Vaccination and Children Health Vaccination and Children

Document Sample
Vaccination and Children Health Vaccination and Children Powered By Docstoc
					Vaccination and
       Children's Health

                                                 2008 version
                                                     英語版




 The Review Committee for Vaccination Guidelines
 Publisher: The Foundation of the Vaccination Research Center
This publication was subsidized by JKA through its
promotion funds from KEIRIN RACE.
* 日本にお住まいのお子様方の予防接種は、原則として日本国の      「予
                              「予防接種法」
防接種実施規則」などの法令に従って(外国において、すでに予防接種を受けられて
いる場合であっても)接種して頂くことになっています。
   従って、日本居住のお子様には母国の予防接種法でなく、日本の予防接種法(接
種液、接種時期、接種回数)で行いますので、不足の予防接種の分は母国に帰国して
からか、あるいは日本国内で自費で接種するようにしてください。
(御不明の点がありましたら、主治医に御相談ください。)


* Any child who lives in Japan is, in principle, vaccinated in accordance with
Japanese laws and regulations, including the “Preventive Vaccination Law” and the
“Implementing Regulations of Vaccination” (even if he/she has already been vaccinated
outside Japan).
   Any child who lives in Japan is vaccinated in accordance with the Japanese
Preventive Vaccination Law (regarding vaccine preparation and vaccination schedule
and frequency), not with the pertinent laws of his/her homeland; therefore, vaccinations
not specified by Japanese law will have to be given to him/her privately in Japan or after
returning to his/her homeland. (Please consult your doctor if you have any questions.)




                  Please confirm the following before vaccination.

1. Is your child in good health?
2. Do you understand the necessity for vaccination and the benefits and possible
   risks (side effects) of the vaccine that will be given to your child today?
  If you have any questions, please write them down.
3. Do you carry a maternal and child health handbook with you?
4. Did you complete a screening questionnaire for vaccination?
                                     Introduction

    Children are often ill and sometimes become extremely sick; vaccination can protect
them from several serious illnesses.
    This brochure has been created to provide you with information about vaccination
and to allow you to have your child vaccinated safely.
    We hope that this brochure will enhance the health and growth of your child.



       [Summary of the revised points in this version]

    In this version, compared with the March 2007 version, the following points have
been revised in accordance with the amendment of rules related to vaccination by the
Ministry of Health, Labour and Welfare.
(1) Revised specifications for the interval between vaccinations
       In the specification of the interval between vaccinations for diphtheria-pertussis-
    tetanus (DPT), polio (acute poliomyelitis), and Japanese encephalitis, the term
    previously used was “at the interval of XX to YY weeks”; this has been revised as
    follows:
    1) In the specification of the intervals for DPT Phase 1 initial vaccination, the phrase
       “at intervals of 3 to 8 weeks” has been revised to “at intervals of 20 to 56 days.”
    2) In the specification of the interval for polio vaccination, the phrase “at an interval
       of 6 weeks or more” has been revised to “at an interval of 41 days or more.”
    3) In the specification of the interval for Phase 1 initial vaccination for Japanese
       encephalitis, the phrase “at intervals of 1 to 4 weeks” has been revised to “at
       intervals of 6 to 28 days.”
    Note:      In this brochure, the previously used expression (XX to YY weeks) is
               stated together with the new one, for convenience.
(2) Added details on the implementation of Phase 3 and 4 routine measles vaccination
    Note 1: This amendment is for children at ages corresponding to the first year of
               junior high school and the third year of high school.
1
Note 2: This amendment has been made in accordance with the strategy of the
        Ministry of Health, Labour and Welfare, taking into consideration the
        following conditions. To prevent measles and rubella, it is important to
        receive Phase 1 and 2 routine vaccinations at specified ages.
        [A] Last year, a measles epidemic affected persons in their teens and 20s;
            consequently, many schools had to close because many students did
            not have sufficient antibody levels to prevent the spread of measles,
            for the following reasons:
            1) Many people had not received measles vaccination.
            2) Many people had not been infected with measles.
            3) Some of those who had received the first vaccination had failed
               to acquire immunity and had little opportunity to enhance their
               immunity by natural infection.
        [B] Because measles is extremely infectious, spreading from person to
            person, and a serious disease that sometimes causes death, the Japanese
            Government established the “Plan for Measles Elimination,” which
            was drawn up to eradicate measles by 2012. As one of the strategies,
            Phases 3 and 4 routine measles vaccinations are to be given to children
            at ages corresponding to the first year of junior high school and the
            third year of high school for the 5 years from 2008 through 2012.
        [C] Rubella is also to be eradicated, in a similar fashion to measles.




                                                                                 2
                                      Table of Contents

1 Get your child vaccinated! ....................................................................... 4
2 What is vaccination? ................................................................................ 5
3 Children who are candidates for routine vaccination
    (vaccination schedule) .............................................................................. 5
4 The intervals at which different vaccines are given to a child ................ 7
5 Let’s make a vaccination plan for your child ........................................... 8
6 Diseases preventable by vaccination, and vaccine side effects ............... 10
    Polio (acute poliomyelitis) ........................................................................... 10
    Diphtheria, pertussis, and tetanus ................................................................ 12
    Measles and rubella .................................................................................... 15
    Japanese encephalitis ................................................................................. 19
    Tuberculosis .............................................................................................. 21
7 Vaccine types and characteristics ........................................................... 23
8 Vaccination validity ................................................................................ 24
9 Before having your child vaccinated ...................................................... 24
10 What to do if your child has a side effect from the vaccination ............. 27
11 Other considerations ............................................................................... 29
Appendices: Screening questionnaire for vaccination





                                                              1. Get your child vaccinated!


                     1. Get your child vaccinated!

   The immunity to diseases which mothers give their infants almost completely
disappears 3 months after birth for pertussis and 12 months after birth for measles.
Consequently, after these periods, infants must ward off disease by producing their own
immunity. Vaccination supports this defense.
   Children go outside more often as they grow; consequently, they are at higher risk
of infection. We recommend that you learn about vaccination and have your child
vaccinated for his/her health.



   Infections

     Infections are caused by microorganisms, including viruses and bacteria,
  that invade the body and multiply. Symptoms may include fever, cough, and
  headache, depending on the type of microorganism.




                                                                                         
2. What is vaccination?


                          2. What is vaccination?

    Vaccination is the administration of weakened forms of infectious viruses and
bacteria or of their toxins. Giving these weakened forms produces immunity against
these diseases (for example, measles and pertussis). A “vaccine” is a preparation used
for vaccination.
    Vaccines cannot be prepared for all infectious diseases. Vaccines are difficult to
produce for some viruses and bacteria.




 3. Children who are candidates for routine vaccination
                          (vaccination schedule)

    Vaccination includes routine vaccination and other forms of vaccination. With regard
to routine vaccination, the Preventive Vaccination Law defines the target diseases,
subjects, and vaccination schedules.
    The schedule for routine vaccination is shown in the following table.





                                                         . Children who are candidates for routine vaccination (vaccination schedule)
                                [Note] The starting date for calculating the vaccination interval is the next day of vaccination.




                                  3-month-old
                                                6-month-old
                                                              9-month-old




                                                                                                                                                                                                  10-year-old


                                                                                                                                                                                                                              12-year-old
                                                                                                                                                                                                                                            13-year-old
                                                                                                                                                                                                                                                          14-year-old
                                                                                                                                                                                                                                                                          15-year-old
                                                                                                                                                                                                                                                                                        16-year-old
                                                                                                                                                                                                                                                                                                      17-year-old
                                                                                                                                                                                                                                                                                                                    18-year-old
                                                                                                                                                                                                                                                                                                                                  19-year-old
                                                                                                                                                                                                                11-year-old
                                                                            1-year-old
                                                                                          2-year-old
                                                                                                       3-year-old
                                                                                                                    4-year-old
                                                                                                                                 5-year-old
                                                                                                                                              6-year-old
                                                                                                                                                           7-year-old
                                                                                                                                                                        8-year-old
                                                                                                                                                                                     9-year-old
         Polio
                                           Two injections are given at an interval of 41 days (6 weeks) or more.

                  First                                                                  Note 1)
Diphtheria,
                  phase
Pertussis,                                 Three injections are given at intervals of 20 to 56 days (3 to 8 weeks) as the initial vaccination,
                  (DPT)                    and a booster is given 6 months or more after the completion of the initial vaccination.
and
Tetanus           Second
(DPT)             phase
                  (DT)
                                                                                             A child born on April 2
                                                                                           A child born on April 1
 Measles (MR)                                                                                                              A child 5 or 6 years old, and in
                                                                                                                                                                  A child who turns 13 years                                                                            A child who turns 18 years
 Note 2)                                                                                                                   the year before starting primary
                                                                                                                           school (i.e., a child in the last year
                                                                                                                                                                  old during the first year of                                                                          old during the third year of
                                                                                                                                                                  junior high school)                                                                                   high school)
                                                                                                                           of kindergarten or nursery school)

                                                                                             A child born on April 2
                                                                                           A child born on April 1
 Rubella (MR)                                                                                                              A child 5 or 6 years old, and in
                                                                                                                                                                  A child who turns 13 years                                                                            A child who turns 18 years
 Note 2)                                                                                                                   the year before starting primary
                                                                                                                           school (i.e., a child in the last year
                                                                                                                                                                  old during the first year of                                                                          old during the third year of
                                                                                                                                                                  junior high school)                                                                                   high school)
                                                                                                                           of kindergarten or nursery school)


                                On or after May 30, 2005, this vaccination is not actively recommended.
                                However, if desired, the vaccination can be given under the Preventive Vaccination Law.
     Japanese
    encephalitis
                                                         Two injections are given at an interval of 6 to 28 days (1 to 4 weeks) as the initial vaccination of
                                                         Phase 1; a booster is given about 1 year after the completion of the initial vaccination of Phase 1.

   Tuberculosis                                         Note 3)
(BCG/Bacille Calmette-Guérin)

          The terms of         and        are the ages for routine mandatory vaccination, according to the
      Preventive Vaccination Law. You are advised to have your child vaccinated within the term of           ,
      a term determined by taking into consideration disease susceptibility (the standard vaccination
      schedule).
          The standard vaccination schedule is not established for measles and rubella; however, we recommend
      you have your child vaccinated as early as possible after the age of 12 months, when immunity acquired
      from the mother disappears, allowing children to contract measles and rubella in early childhood.
          Phase 3 and 4 vaccinations are implemented for the 5 years from 2008 through 2012. A child who
      has received Phase 1 and 2 vaccination is not vaccinated during this period.

      Note 1): The standard booster vaccination for Phase I DPT is scheduled at the age of 12 to 18 months after the
               completion of the initial vaccination in Phase I (3 injections).
      Note 2): Simultaneous vaccination for measles and rubella in Phase 1, 2, 3, or 4 is performed with measles-rubella
               (MR) vaccine.
      Note 3): A child can be vaccinated with BCG at an age of up to 1 year if the child has missed vaccination because of
               unavoidable circumstances, including geographic or traffic conditions, or a natural disaster.

                                                                                                                                                                                                                                                                                                                                  
. The intervals at which different vaccines are given to a child


         4. The intervals at which different vaccines are
                                      given to a child

     Vaccines are classified as live or inactivated vaccines, and appropriate intervals at
which different vaccines are given to a child must be maintained.
     (For the characteristics of each vaccine, see Page 23.)




                                                                     Inactivated vaccine
                Live vaccine
                                                   An interval of
      Polio, Measles, and Rubella (MR)            at least 27 days
     mixture, Measles, Rubella, and BCG                                 Live vaccine

    (When different vaccines are given to a child, the interval from the day following live
    vaccination to the day of another vaccination must be at least 27 days.)




                                                                     Inactivated vaccine
            Inactivated vaccine
                                                   The interval is
                                                   at least 6 days
     DPT, DT, and Japanese encephalitis
                                                                        Live vaccine

    (When different vaccines are given to a child, the interval from the day following
    administration of an inactivated vaccine to the day of another vaccination must be
    at least 6 days.)




     If your child urgently requires multiple, different vaccines, please consult a doctor.
If your child is to be vaccinated several times with the same vaccine, please make sure
that the specified intervals are adhered to.





                                               . Let’s make a vaccination plan for your child


       5. Let’s make a vaccination plan for your child

   Routine vaccination is planned on an individual basis. Consult your doctor to
determine the schedule and order of vaccinations, taking into consideration municipal
programs, the physical condition of your child, and any current disease epidemics.
   In many municipal programs, vaccinations for polio and tuberculosis are given to
many children at the same time (vaccination takes place at a designated time and place,
such as a healthcare center). Find out what is happening in your area.




                                                                                            
. Let’s make a vaccination plan for your child


         Fill in an approximate target date for vaccination.
                                   Your child’s date of birth:                (day) /        (month) /         (year)

                                                                                                           Vaccination
                               Vaccination                                           Target date
                                                                                                              date
Tuberculosis                             (Up to 6 months after birth)         From about         (d/m/y)
(BCG)                                                                         to about           (d/m/y)       (d/m/y)
Polio                                    (Standard vaccination period: from
                                         3 to 18 months after birth)
                    First                                                     From about         (d/m/y)
                    administration                                            to about           (d/m/y)       (d/m/y)
                    Second               (After an interval of at least 41 days
                                                                                From about       (d/m/y)
                    administration       (6 weeks) from the day after the
                                         first vaccination)                     to about         (d/m/y)       (d/m/y)
DPT              Phase 1                 (Standard vaccination period: from
                                         3 to 12 months after birth)
                    First                                                     From about         (d/m/y)
                    administration                                            to about           (d/m/y)       (d/m/y)
                    Second               (After an interval of 20 to 56 days
                                                                               From about        (d/m/y)
                    administration       [3 to 8 weeks] from the day after the
                                         first vaccination)                    to about          (d/m/y)       (d/m/y)
                    Third                (After an interval of 20 to 56 days
                                                                               From about        (d/m/y)
                    administration       [3 to 8 weeks] from the day after the
                                         second vaccination)                   to about          (d/m/y)       (d/m/y)
DPT              Phase 1 addition        (Standard vaccination period:
                                         from 12 to 18 months after           From about         (d/m/y)
                                         the completion of the first          to about           (d/m/y)
                                         administration)                                                       (d/m/y)
DT               Phase 2                 (Standard vaccination period: from From about           (d/m/y)
                                         11 to 12 years old)                to about             (d/m/y)       (d/m/y)
[Note]    Make sure of the timing because your child cannot receive another
          vaccination for 27 days after BCG or polio vaccination.
MR               Phase 1                 (From 12 to 24 months after birth)   From about         (d/m/y)
                                                                              to about           (d/m/y)       (d/m/y)
                 Phase 2                 (A child 5 or 6 years old in the year
                                         before starting primary school        From about        (d/m/y)
                                         (i.e., a child in the last year of    to about          (d/m/y)
                                         kindergarten or nursery school)                                       (d/m/y)
[Note]    For Phases 3 and 4, add vaccination as required.

Japanese         Phase 1                 (Standard vaccination period: from
encephalitis                             3 to 4 years old)

                    First                                                     From about         (d/m/y)
                    administration                                            to about           (d/m/y)       (d/m/y)
                    Second               (After an interval of 6 to 28 days (1
                                                                               From about        (d/m/y)
                    administration       to 4 weeks) from the day after the
                                         first vaccination)                    to about          (d/m/y)       (d/m/y)
                 Phase 1 addition        (Standard vaccination period: from From about           (d/m/y)
                                         4 to 5 years old)                  to about             (d/m/y)       (d/m/y)
                 Phase 2                 (Standard vaccination period: from From about           (d/m/y)
                                         9 to 10 years old)                 to about             (d/m/y)       (d/m/y)



                                 . Diseases preventable by vaccination and vaccine side effects


  6. Diseases preventable by vaccination, and vaccine
                                    side effects

   Some parents have negative attitudes toward vaccination because of concerns
about side effects. However, the vaccines now used in Japan cause side effects less
frequently than did earlier vaccines, although the rate of side effects depends on the
type of vaccine.
   Each child has a different response; some children, therefore, occasionally have side
effects, the severity of which varies. It is important for you to decide whether to have
your child vaccinated after detailed consultation with your doctor, who understands the
physical status of your child.




♦ Polio (acute poliomyelitis)


(1) Cause and course
   Polio is also known as “infantile paralysis” — epidemics occurred repeatedly in
Japan until the early 1960s. Because of the benefits of vaccination, natural infection
has not been reported in Japan since then. Polio is, however, still common in some parts
of the world, including India, Pakistan, and some African countries; consequently,
Japanese can become infected in such places and carry polio viruses into Japan. In
2005, a polio epidemic occurred again in Indonesia, a country where infection with the
wild-type polio virus had not previously been reported.
   The polio virus is transmitted from person to person. The virus spreads through
contact with the feces of an infected person, enters the body through the mouth,
and lives in the throat and intestine. The virus multiplies in the intestine for 3 to 35
days (usually 7 to 14 days). However, most children have no symptoms and obtain
lifelong immunity. In some children with symptoms, the virus spreads to the brain
and spinal cord and causes paralysis (paralysis incidence: 1/1000 to 1/2000). Of 100

                                                                                             10
. Diseases preventable by vaccination and vaccine side effects


children infected with the polio virus, 5 to 10 have symptoms mimicking a common
cold, accompanied by fever, and followed by headache and vomiting. About 1 of 1000
children infected can become paralyzed. Some of these children remain permanently
paralyzed and sometimes die of respiratory distress.


(2) Polio vaccine (live oral vaccine)
     Polio vaccine contains 3 types of polio virus, i.e., polio virus types I, II, and III.
Vaccination gives your child immunity against each type of virus. However, the
first administration may provide immunity against only 1 or 2 types of polio virus.
Therefore, administering the vaccine a second time can provide immunity against other
types of virus which was not achieved by the first administration. An interval of at least
41 days (6 weeks) is needed between the first and second vaccinations.
     When your child has severe diarrhea, postpone vaccination because diarrhea reduces
the effectiveness of vaccination.


(3) Vaccine side effects
     The polio vaccine is safe because the virus is attenuated (weakened). However, the
virus multiplies in the body after vaccination, and in extremely rare cases (1/4,500,000
persons or less), the virus spreads to the brain and spinal cord, causing paralysis.
     In addition, the virus is excreted into the feces for 15 to 37 days (mean: 26 days) after
vaccination. This virus rarely causes paralysis in a person without immunity against
polio virus (a person who has not been vaccinated) or in those with low immunity. The
incidence of these effects is unclear, but they are rare (1/5,500,000). The relief system
supports people with impaired health due to secondary infection with polio vaccine.




11
                                                                        . Diseases preventable by vaccination and vaccine side effects


(4) Vaccination schedule


                 3-month-old
                               6-month-old
                                             9-month-old




                                                                                                                                                                                10-year-old


                                                                                                                                                                                                            12-year-old
                                                                                                                                                                                                                          13-year-old
                                                                                                                                                                                                                                        14-year-old
                                                                                                                                                                                                                                                      15-year-old
                                                                                                                                                                                              11-year-old
                                                           1-year-old
                                                                        2-year-old
                                                                                     3-year-old
                                                                                                  4-year-old
                                                                                                               5-year-old
                                                                                                                            6-year-old
                                                                                                                                         7-year-old
                                                                                                                                                      8-year-old
                                                                                                                                                                   9-year-old
    Polio
                        After an interval of at least 41 days (6 weeks) from the day after
                        the first vaccination, the second vaccination is given.




 ♦ Diphtheria, pertussis, and tetanus


(1) Cause and course
(a) Diphtheria
   Diphtheria is caused by Corynebacterium diphtheriae and is spread by droplet
infection.
   The current diphtheria-pertussis-tetanus (DPT) vaccines have been in use since 1981.
No more than one case of diphtheria is identified each year. Of infected persons only
10% have symptoms, and others are asymptomatic carriers who can spread diphtheria.
   The bacterium lives mainly in the throat but also lives in the nose. Symptoms include
high fever, sore throat, a barking cough, and vomiting; a false membrane is formed,
which can cause asphyxia. Patients must be monitored carefully because the bacterium
produces a toxin that can cause a serious myocardial disorder or paralysis 2 to 3 weeks
after the development of symptoms.




                                                                                                                                                                                                                                                                    12
. Diseases preventable by vaccination and vaccine side effects


(b) Pertussis
     Pertussis is caused by Bordetella pertussis and is spread by droplet infection.
     The number of cases of pertussis has decreased since pertussis vaccination started
in 1948.
     Pertussis begins with symptoms mimicking a common cold. The child then begins
to cough violently and repeatedly, with a flushed face. After coughing, the patient
is forced to inhale with a whooping sound. Usually, fever does not develop. Infants
sometimes present with blue lips (cyanosis) and seizures (fits) because breathing is
interrupted by coughs. Severe complications include pneumonia and encephalopathy.
Infants sometimes die of this disease.



      Droplet infection

       Droplet infection means transmission of viruses and bacteria through
     coughing and sneezing. Viruses and bacteria in the saliva and in airway
     secretions are spread through the air to people within 1 meter.




(c) Tetanus
     Tetanus bacillus does not spread from person to person. The bacteria are usually
found in soil and enter the body through breaks in the skin. The bacteria multiply in the
body and produce a toxin, causing the jaws to clamp shut, spasms, and sometimes death.
Most patients are infected through a small skin break not detected by themselves or
those around them. Children are continually exposed to the infection with the bacteria,
which are usually found in soil. If a mother has immunity against the toxin, a newborn
is protected from tetanus during delivery.




1
                                 . Diseases preventable by vaccination and vaccine side effects


(2) DPT (Diphtheria-Pertussis-Tetanus) vaccine
   The three injections of Phase 1 are given at intervals of 20 to 56 days (3 to 8 weeks)
as the initial vaccination, and a booster is given 6 months or more after completion of
the initial vaccination (3 injections).
   Persons who have had diphtheria, pertussis, or tetanus can receive DPT vaccine.
   The first injection of Phase 2 (diphtheria and tetanus vaccine) is given at the age of
11 years.
   Keep in mind not to miss vaccination, as multiple injections are required.
   To acquire sufficient immunity, your child must be vaccinated according to the
schedule. When the interval between injections is longer than that specified, consult
with your doctor and the municipal office.


(3) Side effects of the DPT vaccine
   The vaccine now used in Japan causes fewer side effects than did earlier vaccines.
The Summary Report of Health Status Survey after Vaccination from 1996 to 2004
(hereinafter called the Health Status Report) showed that side effects are mainly
local reactions, including redness, swelling, and induration at the injection site. The
incidence is 12.7% within 7 days of the first injection and about 40.0% within 7 days of
a booster injection. Induration gradually decreases but can remain for several months.
Some hypersensitive children also have swelling that can involve the entire arm.
   High fever usually does not develop; however, 0.4% of children have a fever higher
than 37.5°C within 24 hours after vaccination. If your child is irritable or you are
concerned about swelling, even if no serious side effect has occurred, please consult
a doctor.


(4) Side effects of the DT vaccine
   The Health Status Report showed that most side effects are local reactions, including
redness, swelling, and induration at the injection site. The incidence is 29.0% within 7
days. As with the DPT vaccine, the induration gradually decreases but can remain for
several months. Some hypersensitive children also have swelling that can involve the
                                                                                             1
. Diseases preventable by vaccination and vaccine side effects


entire arm.
     High fever usually does not develop; however, 0.1% of children have a fever higher
than 37.5°C within 24 hours after vaccination. If your child is irritable or you are
concerned about swelling, even if no serious side effect has occurred, please consult
a doctor.


(5) Vaccination schedule
                     3-month-old
                                   6-month-old
                                                 9-month-old




                                                                                                                                                                                     10-year-old


                                                                                                                                                                                                                 12-year-old
                                                                                                                                                                                                                               13-year-old
                                                                                                                                                                                                                                             14-year-old
                                                                                                                                                                                                                                                           15-year-old
                                                                                                                                                                                                   11-year-old
                                                               1-year-old
                                                                             2-year-old
                                                                                          3-year-old
                                                                                                       4-year-old
                                                                                                                    5-year-old
                                                                                                                                 6-year-old
                                                                                                                                              7-year-old
                                                                                                                                                           8-year-old
                                                                                                                                                                        9-year-old
                                                                            Note)

 DPT Phase 1
                          Three injections are given at intervals of 20 to 56 days (3 to 8 weeks) as the initial vaccination,
                          and a booster is given 6 months or more after the completion of the initial vaccination (3 injections).




 DT Phase 2


Note 1): The standard booster vaccination for Phase I DPT is scheduled from 12 to 18 months after the completion of
         the initial vaccination of Phase I (3 injections).




 ♦ Measles and rubella


(1) Cause and course
(a) Measles
     Measles is caused by the measles virus, which spreads through the air. Measles is so
contagious that any person who is exposed to the virus and is not immune will probably
get the disease. The main symptoms are fever, cough, runny nose, eye discharge, and
rash. For the first 3 to 4 days, patients have a fever of 38°C, which appears to decline
but increases again to 39°C to 40°C, with a rash over the entire body. The fever goes
down within 3 to 4 days, and the rash gradually disappears. The parts affected by the
rash may remain darker for a while.

1
                                . Diseases preventable by vaccination and vaccine side effects


   The main complications are bronchitis, pneumonia, otitis media, and encephalitis.
About 7 to 9 out of 100 children with measles also get otitis media and about 1 to 6 get
pneumonia. About 1 or 2 of 1,000 get encephalitis, and about 1 or 2 of 100,000 die of
subacute sclerosing panencephalitis (SSPE), a chronic encephalitis. About one in every
thousand people is infected with measles dies.



   Airborne infection (droplet nuclei infection)

     This means a type of infection in which viruses or bacteria are released
  into the air and are transmitted to persons within 1 meter from a patient
  or carrier. Measles, chickenpox, and tuberculosis are spread by airborne
  infection.




(b) Rubella
   Rubella is caused by the rubella virus and is spread by droplet infection. The
incubation period is 2 to 3 weeks. The disease develops with mild cold-like symptoms,
and the main symptoms are rash, fever, and posterior cervical lymphadenopathy
(lymph nodes swelling in the back of the throat). Conjunctival congestion also occurs.
Because both rash and fever disappear within about 3 days, rubella is also called
“three-day measles.” The complications are joint pain, thrombocytopenic purpura, and
encephalitis. About 1 of every 3,000 patients get thrombocytopenic purpura, and 1 in
6,000 get encephalitis. Adult patients have severe symptoms.
   When pregnant women contract rubella during the early stage of pregnancy, their
infants are likely to be born with the congenital rubella syndrome, which is characterized
by abnormalities such as cardiac defects, cataracts, and deafness.




                                                                                            1
. Diseases preventable by vaccination and vaccine side effects


(2) Combined measles and rubella (MR) vaccine (live vaccine)
     This vaccine contains live, attenuated measles and rubella viruses.
     Because children are most likely to be infected with measles and rubella at the age
of 1 to 2 years, we recommend you have your child vaccinated (Phase 1) as early as
possible after the age of 1 year.
     Even when a child has been vaccinated with measles and rubella vaccine when
younger than 1 year, he/she can be vaccinated routinely at the scheduled age specified
in Phase 1.
     Phase 2 vaccination is given to a child in the year before starting primary school, i.e.,
the last year of a kindergarten or nursery school.
     Phase 3 vaccination is given to a child who turns 13 years old during the first year
of junior high school).
     Phase 4 vaccination is given to a child who turns 18 years old during the third year
of high school).
     Phase 3 and 4 vaccination is implemented for the 5 years from 2008 through 2012. It
is recommended that you have your child vaccinated in April, May, or June.
     Simultaneous vaccination for measles and rubella in Phases 1, 2, 3 or 4 is performed
with the combined measles-rubella (MR) vaccine.
     Persons who have had either measles or rubella can receive the MR vaccine.
     If your child has been treated with gamma globulin injections, please consult your
doctor before vaccination.


(3) Vaccine side effects
(a) Combined measles and rubella (MR) vaccine (live vaccine)
     Side effects are mainly fever and rash. About 8.6% of children vaccinated in Phase
1 and 3.4% of those vaccinated in Phase 2 have a fever of 37.5°C to 38.5°C. 13.4%
and 4.5% of those vaccinated in Phases 1 and 2, respectively, have a fever higher than
38.5°C. A rash develops in 6.6% and 1.7 % of those vaccinated in Phases 1 and 2,
respectively.


1
                                . Diseases preventable by vaccination and vaccine side effects


   Other side effects are local reactions, including redness, swelling, and induration
at the injection site and urticaria, lymph nodes swelling, joint pain, and convulsions.
(Health Status Survey of MR vaccination in 2006 [preliminary report])
   The data concerning the side effects of measles and rubella vaccines show that
anaphylaxis, thrombocytopenic purpura, encephalitis, and convulsions rarely occur.
(b) Measles vaccine (live vaccine)
   This vaccine contains attenuated measles viruses.
   If your child has been treated with gamma globulin injections, please consult your
doctor before vaccination.
   Compared with other routine vaccines, this vaccine causes fever more often. The
Health Status Report showed that after the period of viral growth (5 to 14 days after
vaccination) 5.3% of children vaccinated have a fever of 37.5°C to 38.5°C, 8.0% have a
higher than 38.5°C, and 5.9% have a measles-like rash. These symptoms usually resolve
within 1 or 2 days.
   Febrile seizures have occasionally been reported after measles vaccination (1 in
300 children). In addition, there have been reports of children having encephalitis/
encephalopathy (1 in 1 to 1.5 million children) and subacute sclerosing panencephalitis
(SSPE) (1 in 1 to 2 million children).
(c) Rubella (three-day measles) vaccine (live vaccine)
   This vaccine contains attenuated rubella virus.
   If your child has been treated with gamma globulin injections, please consult your
doctor before vaccination.
   Rubella vaccine is a live vaccine, and the rubella virus multiplies in the body
as does the measles virus. The Health Status Report showed that 5 to 14 days after
vaccination 1.9% of children vaccinated have a fever of 37.5°C to 38.5°C and 2.7% have
a fever higher than 38.5°C, and 1.2% have a rash and 0.5% have lymph nodes swelling.
Vaccinated persons do not infect those around them.




                                                                                            1
. Diseases preventable by vaccination and vaccine side effects


(4) Vaccination schedule



                        3-month-old
                        6-month-old
                        9-month-old




                        10-year-old

                        12-year-old
                        13-year-old
                        14-year-old
                        15-year-old
                        16-year-old
                        17-year-old
                        18-year-old
                        19-year-old
                        11-year-old
                        1-year-old
                        2-year-old
                        3-year-old
                        4-year-old
                        5-year-old
                        6-year-old
                        7-year-old
                        8-year-old
                        9-year-old
                                           A child born on April 2
                                                A child born
                                                  on April 1
 Measles (MR)
                                      A child 5 or 6 years old, and in         A child who turns 13 years     A child who turns 18 years
 Note)                                the year before starting primary         old during the first year of   old during the third year of
                                      school (i.e., a child in the last year
                                      of kindergarten or nursery school)       junior high school)            high school)

                                           A child born on April 2
                                                 A child born
 Rubella (MR)                                      on April 1
                                      A child 5 or 6 years old, and in
 Note)                                the year before starting primary
                                                                               A child who turns 13 years
                                                                               old during the first year of
                                                                                                              A child who turns 18 years
                                                                                                              old during the third year of
                                      school (i.e., a child in the last year
                                      of kindergarten or nursery school)       junior high school)            high school)


Note):   Simultaneous vaccination for measles and rubella in Phase 1, 2, 3, or 4 is performed with the combined
         measles-rubella (MR) vaccine. Phase 3 and 4 vaccination is implemented for the 5 years from 2008 through
         2012.




 ♦ Japanese encephalitis


(1) Cause and course
     Japanese encephalitis is caused by the Japanese encephalitis virus. It is not directly
transmitted from person to person but by mosquitoes carrying viruses that multiply in
pigs. After a 7- to 10-day incubation period, high fever, headache, vomiting, impaired
consciousness, and convulsions occur, all symptoms of acute encephalitis.
     Most epidemics occur in western Japan, but the virus is found all over the country
except Hokkaido. An outbreak occurs in domestic pigs from June to October every
year, affecting about 80% or more of pigs in certain areas. Japanese encephalitis was
once common in infants and school children, but its incidence has been reduced by
widespread vaccination; recently, most patients have been unvaccinated elderly
persons.
     Encephalitis develops in 1 of every 1,000 to 5,000 persons infected with the virus.
Some persons have meningitis and summer cold-like symptoms alone. The mortality
rate of patients with encephalitis is 15%, and 50% of patients have neurologic sequelae.


1
                                 . Diseases preventable by vaccination and vaccine side effects


(2) Japanese encephalitis vaccine (inactivated vaccine)
   The Japanese encephalitis vaccine, which is now used in Japan, is made from
Japanese encephalitis virus grown in the brains of mice and then killed and purified.


(3) Side effects of Japanese encephalitis vaccine
   The Health Status Report showed that within 2 days of vaccination 1.9% of children
have a fever higher than 37.5°C and 8.2% have redness and swelling at the injection site.
A rash also occurs in 0.3%, but tenderness rarely develops.
   In addition, acute disseminated encephalomyelitis (ADEM) develops extremely
rarely – in 1 in 70 thousand to 2 million patients who receive Japanese encephalitis
vaccines.
   The Ministry of Health, Labour and Welfare (MHLW) of Japan recommends that
municipal offices do not actively promote vaccination against Japanese encephalitis as
a routine vaccination because the MHLW recognizes a causal relationship between the
current Japanese encephalitis vaccines and severe ADEM after vaccination. However,
if your child is at risk for infection with Japanese encephalitis virus, for example, during
travel to an area with an epidemic of Japanese encephalitis, your child is allowed to
receive the vaccine as a routine vaccination after you fully understand the MHLW’s
order and the effects and side-effects of Japanese encephalitis vaccine.



   Acute disseminated encephalomyelitis (ADEM)

      This disease of the central nervous system develops extremely rarely after
  viral infection or vaccination. Fever, headache, convulsions, and movement
  disorders occur several days to several weeks after vaccination.




                                                                                             20
. Diseases preventable by vaccination and vaccine side effects


(4) Vaccination schedule


                    3-month-old
                                  6-month-old
                                                9-month-old




                                                                                                                                                                                   10-year-old


                                                                                                                                                                                                               12-year-old
                                                                                                                                                                                                                             13-year-old
                                                                                                                                                                                                                                           14-year-old
                                                                                                                                                                                                                                                         15-year-old
                                                                                                                                                                                                 11-year-old
                                                              1-year-old
                                                                           2-year-old
                                                                                        3-year-old
                                                                                                     4-year-old
                                                                                                                  5-year-old
                                                                                                                               6-year-old
                                                                                                                                            7-year-old
                                                                                                                                                         8-year-old
                                                                                                                                                                      9-year-old
                On or after May 30, 2005, this vaccination is not actively recommended.
                However, if desired, the vaccination can be received as a routine vaccination.

  Japanese
 encephalitis
                                         Two injections are given at intervals of 6 to 28 days (1 to 4 weeks) as the initial vaccination of Phase 1,
                                         and a booster is given about 1 year after the completion of the initial vaccination of Phase I (2 injections).




 ♦ Tuberculosis


(1) Cause and course
     Tuberculosis is caused by the Mycobacterium tuberculosis. Although the number
of patients with tuberculosis has markedly decreased in Japan, nearly 30,000 new
cases are still diagnosed every year, and the disease can be transmitted from adults
to children. Immunity against tuberculosis cannot be transferred from the mother to
the fetus; consequently, newborns are at risk of infection. Infants and children have
low immunity against tuberculosis; as a result, they sometimes contract systemic
tuberculosis or tuberculous meningitis, resulting in severe sequelae.


(2) BCG vaccine (live vaccine)
     BCG vaccine is made from attenuated Mycobacterium bovis.
     The method of BCG vaccination is an intradermal injection using an apparatus
with multiple needles that is performed twice on the upper arm. The vaccine should
not be given elsewhere on the body because of possible side effects, including keloid
formation. The vaccination site should be dried in the shade for about 10 minutes.




21
                                                                            . Diseases preventable by vaccination and vaccine side effects


(3) Side effects of BCG vaccine
   Red pockmarks appear on the vaccination site around 10 days after vaccination, and
some of them can produce pus. This reaction peaks about 4 weeks after vaccination;
subsequently, the pockmarks are covered with scabs and heal completely up to 3 months
after vaccination, leaving tiny scars. This scarring is not an abnormal reaction but
evidence that a person has acquired immunity through the BCG vaccination. Keep the
vaccination site clean, without a bandage or plaster, because it will heal spontaneously.
However, if the vaccination site is still oozing 3 months after vaccination, please consult
a doctor.
   Another possible side effect is axillary lymph nodes swelling, occasionally seen on
the same side as the vaccination. This reaction can generally be left untreated; however,
if the area is tender, severely swollen, or suppurative, please consult a doctor.
   If your child is already infected with tuberculosis, within 10 days of vaccination
you may observe the Koch phenomenon (a series of reactions, including local redness,
swelling, and suppuration at the injection site, which generally heal after 2 to 4 weeks,
with scarring). If you suspect the Koch phenomenon, immediately consult your
municipal office or a medical institution. In these circumstances, we also recommend
that any family member who might have infected your child with tuberculosis should
consult a medical institution.


(4) Vaccination schedule
                     3-month-old
                                   6-month-old
                                                 9-month-old




                                                                                                                                                                                    10-year-old


                                                                                                                                                                                                                12-year-old
                                                                                                                                                                                                                              13-year-old
                                                                                                                                                                                                                                            14-year-old
                                                                                                                                                                                                                                                          15-year-old
                                                                                                                                                                                                  11-year-old
                                                               1-year-old
                                                                            2-year-old
                                                                                         3-year-old
                                                                                                      4-year-old
                                                                                                                   5-year-old
                                                                                                                                6-year-old
                                                                                                                                             7-year-old
                                                                                                                                                          8-year-old
                                                                                                                                                                       9-year-old




                                        Note)
        BCG

Note:    A child can be vaccinated with BCG until the age of 1 year, if the child has missed a vaccination because of
         unavoidable circumstances, including geographic or traffic conditions, or a natural disaster.




                                                                                                                                                                                                                                                                        22
. Vaccine types and characteristics


                 7. Vaccine types and characteristics

     Vaccines are classified into 2 types: live vaccines and inactivated vaccines.
     Live vaccines are made of attenuated (weakened) live bacteria and viruses. Immunity
is established in a similar fashion to that of a person infected with the disease. Of
vaccines used for routine vaccination, polio, measles, rubella, combined measles and
rubella (MR), and BCG vaccines are of this type.
     After vaccination, attenuated bacteria and viruses start growing; consequently,
vaccines can cause mild symptoms, including fever and rash, that depend on the type of
vaccine. About 1 month is needed to establish sufficient immunity.
     Inactivated vaccines are made from viruses or bacteria that have been killed, i.e.,
components required for immunity are extracted, but the toxicity is eliminated. Of
vaccines used for routine vaccination, the diphtheria-pertussis-tetanus (DPT) mixture,
diphtheria-tetanus (DT) mixture, and Japanese encephalitis vaccines are of this type.
     With this type of vaccine, bacteria and viruses do not multiply, and several
injections are required to establish immunity. Two or three injections are given at
specific intervals to establish basic immunity, and a booster is given about 1 year later
to increase immunity to a sufficient level.
     However, the immunity gradually decreases. To maintain immunity long term,
boosters are required at specific intervals depending on the characteristics of the
vaccine.




2
                                                                      . Vaccination validity


                           8. Vaccination validity

   Vaccination is performed to prevent a target disease; however, immunity is not
established in some children because of their characteristics and physical condition. To
confirm whether immunity has been established, the levels of antibody in the blood are
measured with a blood test.
   With inactivated vaccines, immunity gradually diminishes even after it has been
established. To maintain immunity long term, boosters are required at specific
intervals.




              9. Before having your child vaccinated

(1) General precautions
   Vaccination should be performed when your child is in good health. Always take note
of the physical condition and characteristics of your child. If you have any concerns, do
not hesitate to consult your doctor, healthcare center, or the municipal office in charge,
in advance.
   To have your child vaccinated safely, we recommend that you decide on the day of
vaccination, taking the following into consideration:
   1) Observe your child carefully from the morning on the day of vaccination, and
      confirm that he/she is well. Even if vaccination is scheduled, if your child appears
      sick, consult your doctor and decide whether your child should be vaccinated or
      not.
   2) Thoroughly read the information about vaccination provided by the municipal
      office, so that you fully understand the necessity and side effects of the vaccines.
      If you have any questions, ask the doctor who is to vaccinate your child, before
      vaccination.
   3) Make sure to bring a maternal and child health handbook.


                                                                                         2
. Before having your child vaccinated


     4) The screening questionnaire contains important information for the doctor in
        charge of vaccination. Please fill in the form completely and accurately.
     5) We recommend that the child being vaccinated be accompanied by a parent/
        guardian who is familiar with the child’s usual physical condition.
     A child can only be vaccinated if a parent/guardian fully understands the benefits
and side effects of vaccination and agrees to have the child vaccinated.


(2) A child who cannot receive a vaccination
     1) A child with obvious fever (37.5°C or higher)
     2) A child with a severe acute illness
        No child being treated with a medication for an acute, severe illness should
        receive vaccination.
     3) A child who has had anaphylaxis to any component of the vaccine preparation to
        be given on that day. “Anaphylaxis” is an acute, severe systemic allergic reaction,
        usually within 30 minutes after vaccination, including excessive sweating,
        a swollen face, systemic severe urticaria, nausea, vomiting, hoarseness, and
        respiratory distress, resulting in shock.
     4) With BCG vaccination, a child with a keloid due to a previous vaccination or
        trauma
     5) A child who is or has already been infected with the disease being targeted for
        vaccination.
     6) Other conditions that a doctor considers inappropriate.
        Even if your child does not meet the above criteria, he/she cannot be vaccinated
        if a doctor decides that doing so would be inappropriate.




2
                                                       . Before having your child vaccinated


(3) Children requiring careful consideration on receiving a vaccination
   A child meeting the following criteria should be checked by his/her doctor before
vaccination, and the advisability of vaccination should be determined. When the child
receives a vaccination, it is recommended that the doctor administer the vaccine, or
provide a medical certificate or a written doctor’s opinion.
   1) A child who is being treated for a heart, kidney, liver, or blood disease, or a
      developmental disorder.
   2) A child who has had a fever within 2 days of a previous vaccination or an allergic
      reaction, including rash and urticaria.
   3) A child who has had a seizure in the past
      Whether a child should be vaccinated depends on the age at which the seizure
      occurred, the presence or absence of fever, subsequent seizures, and the type of
      vaccine. Please consult the child’s doctor before vaccination.
   4) A child who has had immunodeficiency diagnosed in the past or has a family
      member or relative with immunodeficiency.
   5) A child with allergy to egg components, antibiotics, or the stabilizers used in any
      step of vaccine production, for example, culture.
   6) With BCG vaccination, a child who is suspected to be infected with tuberculosis
      already, for example, a child who has been in prolonged contact with a family
      member with tuberculosis.


(4) General precautions after receiving vaccination
   1) For 30 minutes after the vaccination, observe your child at a medical institution
      or stay near the doctor. If acute side effects occur, they often develop during this
      time.
   2) Watch for possible side effects for up to 4 weeks (live vaccines) or 1 week
      (inactivated vaccines) after vaccination.
   3) Keep the vaccination site clean. Bathing is allowed, but avoid rubbing the
      vaccination site.
   4) Avoid strenuous physical activity on the day of vaccination.

                                                                                          2
10. What to do if your child has a side effect from the vaccination


     5) If a child has an abnormal reaction at the vaccination site or has a change in
        physical condition after vaccination, consult a doctor immediately.




           10. What to do if your child has a side effect
                                from the vaccination

(1) Usual reactions
     Depending on the type of vaccine, fever, redness, swelling and induration at the
injection site and rash occur fairly often. In many cases, these symptoms disappear
within several days and are not a cause for concern.
     (See the “Side effects of vaccines” for each disease on page 10 and the following
pages.)


(2) Serious side effects
     If your child has severe swelling at the vaccination site, or has fever or seizures after
vaccination, consult a doctor. If your child’s symptoms meet the criteria for notification
of side effects after vaccination, the doctor will inform the municipal government of
these side effects.
     Although side effects depend on the type of vaccine, vaccination extremely rarely
(about 1 in 1 to 2 million) causes serious side effects, such as encephalitis and neuropathy.
In such cases, under the Preventive Vaccination Law the MHLW considers the patient
to have been injured by routine vaccination, and the patient is then compensated by the
government according to this law.


(3) Coincidental reactions
     Symptoms that occur soon after vaccination are often thought to have been caused by
vaccination. However, sometimes these symptoms are caused by another infection that
happens to develop simultaneously. This is then called a “coincidental reaction.”


2
                              10. What to do if your child has a side effect from the vaccination


(4) The relief system supporting people with impaired health due to
    vaccination
  1) A person who has side effects due to routine vaccination and requires treatment
     at a medical institution, or whose ability to perform daily activities is impaired
     due to health injury can be compensated by the government according to the
     Preventive Vaccination Law.
  2) The compensation consists of payment of medical expenses, medical benefits,
     a disabled child’s annuity, a disability annuity, lump-sum death benefits, and
     funeral expenses, all of which are designated by law according to the severity of
     the health injury. All compensation, except lump-sum death benefits and funeral
     expenses, is continually paid until the completion of treatment or improvement in
     the health injury.
  3) Compensation is paid to the patient after the relevant injury has been certified
     to be caused by vaccination, by the governmental review committee comprising
     specialists in vaccination, infection medicine, law, and related disciplines, who
     discuss the causal relationship of the relevant injury with vaccination, i.e.,
     whether the relevant injury is caused by vaccination or other factors (infection
     before or after vaccination, or other causes).
  4) When a child wishes to be vaccinated after the designated period, vaccination is
     considered not to be controlled under the Preventive Vaccination Law (voluntary
     vaccination). If such a child is injured by the vaccination, he/she is supported by
     compensation provided according to the Pharmaceuticals and Medical Devices
     Agency Law; however, this compensation is generally half that provided by the
     Preventive Vaccination Law (medical expenses, medical benefits and funeral
     expenses are very similar).
  * If you need to submit an application for compensation, consult the doctor
     who interviewed your child before vaccination, the healthcare center, and the
     municipal office in charge of vaccination.




                                                                                             2
11. Other considerations


                           11. Other considerations

(1) Notice of vaccination
     Routine vaccination is carried out by the municipal office in accordance with the
Preventive Vaccination Law. A notice of vaccination is sent to parents/guardians
individually. Because the notice is sent on the basis of information from the Basic
Resident Register and the Foreigner Registration Card, please ensure that you report
the birth of any child or any change of address.


(2) Vaccination schedule
     Vaccination is performed at a time appropriate for the disease. We recommend that
you have your child vaccinated during the standard season. (See page 6 for the standard
vaccination season.)




2
MEMO




       0
MEMO




1
  List of Members of the Review Committee for Vaccination Guidelines
             Name                                  Institution Job title
  Masao Iinuma                Japan Medical Association Executive Board Member
                              Tokyo Metropolitan Geriatric Hospital Director of
  Takashi Inamatsu            Department of infectious disease and Research Laboratory
                              Section
  Kazuko Ueda                 Kochi Healthcare Center Director
  Tatsuo Oya                  Kamakura Women’s University Professor
                              Fukuoka National Hospital Director of Department of
  Kenji Okada
                              pediatrics
                              National Institute of Infectious Disease, Infectious Disease
  Nobuhiko Okabe
                              Surveillance Center Director
                              National Center for Child Health and Development
 Tatsuo Kato
                              President
  Akira Nishino               Meiji University Professor
                              Imperial Gift Foundation Boshi-Aiiku-Kai
  Munehiro Hirayama             Japan Child and Family Research Institute Honorary
                                Director
  Masago Minami               The Yomiuri Shimbun (Tokyo Head Office) Senior Editor
                              National Institute of Infectious Disease, Leprosy Research
  Toru Mori
                              Center Director
  Mitsuoki Yamamoto Kitatama Medical Association President
  : Chairperson                      (In order of the Japanese syllabary, titles omitted)


    The Foundation of Vaccination Research Center
                             Shinjuku 1-29-8 Shinjuku-Ward, Tokyo 160-0022




  Editors:     Yoshihiro Saito, MD                       Masao Okazaki, MD
               Department of Pediatrics,                 Medical Information Center
               Medical Information Center                The Jikei University School of Medicine
               The Jikei University School of Medicine


  First edition: July 2008

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:23
posted:7/29/2011
language:Japanese
pages:36