This study was performed to clarify which titers of a pre-existing antibody could be efficiently boosted by vaccination and to assess the persistence of the antibodies. Two hundred healthy volunteer students with HI antibody titers of ≤1 : 32 were enrolled. There were 6～16％ of subjects with the negative HI antibody who had B-cell memory against rubella, because the EIA-IgM antibody remained negative and/or the avidity of the EIA-IgG antibody was high after vaccination. Furthermore most of them had already been vaccinated just once before. The ratio of those in whom the antibody levels increased significantly at one month after vaccination were 98％, 87％, 67％ and 32％ in subjects with an HI antibody titer of ＜1 : 8, ≤1:8, ≤1 : 16 and ≤1 : 32 at pre-vaccination, respectively. The titers decreased significantly at two years after vaccination, however the ratio of decrease under each original level being 4％, 21.9％, 42.6％ and 73.5％ in each group of ＜1 : 8, ≤1:8,≤1 : 16 and ≤1 : 32, respectively. In comparison with the numbers of the subjects with ＜1:8, the ones with ≤1:8, ≤1 : 16 and ≤1 : 32 increased 1.5-, 2.5- and 4.7-fold, respectively. Therefore, the recommendation of an HI antibody titer ≤1 : 16 for vaccination in Japan is thought to be loose, although this is to decrease the risk of congenital rubella syndrome. We think that a new assay for cellular immunity for rubella should be developed in the future in order to ascertain whether congenital rubella syndrome will be prevented or not.

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Peripheral blood tests are performed for the differentiation of febrile diseases, and are useful for diagnosing and determining the effectiveness of treatment in bacterial infections. However, their use for viral infections has not been well-investigated, nor do any clear views exist regarding their use with viral infections. We retrospectively investigated the results of routine peripheral blood tests for febrile diseases (differential leukocyte count and C-reactive protein (CRP)) performed in 1162 patients between the 2004/05 and 2009/10 influenza seasons, and identified the characteristic findings of influenza, along with the differences between cases of seasonal influenza A (including H3N2 and H1N1 ; hereafter, seasonal A ; n＝614) and pandemic influenza (H1N1) 2009 seen during the 2009/10 influenza season (hereafter, A/H1N1/pdm09 ; n＝548). The differential leukocyte count varies with age ; therefore, analysis was performed by adjusting for the age of all patients using a generalized additive model (GAM). Increased granulocytes and decreased lymphocytes were confirmed during the initial stage of influenza infection, followed by inversion to decreased granulocytes and increased lymphocytes. The granulocyte count was significantly lower in A/H1N1/pdm 09 compared to seasonal A, with levels 0.93- and 0.82-fold relative to seasonal A before and after treatment, respectively. The lymphocyte count was 1.12- to 1.30-fold greater in A/H1N1/pdm 09 compared to seasonal A both before and after treatment, indicating significantly higher levels in A/H1N1/pdm09. CRP levels peaked 24-36 h after onset, with peaks of 0.88 mg/dL for A/H1N1/pdm 09 and 1.53 mg/dL for seasonal A. Peripheral blood counts change due to factors such as the time course of the disease, onset of complications, modification resulting from treatment, and side effects of pharmacotherapies. We report the present findings because we consider an understanding of the changes and kinetics of differential leukocyte counts in peripheral blood inherent to influenza to be important for diagnosis (particularly for the decision of doing rapid diagnosis test) and to promote recognition of the onset of complications and side effects during the course.

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A 19-year-old Filipino man was admitted to our hospital because of persisting fever and back pain. He had recognized his symptoms 6 months previously, but a definite diagnosis was not made. Image testing demonstrated a compressed fracture of the thoracic vertebrae accompanied with a perivertebral abscess. A biopsy specimen revealed granuloma compatible with tuberculosis (TB). Anti-TB drugs were initiated, and his clinical symptoms steadily improved. However, he developed neuropathic symptoms due to exacerbation of the abscess two months after starting the anti-TB drugs. An immediate laminectomy was performed resulting in symptom relief ; however severe kyphosis remained. Polymerase chain reaction testing of the abscess collected during the operation was positive for Mycobacterium tuberculosis, confirming the diagnosis of spinal TB. The diagnosis of spinal TB has been a challenge world-wide. Clinicians should be aware of the demographic background as well as the clinical and laboratory features of spinal tuberculosis, facilitating earlier diagnosis.

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