MMWR Reports on Rubella Epidemic in Japan

Most of the 5,442 cases reported from Jan. 1 to May 1, 2013, are unvaccinated adult males.

A rubella epidemic is happening in Japan, according to a report on the outbreak published in the June 14 edition of CDC's MMWR. The report says Japan's Ministry of Health, Labor, and Welfare has asked health care authorities is to provide information on rubella disease and congenital rubella syndrome (CRS) for pregnant women and their households and to encourage vaccination of family members of pregnant women because rubella vaccine is contraindicated in pregnant women and vaccination for women who plan to get pregnant. Local governments in about 100 cities, including several districts in the Tokyo metropolitan area with high numbers of reported cases, "have provided partial funding to help with the cost of MR vaccine or a single rubella vaccine for women planning pregnancy and for men who are living with a pregnant woman," it says.

Japan introduced a single-antigen rubella vaccine in its national immunization program, targeting girls in junior high school, in 1976 and a measles-mumps-rubella (MMR) vaccine targeting children aged 12–72 months in 1989. But adult males remain susceptible to rubella, the report states, and the numbers confirm this: From Jan. 1 to May 1, 2013, a total of 5,442 rubella cases were reported through the rubella surveillance system in Japan, and 77 percent of them were adult males.

"Until the early 2000s, rubella was endemic in Japan, with periodic epidemics approximately every 5 years and seasonal increases in the spring and summer. The number of reported rubella cases remained at record low levels until 2010, and in 2011, a few outbreaks were reported in the workplace among adult males. In 2012, the number of rubella cases sharply increased to 2,392, with the rise in cases continuing into 2013," the report states. Most cases were reported Tokyo and its surrounding prefectures initially, but recently the epidemic has expanded to Osaka, Hyogo, Aichi, Fukuoka, and Kagoshima.

The report was prepared by Keiko Tanaka-Taya, M.D., Ph.D.; Hiroshi Satoh, DVM, Ph.D.; Satoru Arai, DVM, Ph.D.; Takuya Yamagishi, M.D., Ph.D.; Yuichiro Yahata, Ph.D.; Kazutoshi Nakashima, M.D., Ph.D.; Tamie Sugawara, Ph.D.; Yasushi Ohkusa, Ph.D.; Tamano Matsui, M.D., Ph.D.; Takehito Saito, MSc; Kazuhiko Kanou, Ph.D.; Tomoe Shimada, M.D.; Hitomi Kinoshita, DVM, Ph.D.; Kazuyo Yamashita, Ph.D.; Yoshinori Yasui, M.D., Ph.D.; Yuki Tada, M.D., Ph.D.; Yoshio Mori, DVM, Ph.D.; Makoto Takeda, M.D., Ph.D.; Tomimasa Sunagawa, M.D., Ph.D.; and Kazunori Oishi, M.D., Ph.D. of Japan's National Institute of Infectious Diseases, along with Peter Strebel, M.D., Accelerated Control and Elimination of Vaccine Preventable Diseases, World Health Organization, W. William Schluter, M.D., Western Pacific Regional Office, WHO, Hajime Kamiya, M.D., Ph.D., of the Division of Bacterial Diseases, National Center for Immunizations and Respiratory Diseases, Susan E. Reef, M.D., Susan Y. Chu, Ph.D., and Rebecca Martin, Ph.D., Global Immunization Division, Center for Global Health, CDC.

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