Current Problems of Measles Control in Japan and WPR Head of Measles Laboratory WHO Measles Regional Reference Laboratory WHO Grobal Specialized Laboratory National Institute of Infectious Diseases Tokyo, Japan Kei Numazaki, M.D., Ph.D The Fourth Global Measles and Rubella Laboratory Network Meeting WHO, HQ - Geneva, Switzerland 28-30 August 2006 Salle B QuickTimeý Dz ÉtÉHÉg - JPEG êLí£ÉvÉçÉOÉâÉÄ Ç™Ç±ÇÃÉsÉN É`ÉÉÇ¾å© ÇÈÇ…ÇÕïKóvÇÇ• ÅB Infectious Diseases Surveillance System of Japan （Number of sentinel clinics） -----------------------------------------------------------------------------------------------------------1999 2000 2001 2002 2003 2004 Influenza 4,128 4,585 4,649 4,698 4,703 4,673 Pediatric 2,875 2,978 3,019 3,036 3,041 3,039 diseases Ophthalmic 589 625 634 634 634 635 diseases Sexually855 897 911 917 920 922 transmitted diseases Specially-designated sentinel clinics weekly reporting 456 459 470 473 471 471 monthly reporting 445 457 458 465 468 469 -----------------------------------------------------------------------------------------------------------Measles Laboratory, NIID Sentinel-Reporting Diseases (from NIID/IDSC Surveillance Data) ------------------------------------------------------------------------------------------------1999 2000 2001 2002 2003 2004 Measles (excluding measles in Adults) Reported cases Cases per sentinel 5,875 22,552 33,8121 2,473 8,285 1,554 2.04 7.57 11.20 4.11 2.72 0.51 Reported cases Cases per sentinel 2,972 1.03 Rubella Measles in adults (aged > 18 y.o.) 3,123 1.05 2,561 2,971 2,795 4,248 0.85 0.98 0.92 1.40 Reported cases 83 426 931 440 462 60 Cases per sentinel 0.18 0.93 1.98 0.93 0.98 0.13 --------------------------------------------------------------------------------------------------------------------Measles Laboratory, NIID Measles reported per sentinel weekly in Japan less than 18 years of Age (data from Infectious Disease Surveillance Center, NIID) Measles Laboratory, NIID Measles reported per sentinel weekly in Japan more than 18 years of Age (data from Infectious Disease Surveillance Center, NIID) Measles Laboratory, NIID Rubella reported per sentinel weekly in Japan (data from Infectious Disease Surveillance Center, NIID) Measles Laboratory, NIID Recent Cases of Measles and Rubella in Japan (excluding Measles in Adults) 1999 2000 2001 2002 2003 2004 2005 Measles Reported 5,875 22,552 33,812 12,473 8,285 1,547 545 Cases Cases per 2.04 7.57 11.20 4.11 2.72 0.51 0.18 sentinel Rubella Reported 2,972 Cases Cases per 1.03 sentinel 3,123 2,561 1.05 0.85 2,971 2,795 4,239 895 0.98 0.92 1.40 0.29 Measles Laboratory, NIID Reported Cases of Measles in Japan (data from Infectious Disease Surveillance Center, NIID) 0.8 Reported cases per sentinel clinics 0.6 33,812 reported cases 0.4 1,554 reported cases 0.2 0 2005; 545 reported cases 14 20 26 32 38 44 50 4 10 16 22 28 34 40 46 52 6 12 18 24 30 36 42 48 2 8 14 20 26 32 38 44 50 4 10 16 22 28 34 40 46 52 6 12 18 24 30 36 42 48 week 1999 2000 2001 2002 2003 2004 Measles Laboratory, NIID B¾c Ninh Molecular epidemiological study done at NIID in 2005 Preliminary data revealed circulation of three genotypes of measles virus in Hµ Néi Legend: Vietnam H1, H2 and D5 H1 •H2 H2 D5 –indigenous circulation suggested •D5 –most probably imported from Thailand Gia Lai •H1 Nha Trang –importation from China or Japan? –has been in the country but missed on the initial survey? source: NIHE Measles Laboratory, NIID the phylogenies tree of measles virus H1 and H2 isolates, from 2003 to 2004 North Vietnam source: NIHE & NIID jiangs u03-1 jiangs u03-3 jilin02-1 QH04-1 s h02-23 s h02-8 s h02-52 HeN03zhangchao s x-050 s h02-48 s h02-34 tj02urine-11 TJ03-s wab3 TJ03urine-2 tj02urine-17 Hainan03-20 s c03-8 gd02-5 gd02-9 jilin02-3 xj02-18 xj02-28 s ichuan02-4 s c03-7 XJ152 XJ74 s x-266 XJ150 XJ27 Chin9344 TJ-03urine-1 Hainan03-12 hebei03-1 CQ04-3 Chin9372 m v9312 Chin9363 Hainan03-9 9475 Henan02-fanpeijun s ichuan02-2 H1a H1c H1b s h02-43 XJ146 chin94-1 h 9418 Chin9353 edwt-456 S191 XJ26 0.01 A source: CCDC Molecular epidemiological study done at NIID in 2006 Country ISO Code Country Name Year of onset Measles genotype identified Sequence verified Date of submission 7/13/06 2801:VA2165 Singapore 2006 D9 3001:VA2201 Singapore 2006 D9 1102_VA2273.seq 2601_VA2167.seq Singapore 2006 D9 0401_VA2032.seq 7/13/06 Singapore 2006 D9 3001_VA2201.seq 7/13/06 Singapore 2006 D9 2801_VA2165.seq 7/13/06 1102:VA2273 2601:VA2167 0401:VA2032 7/13/06 Measles Laboratory, NIID Recent outbreak of measles in Chiba, Japan May to June, 2006 (data from Chiba Prefectural Government) Cases Age/Sex Clinical specimens Date of onset 6ｙ3ｍ Ｍ NP May16 May19 +/+ D5 + 6y7m F NP May19 May 22 - /+ D5 + NP Ｍａｙ１７ Ｍａｙ ２２ -/+ D5 + 7y2m F NP May20 May 23 +/+ D5 + 1y0m M NP May14 -/+ H1 + 2y8m F NP May 6 May 8 -/+ H1 + NP June 1 June 6 -/+ 6y5m F 1y0m M Date of Measles History Tissue collecting genotype of culture samples identified vaccination /PCR May19 H1 + Measles Laboratory, NIID Estimated Susceptible Cases for Measles in the year of 2004 Infectious Disease Surveillance Center, NIID ：estimated from National Epidemiological Surveillance of Vaccine-preventable Diseases (NESVD) 800000 Adults 700000 600000 500000 Elementary School Children Children of Pre-school Age 400000 Junior, Senior High School; University Students 300000 200000 100000 0 0 1 2 3 4 5 6 7 8 9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Ａｇｅ Measles Laboratory, NIID Estimated Susceptible Cases for Rubella in the year of 2004 Infectious Disease Surveillance Center, NIID ：estimated from National Epidemiological Surveillance of Vaccine-preventable Diseases (NESVD) 1800000 1600000 1400000 1200000 1000000 Female Male 800000 600000 400000 200000 0 0 1 2 3 4 5 6 7 8 9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Age Measles Laboratory, NIID Imported Measles Cases 1996-2003* CDC,USA Total Cases Imported - 290 Japan – 44 cases → 2005 Germany – 24 cases China – 22 cases Philippines – 17 cases Italy – 16 cases India – 15 cases Pakistan – 14 cases Greece, Korea – 10 cases each All other countries – 118 cases *2003 Provisional data 0 case Measles Laboratory, NIID Measles Laboratory, NIID Measles Laboratory, NIID Annual estimated cases of measles in Japan Measles Laboratory, NIID 麻疹ワクチン既接種小児に発症した 麻疹脳炎の一例 症例：12歳男児。 既往歴：1995（平成７）年11月22日（１歳７カ月時）に麻疹ワクチン接種済み。 現病歴：2006（平成18）年６月３日、麻疹ワクチン既接種であった７歳の弟が麻 疹を発症した（EIA 法にて麻疹IgM抗体価7.21、IgG抗体価≧128）。６月14日よ り、患児に38℃台後半～39℃台前半の発熱が出現。15日には全身性の発疹を 認めたため、17日に近医を受診。カタル症状は伴っていなかったが、コプリック 斑を指摘され、麻疹と診断された。18日（５病日）には解熱し、全身状態も良好と なったが、20日（７病日）昼頃より発熱、傾眠傾向が出現。夕方には嘔吐、見当 識障害（自分の名前を答えられず）が認められたため、近医を再診。麻疹脳炎 を疑われ、当科紹介入院となった。 入院時現症：体温39.2℃、心拍80/分、呼吸数36/分。傾眠傾向を認めたが、呼 びかけで開眼（JCS II-10）。痙攣なし。項部硬直、Kernig徴候なし。眼脂、鼻汁、 咳嗽なし。咽頭発赤なし、Koplik斑なし。全身に一部癒合した紅班あり。胸腹部 に異常を認めず Measles Laboratory, NIID Measles Laboratory, NIID Measles Laboratory, NIID Measles Laboratory, NIID Measles Laboratory, NIID
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