Recent trends on traveler s vaccinations in Japan

Transcription

1 5 th International vaccinology Workshop in Japan 2012 February, 18-19, 2012 Recent trends on traveler s vaccinations in Japan Kazunobu Ouchi Department of Pediatrics, Kawasaki Medical School

2 Increase of Japanese Travelers

3 Increase of Japanese Travelers to Overseas No. of Japanese travelers (X10 6 ) Lehman Shock SARS White Paper on Tourism (Ministry of Land, Infrastructure, Transport and Tourism)

4 Increase of Japanese residents overseas (X10 3 ) 1,000 No. of Japanese residents More increase in developing countries 1990 All the world Advanced countries Developing countries 2000 Research on the Number of Japanese residents overseas(ministry of Foreign Affairs)

5 Risk and Immunization rate of Japanese Travelers

6 It is seriously dangerous for Japanese to visit Nepal without vaccination of Typhoid vaccine and Hepatitis A vaccine. Vaccination rate of Typhoid and HAV <5% of Japanese travelers >90% of EU and US travelers Japanese vaccine record holder < 10% J Travel Med 7:37,2000

7 Reported cases of Japanese travelers with VPDs infected overseas Reported Cases(n) Chorela Typhoid Hepatitis A Hepatitis B Okabe N et al Reports of Research Group for Travelers Vaccine granted by MWHL

8 Morbidity of VPDs among Japanese Travelers by Asian Nations Cholera (n=92) Typhoid (n=70) Hepatitis A (n=58) Hepatitis B (n=30) Country No. of Travelers No of reported cases Morbidity No of reported cases Morbidity No of reported cases Morbidit y No of reported cases Morbidit y China 6,724, Thai 2,408, Philippine 797, Cambodia 256, India 198, Nepal 42, Pakistan 27, Bangladesh 14, Okabe N et al Reports of Research Group for Travelers Vaccine granted by MWHL

9 (%) 10 Morbidity of VPDs among Japanese Residents Overseas -Result of a questionnaire in Asia and Africa- Morbidity 5 n= Patrol team of doctors of MFA Clinic of The Japan Society JICA Iida M. et al Reports of Research Group for Travelers Vaccine granted by MWHL

10 Immunization rate (%) Morbidity and immunization rate by VPDs among Japanese Residents Overseas JICA n=2139 Patrol team of doctors of MFA Clinic of The Japan Society n=6900 Unapproved vaccine Morbidity (%) Hepatitis A Tetanus Hepatitis B Rabies Cholera Meningococcal Typhoid Iida M. et al Reports of Research Group for Travelers Vaccine granted by MWHL

11 Another Tragedy of Japanese travelers Two Japanese travelers died with rabies in Japan, 2006, due to dog bites in Philippine. They had never been immunized before and after the dog bites. Shortage of rabies vaccine in Japan since then.

12 Needs of Travel clinics in Japan

13 Higher Needs of Travel Medicine for Travelers Subject of a questionnaire: 5074 Medical institutions in Kanagawa prefecture. Any medical care for travelers in one year? 1059/2166 (49%) A prescription of medicine 31% Vaccination 26% Pre-travel medical examination 25% Issuance of Medical Certification 14% Yoshida T. et al Reports of Research Group for Travelers Vaccine granted by MWHL

14 Visitors of Travel clinics No. of visitors 50,000 20,000 15,000 10,000 Yellow fever vaccine center State of New York: 484 Paris: 56 England:251 Japan:25 5,000 0 Paris Munch London Tokyo Tokyo AFTC UMTC LTC IMCJ TMC Sendai NSMC Kurume TCUK

15 Vaccine lag in Japan -Many unapproved vaccines-

16 The difference between US and Japan in routine vaccination US JAPAN 1985 (7) 2011 (16) 1985 (8) 2011 (8) Measles Measles Measles Measles Rubella Rubella Rubella (female) Rubella Mumps Mumps Diphtheria Diphtheria Diphtheria Diphtheria Tetanus Tetanus Tetanus Tetanus Pertussis(aP) Pertussis(aP) Pertussis(wP) Pertussis(aP) Polio(OPV) Polio(OPV) Polio(OPV) Polio(IPV) BCG BCG Hib (infant) J. encephalitis J. encephalitis HepB Varicella Pneumococcal (infant) Influenza Meningococcal HAV Rotavirus HPV

17 Approved vaccines in Japan 2012 Routine vaccine Measles Rubella Diphtheria Tetanus Pertussis(aP) Polio(OPV) BCG J. encephalitis Voluntary vaccine HBV Mumps Varicella Pneumococcal(PPV23) Influenza HAV Rabies (Cholera) Weil Hib (infant) 2007 Pneumococcal (PCV7) 2009 HPV 2009 Rotavirus 2011

18 Increase of imported unapproved vaccines in Japan Vaccine Meningococcal vaccine 5,900 6,600 Typhoid vaccine ,500 IPV ,000 Rabies vaccine* 60 8,250 others 2,660 11,710 Total 14,320 43,810 *: due to shortage of approved rabies vaccine Matsumoto T. BMSA J 23:10,2011

19 Knowledge and attitude of Japanese travelers

20 Pre-travel visit of Japanese Travelers Subject: Japanese Travelers who visited Surveillance sites of Geo Sentinel Network while sick. (%) % Residents in Japan 30% Residents Overseas Sagara, Y. et al Reports of Research Group for Travelers Vaccine granted by MWHL

21 Knowledge of Travel Vaccines EU* US* JAPAN Is vaccine effective? 83% 74% 45% Is vaccine safe? 35% 46% 15% Vaccination of Hepatitis A 42% 24% 1.3% *:ISTM questionnaire at airport lounge Kimura M. et al Reports of Research Group for Travelers Vaccine granted by MWHL

22 Immunization of Oversea Traveler Q&A -A Pamphlet for Japanese Travelers- Source of information <age of 60: Internet >age of 60: A pamphlet Ouchi K. et al Reports of Research Group for Travelers Vaccine granted by MWHL

23 International Information for Travel and Health WHO CDC

24 Vaccine Guidelines for Travelers 2010 Japanese Society of Travel and Health Committee of Vaccine Guidelines For Travelers 2010 Chairman Vice Chairman Member For Japanese Healthcare workers Takashi Nakano Hiroshi Watanabe Kenji Okada Hitoshi Kikuchi Takaaki Tanaka Tetsuo Nakayama Shinji Hukushima Shinsuke Mishima Kei Miyagi Kouji Yano Editing Adviser Kazunobu Ouchi Atsuo Hamada

25 What s next?

26 J Travel Med 17: ,2010

27 Morbidity and Severity of VPDs Rabies Japanese Encephalitis Higher priority for Clinical trails Severity Meningococcal diseases Hepatitis B Approved vaccine Unapproved vaccine Cholera Typhoid Hepatitis A Travelers diarrhea Influenza Morbidity Source: R. Steffen

28 Clinical trails for approval will be coming soon in Japan. Typhoid vaccine (TYPHIM Vi ) Meningococcal vaccine (MENACTRA )

29 SUMMARY - Increase of Japanese travelers to developing countries. - Higher morbidity of VPDs in Japanese travelers to oversea. - Lower immunization rate in Japanese travelers to oversea, especially unapproved vaccine. - Vaccine lag of travelers vaccine in Japan - More needs of travel clinics in Japan. - More efforts of enlightenment of Japanese travelers and citizens.

30 Thank you for your attention!