Japan has ever based its policy for controlling influenza on a strategy of vaccinating schoolchildren.Mass immunization program for schoolchildren began in 1962. The government discontinuedthe program in 1994, because of growing doubt about its effectiveness. However, it was recently reportedthat vaccinating schoolchildren against influenza provides protection and reduces mortalityfrom influenza among elderly persons. Instead, Japanese government will begin a vaccination programfor elderly persons, because the excess mortality rates increased, as the vaccination of schoolchildrenwas discontinued. Although vaccination rate of Japan is the lowest in developed countries atpresent, the supply of influenza vaccine increases double every year.

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A clinical study of 38 patients (28 men and 10 women) with tuberculous pluerisy was conducted.The age of these patients ranged from 19 to 92 years, with an average age of 48.9 years. In 30 patients, the chief complaint was fever, and other common complaints included chest pain, dyspnea, andcoughing. Bacillus tuberculosis was found in the pleural fluid of 7.9% of the patients. Tuberculous pluerisywas diagnosed histologically, based on pleural biopsy, in 23.7% of the patients. The diagnosisrate of pleural biopsy was 47.4%. There were no significant differences in resultsof blood and pleuralfluid tests between idiopathic pleurisy and concomitant pleurisy, but the tuberculin skin test waspositive in only 50% of the patients with concomitant pleurisy. The tendency was that the longer thetime period between symptom onset and first examination, the greater the pleural fluid retention .The diagnosis rate of pleural biopsy was influenced by the severity of pleural fluid retention. A thoraciccavity drain was inserted for continuous drainage in 15 patients, and every patient underwentINH+RFP-based chemotherapy. Tuberculous pluerisy is an important disease among patients withpleural fluid retention, thus clinicians need to know how to treat this disease.

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We experienced 108 cases of Fusobacterium associated infections, including otolaryngeal, oral, pleuropulmonary, intraabdominal, skin and soft tissue infections, at Aomori Prefectural Hospital during The 5 year-period from 1995 to 1999. A total of 433 organisms, included 113 Fusobacterium spp.(80 Fusobacterium nucleatum, 18 Fusobaterium necrophorum, 5 Fusobacterium varium, 4 Fusobacterium mortiferum, 6 Fusobacterium spp.), were recovered with an average of 4.0 organisms per case of the 108cases, 68% were mixed aerobic and anaerobic and yielded 185 anaerobic bacteria (2.5 per case) and137 aerobic bacteria (1.9 per case) with an average of 4.4 per case. The remaining 32% were purelyanaerobic and yielded 111 organisms with an average of 3.2 per case. Prevotella spp., Bacteroides fragilis group, Streptococcus milleri group, Enterobacteriaceae, Peptostreptococcus spp. Staphylococcus spp. weremost frequently coisolated with Fusobacterium spp.

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Background: Norwalk-like viruses (NLVs), RNA viruses in the family of Caliciviridae, are knownas a pathogen of nonbacterial food-borne gastroenteritis associated with eating raw oysters. NLV canspread from person to person with strong infectivity and can cause large epidemics in communities, schools, nursing homes, and hospitals. Here, we describe an outbreak of gastroenteritis associatedwith NLVs, possibly introduced from outside the hospital, in four different wards on four different occasionsbetween November 1999 and April 2000, in a university affiliated hospital in Tokyo.
Method: Total 61 specimens (stool or vomitus) from 46 patients and staffs were collected. Reversetranscription-polymerase chain reaction (RT-PCR) test was performed on each specimen. Standardprecautions were applied strictly as control.
Result: NLV was detected in 40 specimens from 28 patients and staff (20 patients, 8 nurses). Attackrate of the patients were 0.19, nurses were 0.15, and doctors were 0.07.
Conclusion: The spread of NLV from person to person is considered to be a major infectionpathway in each ward. A nurse is at a high risk of infection as a patient in some wards. A stringentpolicy of control must be applied.

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To examine the optimal pH range for growth on media, growth of Legionella spp. on its selectivemedia, BCYEα, WYOα and MWY agar media, in a pH range of 6.0-8.0 (at 0.5 intervals) was compared. The growth of two strains of L. pneumophila and one strain of L. micdadei on a WYOα agar supplementedwith some selecting antimicrobial agents was markedly inhibited at all pH range except 6.0 and 7.0, suggesting a narrow optimal pH range for growth of these species compared to the BCYEα without selecting antimicrobioal agents. Vancomycin (VCM) added to the selective agar suppressedthe growth of some Legionella spp. depending on the concentration. However, the extent ofsuppression was different among species and/or strains of Legionella spp. The selectivity for speciesother than Legionella spp. was also affected similary by VCM concentration added to their media, suggestingthat it is important to use proper amounts of the selecting antimicrobial agent depending onthe species and/or strains of Legionella spp. or the other species in water samples. Amphothericin B (AMPH-B) added to a selective medium, MWY agar, in the concentration of 80μg/ml hardly affectedthe growth of Legionella spp. examined, but effectively inhibited the growth of fungal strains identified as Aspergillus sp., Trichoderma sp., Scolecobasidium sp. and Mucor sp. which were isolated fromcooling-tower water samples together with Legionella spp. Furthermore, the growth of a combinationculture of one each of the 4 strains of isolated fungi and one each of the 3 strains of Legionella spp. wasexamined at various concentration of AMPH-B. Addition of AMPH-B to the selective medium at theconcentration of 80μg/ml suppressed the growth of spreading fungi, permitting the growth of Legionella spp. to allow efficient detection of the species.

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Fecal samples from 116 healthy goats out of 25 randomly selected farms were examined for verotoxin-producing Escherichia coli (VTEC) during 1996 and 1998 in Okinawa Prefecture. VTECs were detected 204 (15.0%) from 1, 361 E. coli strains, 36 (31.0%) goats out of 13 (52.0%) farms. Randomly selected 88 strains were further characterized according to VT types, serotypes, virulence markers, biochemical properties and drug susceptibility.
VT types were classified as VT1 (46.6%), VT2 (6.8%), and VT1/VT2 (46.6%) by means of reversed latex agglutination test. The VTEC belonged to 18 different O serogroups: O1, O6, O22, O27, O48, O75, O76, O77, O78, O82, O91, O103, O111, O123, O125, O128, O146, anld O158. Serotypes O91: H^- (13 strains), O27: H^- (10 strains), O22: H19 (6 strains) are considered to be predominant, whereas O serotypes O157 and O26 were not isolated. eaeA gene was detected only in 5 strains (5.7 %): O103: H2 and O111: H^-, in contrast, hlyA gene was found frequent in 45 strains (51.1%) belong to various O serogroups, except for O146 (8 strains). On the basis of 20 biochemical features in all isolates, characteristic patterns were divided into 14 distinct types: 47 strains (57.3%) were classified as one type. The VTECs examined were resistant to streptomycin (26.7%), ampicillin (12.2%), kanamycin (8.9%), oxytetracycline (8.9%), and oxolinic acid (3.3%), respectively.
The current results indicate that goats harbored VTEC at high frequencies and may be a potential reservoir of human VTEC infection.

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We investigated the antibody responses and clinical adverse reactions after immunization with live combined measles and rubella vaccine (HF vaccine) in 442 healthy children, aged 12-90 months of age. We obtained 368 paired sera. Among them, 363 were initially sero-negative against measles virus and 343 (94.5%) became sero-positive after immunization. Sero-conversion against rubella virus was demonstrated in 349 (96.7%) of 361 initially sero-negatives against rubella virus. We investigated the clinical adverse reactions in 406 recipients. In 102 (25.1%) recipients, febrile reaction (>37.5C) developed on the day 6.7 of vaccination on average, with a mean duration of 2.2 days. Only two (0.5%) developed high body temperature over 39.5C. Skin rash was noted in 87 (21.4%) on day 7.1 of vaccination on average, with a mean duration of 4.8 days. Lymphoadenopathy was demonstrated in 12 (3.0%). Thus, measles and rubella combined vaccine was safe and sufficiently immunogenic as well as each monovalent one, having clinical advantage in immunization practice.

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A 63-year-old male with liver cirrhosis due to type-C hepatitis virus was admitted on June 14, 1999 to our hospital with complaints of dyspnea, and blisters, swelling and purpuras on his legs. He had consumed raw fish one or two days before.
He was already in a state of shock with sepsis and disseminated intravascular coagulatioo shortly after the admission. Although treatment with MEPM and MINO for sepsis, and daltepalin sodium, antithrombin III and gabexate mesilate for disseminated intravascular coagulation was begun within 12 hours, he died only 30 hours after admission. The causative organism was detected from the blood and the contents of blisters, and was determined as Vibrio vulnificus.
On autopsy, Vibrio vulnificus was also detected from skin and muscular tissue of his legs, but necrotizing fasciitis were not apparently revealed. Coagulating necrosis and acute tubular necrosis were verified in intestine and kidneys respectively probably due to ischemic changes. Pseudolobuli were formed and a small hepatocellular carcinoma was detected in the liver.
Vibrio vulnificus has two infection channels; one is oral intake and the other is an external wound. The former is said to become serious. It has a rather short period from the starting of the symptom to death, and is highly fatal. If this bacteria is suspected by the clinical coarse of the patients or the laboratory examinations, it is necessary to dose effective antibiotics in its early stage. And for prevention, susceptible patients must be informed of the existence of this disease and the necessity of adequately heating raw seafood.

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A 56-year-old woman with Ph¹-Positive acute Lymphoblastic Leukemia was admitted to our hospital for induction chemotherapy in June 1999. The patient was presented with a central scotoma of left eye during treatment course and was given diagnosis of endophthalmitis . Thereafter she also developed skin induration and suffered from serious pneumonia.
Amphotericin B administration was started because of high titer of β-D-glucan, but soon discontinued due to its adverse effect. Blood cultures yielded colonies of fungus and it was identified Fusarium solani. Her general condition deteriorated with progression of pneumonia, and she died of respiratory insufficiency. Autopsy was performed, and its specimen revealed the disseminated infection of Fusarium solani (lung, eye, heart, kidney and skin).
We should pay special attention to the fusariosis in Japan also.

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Although Streptococcus salivarius is one of the normal flora in the oral cavity and gastrointestinal tract, the agent may cause bacteremia, meningitis, endocarditis and sinusitis under certain circumstances. We report a 3-year-old female with meningitis after oral trauma by a skewer due to penicillin resistant S. salivarius. The girl injured her throat accidentally with a skewer. Four hours later, she became febrile and came to our emergency room. Plain CT scan was normal, and cefalexin was prescribed. The next day, she had fever, lethargy, meningeal signs, and her cerebrospinal fluid (CSF) showed neutrophilic pleocytosis. The blood culture was negative, but the CSF culture was positive for S. salivarius. The minimal inhibitory concentrations (MIC) for panipenem, penicillin G, ampicillin, cefotaxime, ceftriaxone, vancomycin were 0.125μg/ml, 2μg/ml, 2μg/ml, 0.5μg/ml, 0.5μg/ml, 0.5μg/ml, respectively. Intravenous administration of panipenem betamiprom (PAPM/BP) 2g/day for 7 days and 8 courses of dexamethasone 0.15mg/kg/dose were effective, and she has had no apparent sequelae except for a slight abnormality in her electroencephalogram. Traumatic meningitis is often caused by S. pneumoniae, but may be also caused by the normal flora pathogens including S. salivarius. In addition, our case suggests that not only S. pneumoniae but also S. salivarius can be penicillin resistant. Taking the drug resistance into consideration, we have to be careful in choosing antibiotics for treating such patients.

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