As of April 1, 1999, the new Infectious Diseases Control Law became effective in Japan. Under the new law, there are three types of category for medical care systems such as “Specified Infectious Disease Medical Hospital”, “Category 1 Infectious Disease (Ebola virus hemorrhagic fever, Marburg disease, Lassa fever, Crimean-Congo hemorrhagic fever and plague) Designated Hospital” and “Category 2 Infectious Disease (Cholera, Sigellosis, Typhoid fever, Paratyphoid fever, Poliomyelitis and Diphtheria) Designated Hospital”. In these categories, “Category 1 Infectious Disease Designated Hospital” should be designated by prefectural governments, one hospital per prefecture. Recently some papers indicated that (1) whether each government should arrange a category 1 hospital, (2) whether strict isolation with precautions against airborne spread including negative air pressure with anterior-room should be required, (3) plague is not a dangerous disease and the patient with plague is not required of Category 1 hospital but Category 2 hospital for medical care and infection control. The purpose of this article is, including a counterargument for these opinion, to summarize the point of view for the new medical care system under the new law and to search for the future medical care system in Japan.
First of all, medical care for patients with infectious diseases should not be a special one but the extension of the general one. Second, we understand that one of the purposes for Category 1 hospital is the core hospital concerning the therapy, pre/post education and research for infectious diseases in each prefectures. Third, the constructive standard for Category 1 hospital should be a strict one including negative air pressure rooms with an anterior-room and an outside hall, and the air should not be recirculated.
Under the big chance of enforcement of this new Infectious Diseases Control Law in Japan, we should try to restruct about medical care system for patients with infectious disesases in a longrange plan.

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Imported malaria has been increasing according to the recent globalization of Japan. There are about 120 clinical cases of malaria which include a few pediatric cases (approximately 1%) every year. Generally, pediatric cases often have an atypical onset and course compared to adult cases, and also develop serious and fatal effects in a short time. In this study, we examined imported malaria cases in subjects under 15 years old from 1980 to 1999 conducted by Research group on clinical evaluation against orphan drugs in the treatment of imported tropical diseases and parasitic diseases. During the 20 years we found 44 clinical cases in children. Of these 70% were foreign cases. Among the species of parasites, there were 21 cases of Vivax malaria and 17 cases of Falciparum malaria and a few cases of Malariae and Ovale malaria were also found, which is rare even in adults. Concerning the drugs chosen in Japan for chemotherapy to treat malaria, chloroquine and primaquine seemed to be employed most frequently before 1990, however mefloquine or artesunate seemed to be more common after 1990. Also, most pediatric cases were former residents or refugees from tropical countries, however some cases were in Japanese children who had recently visited those areas with their families.
There have been no fatalities in pediatric cases of malaria, however tropical diseases, including malaria, must be rule out, when examining pyretic children, considering the number of travelers going abroad has been increasing.

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Fifteen children with influenza type A (H3N2) virus infection (mean age, 38 mosths) were treated with amantadine. Amantadine was prescribed as 5 mg/kg/day and the serum concentration was measured in 5-7 days. As a result, the mean serum concentration of amantadine was 164.6-92.5ng/ml (range, 67.4-446.9ng/ml). Adverse reactions were not associated to them. Amantadine therapy against influenza type A infection is probably safe in children because of the low serum concentration shown in this study.

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Retrospective studies of treatment of tympanostomy tube insertion in infantile otitis prone patients caused by Penicillin-resistant Streptococcus pneumoniae were performed. Insertion of the Koken B type tympanostomy tube was performed with local anesthesia. The results were as follows:
1. In 25 otitis prone children, 19 (76.0%) were not recognized as having otitis media and otorrhea, but 6 (24.0%) were recognized.
2. Of the 25 children, 20 had the tympanostomy tube removed. Eighteen were not recognized as having otitis media and otorrhea during tympanostomy tube insertion, but 2 were recognized.
3. In 18 children, 2 developed otitis media after tympanostomy tube removal, but the other 16 children did not.
4. In 2 children who were recognized as having otitis media and otorrhea during tympanostomy tube insertion, 1 child actually had otitis media, whereas the other did not.
5. From this study, tympanostomy tube insertion is a useful method for treating the otitis prone children caused b Penicillin-resistant Streptococcus pneumoniae

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We investigated the performance of the new p24 antigen detection kit (VIDAS HIV p24) with the conventional antigen kit (HIV-1 Ag monoclonal; Abbott). The new kit is an enzyme-linked fluorescent immunoassay (ELFA) and all of the assay steps are performed automatically by the VIDAS instrument within 100 minutes. With the seven HIV-1 seroconversion panels, three seroconversions were detected on an average of 6.8 days earlier with ELFA than the conventional ETA kit. ELFA showed negative results for all of the 11 false positive samples by the combined (p24, anti-HIV) detection kit (VIDAS HIV DUO). The results obtained suggest that ELFA are very useful for an earlier diagnosis of HIV infection and re-test for false positive samples by other HIV diagnosis kits.

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We have recently encountered an outbreak of hepatitis A in Tokyo. Between July 1998 and November 1999, 21 patients were treated at our hospital. They were all male and 18 patients (86%) had had sex with men (MSM). About a half of the patients were seropositive for syphilis, hepatitis B and HIV. The VP1/2A region could be amplified by nested PCR in 6 of the 21 patients. They had the same sequences and were grouped into genotype IA. Homosexual activity should be kept in mind as a leading risk factor for hepatitis A in the recent Japanese population.

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We report a 20-year-old woman who developed meningococcemia. The patient developed fever, vomiting and skin rash, then was sent to our hospital for shock. Physical and laboratory examination revealed septic shock and DIC. Her blood culture grew Neisseria meningitidis (W135). She recovered promptly with PCG, gabexate mesilate and intensive care for shock.
Hemolytic activities of the patient's complement were less than 12/CHSO during the course. Screening for each component of the complements suggested that this patient had deficiency of C7.
Meningococcal disease has seldom seen in Japan. Early recognition is essential so that appropriate antibiotic therapy and supportive care can be promptly started because shock and death may ensure within hours after onset of symptoms.

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Rubella is an acute viral infection characterized by rash, fever and lymphoadenopathy, and often affects school-age children in Japan. More than 80% of adults are considered to be immune to this disease. Encephalitis, meningitis, purpura and arthritis are well-known complications of rubella virus infection, while hemolytic anemia is rare. Here, we report an adult case with hemolytic aneumia associated with rubella virus infection.

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