国立感染症研究所

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Measles situation update, epidemiologic week 1-20, 2018 (as of 23 May 2018)

June 1, 2018

 

    Measles is an infectious viral disease characterized by high fever, rash, and catarrh. It is highly infectious and can be transmitted via the airborne route. Complications from infection can lead to death, but prevention of infection is possible through vaccination. Japan’s policy regarding measles has been to maintain its measles elimination status, which was achieved in March 2015 (based on the Guidelines for the Prevention of Specific Infectious Diseases: Measles”, released as a notice in December 2007 and last updated in 2013 [http://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000112477.pdf, in Japanese]). However, with measles transmission occurring in many countries overseas, cases of imported measles from Southeast Asia (e.g. Indonesia, the Philippines, Thailand) and Europe (e.g. Italy) continue to be reported in recent years. On 20 March 2018, a tourist from overseas traveling in Okinawa Prefecture was diagnosed as measles, and thereafter additional cases of measles were reported from across the prefecture

http://www.pref.okinawa.jp/site/hoken/eiken/kikaku/kansenjouhou/measles.html, in Japanese. Since then, cases infected in Okinawa Prefecture developed illness in other prefectures, and the Ministry of Health, Labour and Welfare circulated an alert notice (http://www.mhlw.go.jp/seisakunitsuite/bunya/kenkou_iryou/kenkou/kekkaku-kansenshou/rubella/dl/180427_1.pdf, in Japanese). While reports of new measles cases from Okinawa Prefecture are now declining, cases suspected to have been infected within Japan continue to be reported. This report provides the latest information on the epidemiologic situation of measles in Japan, based primarily on the data from the national infectious disease surveillance system (National Epidemiological Surveillance of Infectious Diseases), and indicates the need for continued vigilance.

 

    During weeks 1-20 in 2018, 161 cases of measles were diagnosed (as of 23 May 2018), and among these cases, 145 (90%) were laboratory-confirmed cases (99 cases of measles and 46 cases of modified measles). 89 cases were male and 72 cases were female, and the median age was 29 years (range: 0-58 years). Cases were reported from the following prefectures: Okinawa (88 cases); Aichi (25 cases); Fukuoka (17 cases); Tokyo (11 cases); Saitama (6 cases); Ibaraki and Kanagawa (3 cases from each prefecture); Yamanashi and Osaka (2 cases from each prefecture); and Chiba, Shizuoka, Hyogo, and Yamaguchi (1 case from each prefecture). The suspected location of infection was domestic for 136 cases, overseas for 12 cases (8 cases from Thailand and one case each from Bangladesh, India, Nepal, and the Philippines), and unknown for the remaining 13 cases. With regards to measles vaccination history, there were 35 (22%) with no history, 75 (47%) with unknown history, 34 (21%) with one dose, and 17 (11%) with two doses. Among the 17 cases who had been vaccinated with two doses, 10 were of the milder, modified form of measles. Among the 35 cases without any history of vaccination, 33 were of the typical form of measles, and 30 of them were laboratory-confirmed measles. Among the total cases, there were 30 cases with information regarding their isolated measles virus reported to the Infectious Agents Surveillance System, and excluding the one case (3%) with the vaccine strain, 25 (83%) cases were genotype D8 and 4 (13%) cases were genotype B3. For the 12 cases with travel history recorded, the location of travel was Thailand (8 cases) and Nepal (1 case) for genotype D8 and the Philippines (2 cases) and Bangladesh (1 case) for genotype B3 (as of 28 May 2018).

 

    Measles transmission occurs through the airborne route and is highly infectious. In addition, complications occur frequently, and, regardless of age, can lead to severe outcomes that may potentially lead to death. To prevent the spread of measles, ensuring the administration of two doses of the measles-rubella (MR) vaccine through the routine immunization program (https://www.niid.go.jp/niid/ja/id/655-disease-based/ma/measles/idsc/7982-mrvaccine2018.html , in Japanese) is critical, and provides protection for both the individual and at the population level; also essential is the rapid detection of and response to a measles case. When symptoms such as fever and rash develop where measles may be suspected, it is important to notify the medical facility before making a visit to prevent measles transmission (http://www.mhlw.go.jp/seisakunitsuite/bunya/kenkou_iryou/kenkou/kekkaku-kansenshou/measles/dl/leaf.pdf, in Japanese). For healthcare providers seeing a patient presenting with symptoms such as fever and rash, it is important to consider measles as a possible diagnosis and obtain information regarding travel history, any contact with a person with febrile rash illness, and history of measles vaccination. During such patient interview, information regarding the measles situation overseas is useful (e.g. http://www.wpro.who.int/immunization/documents/measles_rubella_bulletin/en/, http://www.searo.who.int/entity/immunization/data/en/)

 

    In addition, to reduce the possibility of importing measles from overseas as much as possible, MR vaccination prior to travel for international travelers is recommended, after verifying that there is a need (e.g. based on vaccination history) (https://www.niid.go.jp/niid/ja/id/655-disease-based/ma/measles/idsc/7982-mrvaccine2018.html , in Japanese). For international travelers who have returned, the possibility of developing measles should be considered for about two weeks following return, and it is important that they monitor their health condition. In addition, it is necessary to recognize that there is a risk of infection at locations where there is a large flow of people, such as airports, tourist destinations, train stations, and shopping centers. And, as a prevention strategy, given that one of the first persons to come in contact with measles patients are healthcare workers, it should be confirmed that they have documentation with 2 doses of MR vaccine since one year of age (including for administrative staff); for those without the necessary dose(s) of vaccine, the importance of receiving vaccination should be emphasized. Lastly, when a diagnosis of measles has been made, it should be reported immediately as required under the Infectious Diseases Control Law, and appropriate infection control measures that take into account the high infectivity of measles should be implemented.

 

    For additional, detailed information regarding measles, including the latest information, please see below:

 

●National Institute of Infectious Diseases. (information regarding measles in Japanese)

https://www.niid.go.jp/niid/ja/diseases/ma/measles.html

●National Institute of Infectious Diseases. Measles in Japan, as of February 2018. IASR.

<brhttps://www.niid.go.jp/niid/ja/id/657-disease-based/ma/measles/idsc/iasr-topic/7959-458t.html

●National Institute of Infectious Diseases. (latest measles data, mostly in Japanese)

https://www.niid.go.jp/niid/ja/id/222-disease-based/ma/measles/idsc/trend/575-measles-doko.html

●Ministry of Health, Labour and Welfare. (information regarding measles in Japanese, including Q&A)

http://www.mhlw.go.jp/seisakunitsuite/bunya/kenkou_iryou/kenkou/kekkaku-kansenshou/measles/

●Ministry of Health, Labour and Welfare. (notice regarding the measles situation in Japanese, 26 April 2018) http://www.mhlw.go.jp/seisakunitsuite/bunya/kenkou_iryou/kenkou/kekkaku-kansenshou/rubella/dl/180427_1.pdf

●National Institute of Infectious Diseases. (information regarding the measles-rubella (MR) vaccine in Japanese)

https://www.niid.go.jp/niid/ja/id/655-disease-based/ma/measles/idsc/7982-mrvaccine2018.html

●National Institute of Infectious Diseases. (guidelines for responding to measles at medical facilities in Japanese) https://www.niid.go.jp/niid/images/idsc/disease/measles/guideline/medical_201805.pdf

●Okinawa Prefecture (information regarding the latest measles situation in Okinawa Prefecture in Japanese) http://www.pref.okinawa.jp/site/hoken/eiken/kikaku/kansenjouhou/measles.html

●FORTH (For Travelers’ Health) (information regarding travel health in Japanese)

http://www.forth.go.jp/useful/vaccination.html

●Ministry of Foreign Affairs / Overseas Safety HP (information regarding measles and rubella overseas in Japanese)

https://www.anzen.mofa.go.jp/info/pcwideareaspecificinfo_2018C028.html

● WHO WPRO. Expanded programme on immunization. Measles-Rubella Bulletin.http://www.wpro.who.int/immunization/documents/measles_rubella_bulletin/en/

● WHO SEARO. Vaccine preventable disease (VPD) surveillance data.http://www.searo.who.int/entity/immunization/data/en/

●WHO EURO. WHO EpiData.

http://www.euro.who.int/en/health-topics/disease-prevention/vaccines-and-immunization/publications/surveillance-and-data/who-epidata

●ECDC. Monthly measles and rubella monitoring report, May 2018 https://ecdc.europa.eu/en/publications-data/monthly-measles-and-rubella-monitoring-report-may-2018

 

Infectious Disease Surveillance Center, National Institute of Infectious Diseases

Copyright 1998 National Institute of Infectious Diseases, Japan

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