In attempt to elucidate the route and source of Vibrio vulnificus infection, serotyping and drug sensitivity tests of environment-derived strains and human clinical isolates were performed.
1) Serotyping of isolates from the two types of source were determined. Of environment-derived strains, 72.5% were classified into 18 types, and O7 was the most frequent type, accounting for 73.1%, and the second frequent type was O4, accounting for 6.1%. Of human clinical isolates, 87.1% were classified into eight types, and O4 was the most frequent, accounting for 73.5%, and O7 was the secondly most frequent, accounting for 12.9%.
2) Serotypes were investigated by regions. In eastern Japan, 69.2% were classified into 18 types, and O7 and O4 accounting for 44.6% and 5.7%, respectively. In western Japan, 64.8% were classified into eight types, and O7 was the most frequent, accounting for 20.4%, and secondly frequent type was O4, accounting for 11.1%.
3) Regarding the relationship between biotypes and serotypes, environment-derived biotype-I strains were widely distributed in the serotypes, but most biotype-I human clinical isolates were distributed in serotypes O1-O7, showing a difference between the two types of sources. However, many biotype-II strains from the two types of sources included in the serotype O7 group.
4) Drug sensitivity was compared based on MIC₉₀ between strains from the two types of sources. Environment-derived strains were sensitive to ABPC, PIPC, CPZ, CTX, LMOX, MEPM, GM, EM, TC, DOXY, MINO, CP, NA and CPFX, but some strains were resistant to CER, CET, CTX, CMZ, KM and LCM. Human clinical isolates were sensitive to EM, TC, DOXY, MINO, CP, NA and CPFX, but some strains were resistant to ABPC, PIPC, CER, CET, CPZ, CTX, CMZ, LMOX, MEPM, KM, GM, AMK and LCM.

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Following cerebrating ceremony in 20 June 2002, for the completion of Hiuga Sun-Park Hot Spring Bath “Ofunade-no-Yu” facilitie Msi, yazaki Prefecture, Kyushu Island, 200 neighbors were invited each day to experience bathing on 20 and 21 June. The Bath “Ofunade-no-Yu” officially opened on 1 July 2002. On 18 July, H iuga Health Center was informed that 3 suspected Legionella pneumonia patients in a hospitala nd allo f them have bathing history of “Ofunade-no-Yu”. Health Center officers notified Hiuga City, the main proprietor of the Bath business, that on-site inspection on sanitary managementswill be done next day and requested the City to keep the bath facilitieass they are. On 19 July, Health Center officers collected bath water from seven places and recommended voluntaryclosing of “Ofunade-no-Yu” business. Because of various reasons, Hiuga City did not accept the recommendation and continued business up to 23 July. Because Legionellap neumophila serogroup 1 strainsf rom 4 patients's puta and several bath water specimens were determined geneticallys imilar by Pulsed Field Gel Electrophoresis of Sfi I-cut DNA, “Ofunede-no-Yu” was regarded as the source of infectiono f thiso utbreak. On 24 July, “Ofunade-no-Yu” accepted the Command to prohibit the business.Among 19, 773 persons who took the bath during the period from 20 June to 23 July, 295 became ill, a nd 7 died. Among them, 34 were definitelyd iagnosed as Legionella pneumonia due to L. pneumophila SG 1, by either one or two tests of positives putum culture, Legionella-specific urinary antigen, and significanrt ise of serum antibody titera gainst L. pneumophila SG 1.
In addition to the 8 items shown by Miyazaki-Prefecture Investigation Committee as the cause of infection, Hiuga City Investigation Committee pointed out following3 items: 1) Insufficienktn owledge and understanding of stuffs on Legionella and legionellosis;2) Residual water in tubing system aftert rialr uns might lead multiplicatioonf legionellae in it; and 3) Inadequate disinfectioann d washing for whole circulations ystem prior the experience bathing.
The Hiuga City Committee directed 24 measures to improve the sanitary condition of the facility including following 5 items. 1) Fix the manual for maintenance and management of the bath. 2) Keep sufficienotv erflow of bath water. 3) Put disinfectiono f filteris nto practice.4) Precise measurement and controlo f the residualc hlorinec oncentration in bath water. 5) Replacement of filtratinmga terial from crushed porous ceramic into natural sand.

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In 1999, the Ministry of Health, Labour and Welfare issued guidelines on prevention and control of influenza. These included recommendations for public education about influenza and promotion of vaccination among persons at high risk for complications from influenza. In response, several public education programs were implemented, including an “influenza hotline” that was established within the Infectious Diseases Surveillance Center, National Institute of Infectious Diseases. To assess the informational needs of callers about influenza and evaluate the impact of different communication modalities, we analyzed data from telephone consultations made to the “influenza hotline” and from a survey that was conducted among a subset of callers.
During the influenza seasons of 2000-2001 to 2002-2003, there was an average of 2, 230 callers to the “influenza hotline” each season, range 1, 809-2, 696. The majority (42.4%) of callers were women aged 30-39 years, which might reflect young mothers. The most frequently asked questions were about influenza vaccination of infants and young children, which accounted for 20.6% (1, 501/7, 295) of all vaccine-related questions during the four seasons. Questions about the number of recommended influenza vaccine doses was the second most frequently asked topic and comprised 17.8% (1, 300/7, 295) of all vaccine-related questions. Over the period 2000-2001 to 2002-2003, questions about the recommended number of influenza vaccine doses decreased among elderly callers, but not for callers aged<60 years. The number of calls about the location of influenza vaccine clinics, availability of influenza vaccine, and vaccination of elderly person declined from 1999-2000 to 2002-2003.
Of callers that were surveyed (N=3, 316) about where they received information about influenza, the most frequently reported sources were newspapers (47.7%), and the internet (26.2%). Internet use by callers showed differences among age groups. Only 2.4% of callers aged≥60 years reported receiving influenza information through the internet in contrast to 33.9% among callers aged<60 years.
Our study suggests a high public demand for information about influenza, especially by mothers regarding influenza vaccination of infants and young children, and recommended influenza vaccine doses for adults. To improve education of the public about influenza, multiple communication strategies should be utilized, including written information, and the internet.

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Chlamydia pneumoniae is a significant cause of both lower and upper acute respiratory illnesses, including community-acquired pneumonia. Furthermore, C. pneumoniae has been reported to frequently cause pneumonia in association with other respiratory pathogens, mainly Streptococcus pneumoniae. In this study, we investigated the clinical presentation of mixed pneumonia with Chlamydia pneumoniae and S. pneumoniae and compared it with S. pneumoniae pneumonia. A total of 13 cases of mixed pneumonia and 58 cases of S. pneumoniae pneumonia identified at Kawasaki Medical School and related hospitals between April 1996 and March 2001 were analyzed. The diagnosis ofC. pneumoniae infection was based on isolation and serologic testing of antibodies by the microimmunofluorescence test. The clinical presentation of mixed pneumonia and S. pneumoniae pneumonia was almost identical and no statistical differences were observed between the two groups. This is the same as what was observed before except eleven out of the 13 of the mixed pneumonia patients responded to treatment with only β-lactam antibiotics. Our results indicated that C. pneumnoniae may not be the primary cause of community-acquired pneumonia but it might descript the normal clearance mechanisms, enabling other pathogens to invade.

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The prevalence of Toxocara canis infection in household dogs was estimated by examining feces from 1, 743 dogs aged between 1 month and 15 years old. Fecal samples from 75 (4.3%) of the 1, 743 dogs were positive for the eggs of T. canis. The dogs with positive fecal samples ranged from 1 month to 5 years old in age. The infection rate in dogs aged 1 to 6 months old was significantly (p<0.01) higher than that in dogs aged 7 months to 2 years old or over 3 years old. Indoor dogs aged 1 to 6 months old showed a significantly (p<0.01) lower prevalence than outdoor dogs of the same age group. With respect to the place of origin of the dogs, those originating from individual households (5.7%) showed (p<0.05) a higher prevalence as compared to the animals purchased from pet shops/breeding kennels (3.5%). Considering the origin and the living conditions, the prevalence in indoor dogs originating from indlvidual households was significantly (p<0.05) higher than that in indoor dogs purchased from pet shops/breeding kennels.

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A total of 2, 320 cases of influenza A (1, 517 cases) and B (803 cases) in the 2002-2003 influenza season were analyzed. Influenza infection was confirmed by a rapid diagnosis kit, based on the immunochromatography method, at 24 clinics in 18 of the 47 prefectures of Japan. Influenza A/H3N2 was reported between November 22 and April 12 (the median at January 21), and influenza B was reported between December 24 and April 20 (the median at February 16). The mean age of type B patients (16.7 years old) was significantly younger than that of type A patients (26.7 years old) (p<0.001). Pneumonia was more frequently a complication of type A (0.63%) than of type B (0%, p<0.05). Although 5 type A patients needed hospitalization, neither hospitalization nor death was associated with type B.
Of the 2, 293 cases, 27 (1.2%) were infected with both influenza of A and B. The age of these 27 patients ranged from 2 to 51 years (mean of 11.2 years), but 20 of the 27 patients were 9 years of age or under. Type B followed type A in 25 patients. The median date of these 25 type A patients was January 22, similar to that of all cases of type A, January 21. However, the median date of type B infection was March 3, 15 days later than that of all patients with type B, February 16. The mean age of the 27 cases was significantly younger than that of all cases of type A (p<0.001) and type B (p<0.05).
In epidemics consisting of multiple types of influenza viruses, patients may be infected by more than one virus. This is especially true for children.

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Human metapneumovirus (hMPV) was newly discovered as a pathogen in 2001 and is thought to be associated with respiratory disease. To elucidate the prevalence and clinical significance of hMPV among children, we investigated the positive cases of hMPV-RNA by reverse transcriptionpolymerase chain reaction (RT-PCR) in their nasopharyngeal specimens collected from January to August 2003 in Hiroshima Prefecture, Japan. Our prospective study revealed 77 hMPV-positive cases among 377 children with acute respiratory diseases. Clinical diagnoses of 77 hMPV-positive cases were as follows; bronchitis (33.8%), pneumonia (24.7%), acute respiratory illness (19.5%), asthmatic bronchitis (11.7%) and bronchiolitis (5.2%). The most common symptoms were cough (97.4%), high fever (94.8%) and rhinorrhea (76.6%). Most of the hMPV-positive cases were identified in the spring (between March and May), indicating the presence of an epidemic of hMPV infection in Hiroshima Prefecture. Phylogenetic analysis of the amplified F gene of hMPV isolates revealed that hMPV strains were divided into two genotypes and that thier simultaneous circulation occurred within the same epidemic area of Hiroshima Prefecture.

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