We ever reported an incidence of congenital rubella syndrome epidemic which occurred in Ryukyu Island in 1965, then under US administration, involving a surprisingly great number of patients, the number so far rare in the history of this disease.
To establish the future prophylactic measure of rubella and congenital rubella syndrome (CRS), it is thought to be of great value to look into the prior status there to that epidemic
In this line we examined 237 (125 males and 112 females) pupils in Okinawa Deaf-and-Dumb School, the only school of that sort in those areas, with our following diagnostic criterion: CRS=congenital deafness plus rubella retinopathy.
The results were as follows:
Twenty six cases (15 males and 11 females) were found to be CRS. Twenty cases of them were children born during 1956-1957. This is a coincidental fact with the observations of the doctors in those localities that there broke out an rubella epidemic around the year eight years prior to the 1965's epidemic.
The defects assorted in the CRS patients studied were: rubella retinopathy with deafness and heart disease-5 cases (patent ductus arteriosus-4 cases and pulmonary artery stenosis-1 case) and with deafness alone-21 cases. Rubella HI antibody was tested in 24 cases of them by the use of Courland Duracyte Rubella Diagnostic Kit for Micro-Technic. All were shown to have the antibody ranging from 1: 10 to 1: 160.
It was disclosed by this survey that there undoubtedly an rubella epidemic around the year 8 years prior to the 1965 epidemic. The scale of this, however, was thought small and the areas limited, despite it durated for more than 2 years. This explanes one of the main factors contributed to the 1965 epidemic, of CRS that many expectant mothers had remained susceptible to the virus till that incide.

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During the one-year period from December 1969, a number of 133 healthy children ranging in age from eleven months to seven years and 7 adults were subcutaneously' inoculated with a live attenuated mumps virus vaccine (Urabe vaccine). In parallel, another group of 180 children of the same age range received a mixed vaccination with the mumps vaccine in combination with a iurther attenuatea live measles vaccine (CAM or Schwarz vaccine). One hundred and seventy children under ten years of age were also admitted to the study to serve as control; receiving either the CAM or Schwarz vaccine alone against measles.
Observations were made at clinical response in above three groups over the ensuing twenty days, and determinations of the HI antibody titers against mumps and measles were made before and after the vaccinations.
I. Clinical reaction
1) Almost no significant clinical reaction was observed in the group receiving the mumps Urabe vaccine alone.
2) Elevation of temperature above 37.5°C was seen in 43.8 and 47.5 per cent of the children receiving CAM vaccine alone and Schwarz vaccine alone, respectively; whereas in the group with conjugation of mumps Urabe vaccine and measles vaccine, 21.2 per cent of Urabe vaccine-CAM vaccine cases and 40.0per cent of urabe vaccine-schwarz vaccine cases displayed febrile responses. These results indicate the effectiveness of (Urabe strain) in suppressing the febrile reaction to measles vaccination in combined inoculation.
II. Serum antibody response
1) The seroconversion rate to positive HI antibody against mumps virus was determined as 87 per cent (92 out of 106 subjects with negative prevaccination antibody titers) for the group inoculated with the Urabe vaccine alone, 98.5 per cent (134/136) for the combined Urabe-CAM vaccination group, and 100 per cent (20/20) for the combined Urabe-Schwarz vaccination group. However, the mean HI antibody titer (GMT) ranged relatively low from 6.1 to 9.5.
In the mumps Urabe vaccine group, out of 90 cases who had negative pre-inoculation antibody titers and received two separate doses of the vaccine with 6 week interval, 87.8%(79/90) showed conversion to positive HI, GMT being 6.2, after the initial inoculation and HI conversion rate reached 98.9%(89/90), GMT being 16.0, after the second one apparently under the booster effects.
A significant rise in HI antibody titer, fourfold or greater, occurred in 67.2 per cent (39/58) with positive pre-inoculation antibody in response to the Urabe vaccine.
2) Seroconversion to posive HI antibody against measles occurred in all the 130 children given the measles CAM vaccine alone and in all the 40 subjects who had received the Schwarz vaccine alone. The same response was noted also in 97.8 per cent (131) of the combined mumps-Urabe and measles CAM vaccination group of 134 children and in 100 per cent of the combined mumps and Schwarz vaccination group of 23 children, wherein the rise of HI antibody titer was as marked as in the group of vaccination with the measles vaccine alone.
Clinical reaction was practically nonexistent with the live attenuated mumps virus vaccine (Urabe vaccine) and it yields a fairly good seroconversion rate. To accomplish a sufficient rise in the antibody titer, however, it is considered advisable to administer two doses with an adequate interval. An evidence was observed for the effectiveness of combined inoculation with further attenuated live measles vaccine for the suppressing the febrile response associated with the measles vaccine.

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The treatment of Japanese B encephalitis (JBE) with ACTH and corticosteroid has been tried and reported several times by us. Since 1967, synthetic α^1-24 ACTH-Z has been brought into use instead of NH-ACTH-Z ever used and its clinical evaluations are stated in this paper.
The subjects were twelve cases of JBE admitted to the Kyoto Municipal Hospital during 1967-1969, the ages ranging 48 to 80.α^1-24 ACTH-Z (0.5-1.0mg/day) was the dosis and urinary 17-OHCS and plasma cortisol levels were pursued along with clinical observations. In almost all the cases, predonisolone (40-60mg/day) was combinated.
A) Adrenocortical functions and clinical course: Those who were well responsive to ACTH with increased urine 17-OHCS and blood cortisol levels were mostly curable, whereas, those non-responsive and, therefore, regarded as adrenocortical hypofunction were prognostically unfavorable.
B) Recommendable dosage of ACTH: Our experiences suggested concomittantly with many other's literatures that 0.5-1.0mg/day of synthetic α^1-24 ACTH-Z would be sufficient.
C) Necessity of combination use of corticosteroids with ACTH: As frequently reported by us, there is a close relationship between adrenocortical function and the clinical course in JBE patients. Therefore, combination with corticosteroid is considered necessary particularly in old or serious cases. The dosage should, at least, be 40-60 mg/day as predonisolone.
D) Clinical effects of this treatment: With this therapy, 12 were recovered and 5 were mortal. It can be said in comparing our clinical data and many others' as well with data without ACTH and corticosteroid that it shortens the febrile periods, hastens the conciousness recovery and delays the death. It is clear that the mortality has been reduced by this therapy.

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米国教育厚生省 (Departrn ent of Health, Education, and Welfare) の定期刊行物に, Center for Disease Control (CDC) から“Morbidity and Mortality Weekly Report”(MMWR) という週刊パンフレットが発行されています. 内容は合衆国の屈出伝染病の週間州別発生速報が主ですが, ほかに各種疾患の集団発生報告や調査記録なども載つています. その中から興味ありそうな記事を選んで抄録しましよう.

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