From: Kentaro Iwata [edited]


[This report is an update and revised version of previous reports by Dr Mugen Ujiie, Tokyo, Japan. - Mod.CP]

A rubella epidemic still continues in Japan. The epidemic was mainly in Tokyo, the capital of Japan, but now has spread to almost all over Japan. According to the National Institute of Infectious Diseases, as of week 21, 2013 [week ending 25 May 2013], Osaka area, on the west side of Japan, exceeded Tokyo in regards to the number of rubella cases. 204 cases of either clinically or laboratory-confirmed rubella cases were reported from Osaka that week, followed by Tokyo (112 cases), Hyogo (85 cases), and Kanagawa (61 cases). 672 cases of rubella were reported on week 21 from all over Japan. As of this week, 8507 cases of rubella were reported in total, which is far more than the total number of rubella cases reported in 2012 (2392). The majority of the patients are males in their 30's, who often missed rubella vaccination (vide infra).

As of [10 May 2013], 5 new cases of congenital rubella syndrome (CRS) have been reported in 2013. In the last decade, 25 cases of CRS were reported in Japan, including those reported this year [2013]. Some municipalities decided to subsidize vaccination fees for those who are at risk. However, Japan's Government has not moved forward to change the current status; it will not subsidize vaccination fees for anybody beyond children on the routine vaccination schedule, nor develop catch-up vaccination program for adolescents or adults at risk.

Generally, rubella is common in the spring to summer. Therefore, the number of patients may continue to rise. Urgent vaccinations against rubella need to be promoted for all of people who have never had rubella before and have not been immunized against it.

The original information sources for this report include:
- National Institute of Infectious disease
http://www0.nih.go.jp/niid/idsc/idwr/diseases/rubella/rubella2013/rube13-21.pdf (partly in Japanese),
http://www.nih.go.jp/niid/en/iasren/2930-inx393-e.html
- Tokyo Metropolitan Infectious Disease Surveillance Center
http://idsc.tokyo-eiken.go.jp/assets/weekly/2013/10e.pdf

Rubella is an acute, viral infection spread via droplets. While the illness is generally mild in children, it has serious consequences in pregnant women, causing fetal death or congenital defects known as congenital rubella syndrome (CRS). When an adult woman is infected with rubella virus early in pregnancy, she has a 90 percent chance of passing the virus on to her fetus. This can cause miscarriage, stillbirth, or severe birth defects known as CRS. Infants with CRS may excrete the virus for a year or more. Children with CRS can suffer hearing impairments, eye and heart defects, and other lifelong disabilities, including autism, diabetes mellitus, and thyroid dysfunction, many of which require costly therapy, surgeries, and other expensive care.

Rubella vaccine is normally included as a component of the MMR (measles, mumps, rubella) triple vaccine administered in early childhood. The rubella component of the MMR triple childhood vaccine is a live [naturally] attenuated strain that has been in use for more than 40 years. A single dose gives more than 95 percent long-lasting immunity, which is similar to that induced by natural infection. Because of the occurrence of aseptic meningitis after injection of MMR in 1980's to early 1990's, which was believed to be caused by the mumps component in MMR, the coverage rate of rubella immunization decreased significantly in Japan, particularly in the male population. The Ministry of Health (back then) was intimidated by scores of lawsuits, and was not willing to encourage vaccination programs since then. Japan still has occasional outbreaks of measles and sporadic cases of bacterial meningitis or Japanese encephalitis. These are believed to be partly due to defective vaccination policy and programs in Japan.

--
Communicated by:
Kentaro Iwata, MD, MSc, FACP, FIDSA
Division of Infectious Diseases Therapeutics
Kobe University Graduate School of Medicine
Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo 650-0017
Japan

[ProMED-mail thanks Kentaro Iwata for provision of this update. It is surprising that under the prevailing circumstances the Japanese government has decided against financing catch-up vaccination. - Mod.CP

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