Rubella virus infection can lead to problems with congenital rubella syndrome (CRS) in the next generation due to fetal infection, but these problems are preventable with vaccination. In other words, rubella epidemics and the occurrence of CRS can be eliminated by vaccination. In Japan, until recently, rubella epidemics occurred every 5 years, and there were at least 1,600 CRS cases between 1965 and 1985. Following the 1994 revision of the Preventive Vaccination Law, national surveillance from approximately 3,000 clinics has shown that the number of rubella cases has dramatically decreased to a few thousand and the occurrence of CRS has decreased to only a few cases. However, the vaccination rate during a transitional period from 1995 to 2003 has been unsatisfactory. This has been especially true for junior high school students, because individual vaccination has replaced mass immunization in urban areas. As a result, the negative antibody rate in females below 18 years of age has increased to approximately 27%. If this trend continues, there is likely to be an increase in rubella epidemics and occurrence of CRS in the near future. Vaccination is not compulsory under Japanese law, and vaccination campaigns alone have proved unsuccessful in promoting vaccination. Another system of motivating individuals to seek vaccination will be needed in order to maintain a high vaccination rate without such campaigns.

In India, given the scarce availability of sensitive and specific methods, Chlamydia trachomatis genital infections may lead to severe clinical complications when left undiagnosed or underdiagnosed. The present study was conducted to evaluate the diagnostic efficiency and feasibility of polymerase chain reaction (PCR) assays using genital and urine specimens from men and women in India. Genital swabs and urine specimens collected from 143 patients attending the sexually transmitted disease (STD) clinic, Government General Hospital, Chennai, were tested by culture and a plasmid based PCR. Culture was positive in 27 (18.9%) patients. PCR gave positive results for 46 (32.2%) cases using genital specimens, and the positivity rate in urine was 25.2%. Once the discordant results between culture and PCR had been resolved by using a major outer membrane protein PCR, the overall sensitivity, specificity, and positive and negative predictive values for the plasmid PCR in genital specimens were 100%, 98%, 95.7%, and 100%, respectively. Corresponding values for urine PCR were 81.8%, 100%, 100%, and 92.5%, respectively. The prevalence of confirmed C. trachomatis infection was 30.8% in this STD population. The results confirmed the need to use sensitive and specific molecular assays like PCR to prevent underdiagnosis of genital chlamydial infections and to facilitate better clinical management of this infection in India.

Some parenteral drugs augment the in vivo action of endotoxin. It is necessary to regulate the overall toxic action of contaminating endotoxin by developing a clinically relevant test method for the safety control of such drugs. Although the responses of human peripheral blood cells (hPBC) to endotoxins to produce tumour necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and IL-1β showed considerable variation depending on the endotoxin and also on the individuals used as sources of blood, the responses to each of the endotoxins evaluated relative to that to the Japanese reference standard endotoxin were found to be highly reproducible irrespective of the sources of hPBC. The evaluation procedure based on the relative responsiveness to various endotoxins was shown to be highly effective to detect differences in responsiveness among the endotoxin test, the pyrogen test, and the cytokine induction in hPBC. When eight human monocytoid cell lines were examined, only THP-1 and 28SC cells showed a significant dose-dependent IL-6 production. However, THP-1 failed to show consistency with hPBC in responses to the panel of endotoxins. 28SC cells showed appropriate consistency with hPBC not only in terms of respective responses to the endotoxins but also with regard to detection of the effect of human interferons to augment endotoxin to induce IL-6.

We report a case of Legionella pneumophila pneumonia in a patient with interstitial lung disease. Intensive environmental investigations revealed that a system of all-day-running bathwater was the source of infection. In this case, the concentration of L. pneumophila in the hospital bathwater was low. We therefore emphasize that even a low concentration of L. pneumophila in environmental water can cause serious infections to immunocompromised patients in a hospital.

The incidence of Escherichia coli having pathogenic genes for diarrhea was studied in Laos in 2002. A total of 525 E.coli strains from 278 patients (basically, two E.coli isolates from each patient) were examined by PCR to detect the known pathogenic genes (stx, eae, elt, est, ipaH, and aggR). These genes were detected in 23 strains from 16 patients (16/278: 5.8%). In 10 cases of the 16, one of the two isolates from each individual was negative for the gene, and in the other six cases, both isolates had the gene (same gene in four cases). E. coli having eae but no stx (enteropathogenic E. coli [EPEC]) was found in two cases out of 278 (0.7%). Nevertheless, Class I classical EPEC (serogroup-based) was found in 77 cases (28%). Enterotoxigenic E. coli, enteroaggregative E. coli, and enterohemorrhagic E. coli were found in 9, 4, and 1 cases, respectively. Enteroinvasive E. coli was not detected. This study suggested that the incidence of diarrhea due to E. coli is not as high as has been previously thought.

We examined IgG antibody to Toxoplasma in sera from 1,693 inhabitants aged 20 - 85 years in Jakarta. The seroprevalence rate was 70%, without any significant differences between males (71%) and females (69%). Some epidemiological factors contributing to the high prevalences of antibody to Toxoplasma in inhabitants of urban areas in Indonesia were discussed.

Emergence of Influenza A H1N2 viruses was documented worldwide during the 2001- 2002 influenza season. In Japan, H1N2 viruses were isolated from two students of a junior high school in an influenza outbreak in Yokohama City, February 2001. Genetic and antigenic analyses demonstrated that the H1N2 viruses isolated in Japan shared common features with those isolated in other countries.

To assess the causal association of autism with measles, mumps, and rubella (MMR) vaccine versus that with monovalent measles, mumps, and rubella immunization, a 1:2 sex-adjusted logistic regression analysis was conducted using data on subjects who were growing up in the Tokyo area between 1988 and 1992. When MMR immunization was used as a reference, monovalent measles immunization (odds ratio [OR] = 5.33, 99% confidence interval [CI]: 1.03-27.74), non-mumps immunization (OR = 8, 99% CI: 1.33 - 48.2), and non-rubella immunization (OR = 8.57, 99% CI: 1.30 - 56.4) with development of autistic spectrum disorders (ASD) were significantly increased. These results suggest a decreased risk of developing ASD with MMR compared to monovalent antigens. However, our findings may reflect potential selection bias due to requiring written consent, possible delayed vaccination in suspected autism cases, and small sample size (case = 21). For the case group and the control group, immunization completeness rate of each antigen, regardless of the timing of immunization, was 90.5% versus 100% in measles, 42.9% versus 78.6% in mumps (P < 0.01), 52.3% versus 83.3% in rubella (P < 0.01), 14.3% versus 45.2% in varicella (P < 0.01), 100% versus 90.5% in polio≥2, 100% versus 97.6% in Diphtheria (D), pertussis, and tetanus (T) ≥3, 85.7% versus 66.7% in DT, 95.2% versus 92.9% in BCG, and 52.4% versus 81.0% in Japanese encephalitis ≥3 (P < 0.01). Only two case subjects and four control subjects received their measles, mumps, and rubella immunizations separately, suggesting that few Japanese parents might have had concerns about the safety of MMR vaccine. A nation-wide study would be a practical measure to scientifically judge the safety of MMR and other routine childhood immunizations.