[Alterations in epidemics and vaccination for measles during a 20 year period and a strategy for elimination in Kurashiki City, Japan].

In Japan, an epidemic of measles occurs every few years. An estimated 100-200,000 people contract the disease each year and 50-100 patients die. Following the eradication of poliomyelitis, the World Health Organization made plans for global eradication of measles, and the Japanese Association of Pediatricians began advocating vaccination to eliminate measles in Japan by 2005. However, no big response has occurred nationwide. Therefore, we retrospectively look at changes in epidemics and measles vaccination during the past 20 years in Kurashiki City, Okayama Prefecture and developed a strategy for elimination through the results. The Japanese surveillance showed the numbers of measles patient in Okayama to be a few times higher than the mean number nationwide. The number of persons vaccinated was approximately 2,000-3,000 per year, while the number of births was about 6,000 per year. After passing a revised vaccination law in 1994, the number of vaccinations increased to more than 4,000, and the epidemic situation decreased to the nationwide level. However, the number of measles patients older than 15 years of age who were admitted to our hospital increased from 4% to 24% in the ratio to the whole. In the United States, school regulations require that children be vaccinated for MMR twice before admission to school, but the revised vaccination law in Japan was changed from a requirement to a recommendation. To eliminate measles, we should increase the vaccination rate for infants, and should vaccinate adolescents who have not been vaccinated or do not have a past history of measles. It is important to choose the subjects and then confirm their vaccination after the recommendation. We have developed a strategy that includes 1) advocacy for vaccination 2) selection for vaccination, 3) request for certification of vaccination, 4) convenience for vaccination. The goal after two years is for 1) a vaccination rate of more than 90% by end of one year of age, 2) a rate of vaccination and past history of measles in more than 90% of children before admission to kindergarten or public school.