Infectious
Diseases &Campus Life

1100
(n)

1,106

2013・HIV carriers

1000

900

C O N T E N T S● HIV/AIDS knowledge● Prevention of Sexually
Transmitted Infections● Infection Control Abroad● Caution regarding Tuberculosis● Infectious Diseases andRecommended Vaccinations

Basic HIV/AIDS Knowledge
1――●

In Japan, 1106 people were
newly infected with HIV in 2013
(1060 men and 46 women); 71%of the infections occurred due tohomosexual intercourse and 18%
due to heterosexual intercourse.
However, there might be an
unknown number of people
infected with HIV. In addition,
484 people had new-onset AIDS
with typical symptoms in 2013.
Safe sex using condoms is the
only way to prevent sexuallytransmitted HIV infections.

Globally, there are 35,000,000 people
with AIDS or as HIV carriers, and2,100,000 people are newly infectedwith HIV every year; therefore, this isa public health issue.
➡ English
About HIV/AIDS

800

700

600

500

484

2013・AIDS patients
400

Change in the number of
HIV carriers and
AIDS patients
Newly diagnosed HIV carriers

300

Newly diagnosed AIDS patients

Who said that the“AIDS era had ended”?

Free sex is dangerous !
The risk of HIV infection is increasing.
1985

1990

1995

Data from Ministry of Welfare, Health and Labor, Japan

2000

2005

2010

2015

(year)

200

100

0

1

2
Basic HIV/AIDS Knowledge――●➡ English

HIV infection and proliferation――

If you have suspicious event,

AMDA International Medical Information
Center: Telephone Consultation in English

HIV infection/AIDS results inimmunodeficiency and a high risk of
detrimental effects on health.
HIV infection/AIDS results inimmunodeficiency.
HIV transmitted via blood or semen into
the body damages the helper T cells,
which have a primary role in the immune
system. Then, genetic information forwhat will you do?

Please consult the
Health Administration Center.

HIV is inserted into the helper T cell
genes. Owing to helper T cell activity, HIVproliferates, exits the helper T cells, andis inserted into other helper T cells. As aresult, HIV gradually damages the immune
system.

HIV Infection――-Natural Course of HIV without Therapy1200➡ English

SHARE: Telephone
Consultation on Medical Careprimary infection

death

HIV tests at the
public health center.

108

1100

107

900
800

106

700

105

600
500

Serum Virus Volume

Helper Tcells ( /ｍｍ³)

1000

If you think that it is possible that you are
infected with HIV or have a sexuallytransmitted disease, do not hesitate to visit
the Health Administration Center foradvice from medical professionals. Of
course, your confidentially will beprotected, and medical professionals will
provide appropriate suggestions based onyour school life.

If you suspect an HIV infection, schedule
a free and confidential HIV test by callinga public health center. The test requires
only 5 mL blood. Tests for other sexuallytransmitted diseases might also be
available. Do not hesitate to contact the
public health center.

104

400

An examination should bescheduled 2 months after
the possible transmission of
infection.
HIV antibodies are tested for at the publichealth center, and it takes 4–8 weeks for
the HIV antibody titer to increase after
the transmission of infection (“window
period”). During this time, it can be difficult
to achieve an accurate result. Therefore, anantibody test should be conducted at least
2 months after possible infection.

Do not use a blood donation
as an opportunity to test for HIV.
During the window period, the test could
be negative even if you are infected,
and HIV could be transmitted throughyour blood if it used for therapy. A blood
donation is not an opportunity to test forHIV, and the HIV test results will not beprovided to the donor.

300

103

200
100
0

0

3

6

9

12
1
← weeks years →Early phase of infection(Acute phase: 0–3 months)

Early phase of infection(Acute phase: 0–3 months)

Three to 6 weeks after infection
with HIV, symptoms similar to
those of the common cold areobserved. Internally, HIV-infected
helper T cells produce
considerable amounts of HIV, andthe number of helper T cells
dramatically decreases. However,the number of helper T cells
normalizes to 1000/mm3 after aperiod of time, and this becomesthe normal level; this is theasymptomatic period. The ability
for HIV to transmit is very high
4–8 weeks after HIV infection
because the patient has a highamount of HIV but does notproduce HIV antibodies.

2

2

3

4

5

6

Asymptomatic period

Asymptomatic period
Approximately 12 weeks after
infection, the immune systemdecreases the HIV titer, and thesymptoms disappear, as in healthypeople. The asymptomatic period
continues approximately ≤10years, without therapy. However,HIV proliferates and can betransmitted to other people, evenduring the asymptomatic period,
and the number of helper T cells
continues to decrease.

＊ compromised infection: With aweakened immune system, patientsare susceptible to infectious diseases
caused by very weak bacteria that
could not cause disease onset with anormal immune system.

7

8

9

10

11

102

AIDS onset

AIDS onset
When the number of helper T cells
in the blood decreases to <200/
mm 3, a slight fever and generalfatigue occur. Then, immunity is
destroyed, the volume of HIV
increases, and the ability for HIV
to be transmitted increases. As acompromised host, infections＊such as pneumocystis pneumonia
or cytomegalovirus retinitis orcancers such as Kaposi’s sarcoma
or malignant lymphoma canoccur, and the patient will
eventually die. It takes
approximately 10–12 years from
infection to death in the natural
course of AIDS. However, owing
to the developments in therapy,
the duration between infection
and onset or onset and death isbecoming dramatically longer.

Organizations (Tel or web sites) where you can get information● Home pages of organizations in theprivate sector● API - Net:
http://api-net.jfap.or.jp/● Life AIDS Project (LAP)
http://www.lap.jp/● AIDS prevention groups and victim
support groups● Positive Living And Community
Empowerment TOKYO
Care service and consultation● Japan HIV Center
Support for people who are suffering from
AIDS-related prejudice or discrimination
Tel : 03-5259-0622 (Tokyo)
06-6393-8851 (Kansai)● Japan AIDS & Society Association
Research and information exchange on AIDS
Tel : 03-6279-3094● Tokyo HIV/telephone counseling
Tel : 03-3292-9090● NPO OCCUR
Comprehensive support group for gays andlesbians
Tel : 03-3383-5556● NPO AMDA International Medical
Information Center
Offering telephone-based medical
information in English
Tel : 03-5285-8088 (Tokyo)
06-4395-0555 (Kansai)● Services from the Health in Asian & African
Regions
Medical consultation service in English
Tel : 03-5807-7581● PHJ
Japanese branch of an internationalorganization for medical aid
Tel : 0422-52-5507

31
Prevention of Sexually1 Transmitted Infectio ns (STI)――●For Men――

For Women――

It is easier to detect STIs
when men urinate.
① The most common STI ischlamydia.

There are currently no symptoms.
However, signs of chlamydia infection can
include a whitish transparent secretionfrom the male genitals or pain/itching
during urination.
● Examination and therapy
The Department of Urology diagnoses
chlamydia based not only on a physicalexamination but also on tests of urine/
endothelial cells from the urine duct.
Standard therapy involves continuous
administration of antibiotics for 14 days.

② The more obvious symptomsof gonorrhea make detection
easier.

Light itching or heat is felt in the urinary
tract 3–7 days after infection withgonorrhea. Mucus, followed by whitish,
turbid pus, is excreted with urine. Pain orheat will also be felt.
● Examination and therapy
The diagnosis is based on the detection ofgonorrhea in urine, mucus, or pus from theurine duct. Standard therapy involves oral
or intravenous administration of
antibiotics. It takes almost 2 weeks for acure, which should be confirmed by a
medical professional. If the therapy isinappropriately discontinued, thegonorrhea infection can easily become
chronic or recurrent.

③ The issue with genital herpes.

Infection is transmitted by mucus
containing the herpes virus. A week after
infection, small blisters appear on theforeskin and top of the penis; when the4➡ English

Sexually Transmitted Diseases

It is harder for women
to feel the malaise．

blister breaks open, a thin ulcer develops.
Then, sharp pain, fever, headache, andexhaustion occur for approximately 3
weeks. Genital herpes can easily recur
because the herpes virus persists inneurons; recurrence is triggered byexternal injury, fever, sex, or mental stress.
● Examination and therapy
Herpes is diagnosed based on a blood test.
Anti-viral medication is effective for
symptom control, but cannot kill the virus
completely. It is important to avoid
transmission to others when recurrence istriggered by physical or mental stress.

④ Tell your partner andget treated together.

It is easier to detect infection in men
because of the obvious symptoms. When
you are diagnosed with an STI, you shouldtell your partner and advise him/her to visit
the clinic/hospital. It is important toprevent infection of others.

*STIs
Syphilis, condyloma acuminatum,
trichomoniasis, candidiasis, scabies,
pubic lice, and viral hepatitis arealso STIs.

① Women have very slight
symptoms witha chlamydia infection.
Therefore, women who have had sexualintercourse should ask to be tested forchlamydia during a gynecology
appointment. Some public health services
also perform the test.
● Examination and therapy
Samples from the cervix are examined.
Standard therapy involves oral
administration of antibiotics for 14 days.

② Gonorrhea can be transmitted
through oral sex.
STIs can be transmitted through any
location with a membrane. Therefore,
gonorrhea can be transmitted by sexual
contact (genitalia, oral, anal) through themembranes. Because the symptoms areslight in women, it is more difficult to
detect gonorrhea. Polyuria or pain withurination can be a sign of cystitis induced
by gonorrhea.
● Examination and therapy
For diagnosis, samples from the vagina or
cervix are tested. Standard therapy
involves oral administration of antibiotics
for 2 weeks. Gonorrhea can easily become
recurrent or chronic if the medication isceased earlier than recommended. It is
important to have a cure confirmed by adoctor.

③ Genital herpes is an STI
that recurs.
When a woman is infected with genital
herpes through her partner’s semen, small
blisters appear in the genital area within 1
week of infection. After the blister breaks
open, a thin ulcer grows, followed by sharp
pain, fever, headache, and exhaustion for 3
weeks. Then, recurrence can be caused bystimuli such as external injury, fever,
menstruation, sex, and mental stress.
● Examination and therapy
Diagnosis is based on analysis of blood
samples. Although anti-viral medication iseffective, it will not completely kill theherpes virus. It is important to prevent
infecting others; therefore, causes ofrecurrence should be avoided, such as
injury, fever, sex, and mental stress.

④ Do not neglect eventhe slightest signs.
If you do not do anything after you are
infected, inflammation will spread fromthe uterus to the oviduct/ovary glands. The
risk of sterility, miscarriage, or extrauterine
pregnancy increases. In addition, newborn
babies can become infected and develop
serious pneumonia, eye disease, or brain
damage.

5

2Prevention of Sexually Transmitted Infectio ns (STI)――●➡ English

Drug Abuse

Absolutely
No Drugs!

The pill is only for birth control.
It is a mistake to think that the pill (oralcontraceptives) prevents sexual diseases
including AIDS. The pill is only for birthcontrol and is totally useless against the
AIDS virus. The AIDS virus is transmitted
through the mucous membranes of sexualorgans, semen, and vaginal fluid. Because
the pill cannot prevent physical contact, itcannot prevent the transmission of AIDS.
Condoms can prevent direct physicalcontact of mucous membranes and semen

or vaginal fluid; therefore, they are
effective in preventing AIDS as well as
pregnancy. However, condoms are
effective only if they are worn from thestart of the sexual contact. To avoid tears
or slipping off, remove the air the air of tip
so that the condom will fit tightly on themale penis. In other words, wear itcorrectly to make sure the condom iseffective.

The use of illegal drugs is becoming
increasingly common among university
students. Simplistic ideas such as “drugs help
you lose weight” or “drugs are good for sex”
pique young adults’ interest in using thesesubstances. Illegal drugs are extremely
addictive, and are related to crime,
unprotected sex, and therefore sexualtransmitted infections (STIs) such as HIV/AIDS.
Recently, there has been an increase in socalled “loophole drugs” that are easily
obtained through the internet. However,these drugs contain illegal compounds suchas stimulants, so they have now come to be
known as “dangerous drugs.” Let’s look atillegal drugs in more depth.

● Cannabis
Gateway drug

How to use condom● Push any air outof the tip. If air gets
inside, the pressure
can cause tearing.

● Observe the expiration date;after this point, the quality candecline, and it can tear easily.
● Press it firmly
with your hands all
the way down.

● After ejaculation,
keep it from falling
off and pull it off.

6

● Vaseline or oil can damage thematerial. Use water-soluble
lubricants instead.

Within a few minutes of taking cannabis, you
begin to feel “high.” You also feel relaxed,
euphoric, and more talkative (loquacious),but you also experience cramps. Your
perception begins to change, colors appear
more vivid, sounds seem louder, and time
feels as though it is moving slowly. However,continuous usage of cannabis induces apathy
for study/work, and a high risk of accidents.
Cannabis abuse raises tolerance of the drug,
which thereby increases the amount of
cannabis needed to achieve the same high.
Cannabis is a highly addictive drug because it
does have noticeable side-effects
immediately after stopping cannabis abuse.
Cannabis is referred to as a gateway drug,
because its abuse brings users into contact
with people who use other illegal drugs,
making these drugs easy to access.

● Cocaine

Very dangerous narcotic drug
Cocaine stimulates the central nervous
system and induces feelings of pleasure andeuphoria immediately upon ingestion; theseeffects fade quickly because cocaine-induced
biotransformation is very fast. Cocaine entails
high risks, and leads to social problems
such as crime, deep debt, and bankruptcy.
Cocaine can lead to failure in many aspectsof life. This is because it decreases brain
metabolism, which may induce various
mental symptoms, such as sleeplessness andhallucination/delusion; nervous symptoms
such as headache and convulsion; and various
physical symptoms including cardiovascular,
respiratory, or gastrointestinal problems. The
opportunities to use cocaine are growing as
people are increasingly able to travel abroad
for study or training. Even “casual” use of

cocaine can ruin your life, so its use should
be avoided at all costs.

● Amphetamine

Strong and dangerous stimulant
drugs
Amphetamine abuse releases users fromboredom and malaise, and quickly brings
about pleasant feelings and euphoria.
Therefore, Amphetamine abuse quickly
becomes habitual, eventually resulting in
addiction—a state in which the user cannot
do without the Amphetamine. These drugs
have toxic effects on the mental condition,
which can induce various psychotic
symptoms. Amphetamine are water-soluble
and odorless white powders, which areeasily absorbed through the mouth, skin,veins, and via inhalation. Inhalation ofheated Amphetamine smoke increases
serum concentration of the Amphetamine,
which is absorbed through the pulmonary
alveolus. Amphetamine poisoning entails
schizophrenia-like symptoms such as
d e r an g e m e nt o f e g o. and depressive
symptoms such as mood disorders. Even
after quitting stimulants, long-term abuse
can lead to flashbacks of psychotic
symptoms induced by a small amount ofAmphetamine or alcohol intake at a future
point in time. Avoid being in the presenceof Amphetamine, and do not be fooled into
thinking that just using them once will beokay.

● MDMA

Strong effects on psychiatric andnervous system
MDMA, which is often called “ecstasy,”
stimulates the production of serotonin in
the brain. This induces feelings of euphoria,
affection for others, and hallucinations.
Hallucinations from MDMA are weaker thanthose from other hallucinogens, such as
LSD; however, the ongoing feelings ofrelaxation and euphoria that continue after
the hallucination can hold the user
spellbound. The drug-induced release ofhigh amounts of serotonin over a long
period of time and damages
neurotransmitters, which in turn decreases
mental activity and causes a decline inbodily mobility. In addition, damage toserotonin-producing neuron cells bringabout mental disorders such as sleep
disturbance, serious anxiety disorders, anddelusions. Therefore, MDMA is also a very
dangerous drug.

7

Infection control abroad➡ English

Traveler’s HealthNotable infectious diseases when traveling abroad．
infectionroutedrink /
food

insect /animalvectordiseasemain symptoms
diarrhea like water in which rice has been
washed, vomiting, dehydration○

shigellosis
fever up, left lower abdominal pain, diarrhea,(bacillary dysentery) bloody mucous stool

bad sanitation area—

typhoid abdominalis high fever up, relative slow pulse, rose rash

Asia, Africa,
Latin America—

hepatitis A

jaundice subsequently common cold symptoms, Asia, East Europe, Africa
general fatigue
Latin America○

hepatitis E

same as hepatitis A, however more serious

Asia, North Africa, Mexico—

malariafever up with a chill, muscle pain, headacheanopheles

Asia, Oceania, Africa,
Latin America—

yellow fever

fever up with a chill, headache,jaundice,bloody stool, hematemesis
aedes aegypti

Latin America, Africa

dengue fever

sudden fever up, headache, eye pain,
muscle pain, eruption
aedes aegypti, aedes albopictus

Southeast Asia, West Pacific
Ocean, Africa, Latin America, East
Mediterranean Sea

west nile fevercommonly asymptomatic, sudden high fever
culex pipiens pallens, aedes albopictus
fever up, headache, vomit, consciousness disorderjapanese encephalitis culex tritaeniorhynchus

Asia, Africa
Africa, Middle East, Central Asia,
West Asia, Europe, Far East Russia,
North America
Asia, West Pacific Ocean

○
—
—
—

○

plagueSwelling and pain of Lymph nodes,
blood spot in skin, high fever up
flea in rodents including squirrels and rats

Madagascar, Africa, The USA
southwest, South America, Asia—

rabiesever up, dysesthesia in bite injury, Hydrophobia,
hypersensitive for wind or light, confusiondog, raccoon, fox, batworld wide except Japan,
United Kingdom, Australia,
New Zealand, Sweden○

The USA southwest,
Canada, Latin America—

fever up, cough, dyspnea

Southeast Asia, China,
Egypt

—

difficult in opening mouth, dysphoria,
dysuria(urinary disturbance), body muscle rigidity

Asia, Africa,
South America○

The USA southwest,
Latin America—

Africa—Africa, Asia, Middle East,
East Europe—

hantavirus pulmonary fever up, muscle pain, progressive dyspnea
syndrome(HPS)ratavian influenza (AI) chicken, duck, goosetetanuscold-or pneumoniae-like symptoms,
coccidioidomycosis common
erythema, ulcer formation based on woundebola hemorrhagic high fever up, vomit, diarrhea, gingival andblood /
nasal bleeding
fever (EHF)
body fluid
crimean-congo
similar to EHF
hemorrhagic fever

Don’t drink tap water

In developing countries, most tap water iscontaminated. It is recommended that you
drink boiled or bottled water. You should
buy water at supermarkets or convenience
stores in order to be more sure of its origin.
Bottled, carbonated/sparkling mineralwater may be better because it is difficult
to create imitations. Be wary of water thatis served at hotel restaurants. Also, be
careful of ice, juice with ice, ice candy, andice cream because it you cannot be certain
if the original water is contaminated.
● How to disinfect water
If you cannot obtain bottled water, boil
clear water for at least one minute andthen leave it for 2–3 minutes after turning
off the heater. This method will kill mostbacteria and viruses. If you cannot boil
water, please use a disinfectant agent anda filter before drinking the water.

Caution――❷

Avoid dangerous food
Similar to the situation concerning water,
you should be prepared for foodcontamination in developing countries.
Have your meals at the hotel or a tourist
restaurant, as these generally havemoderate sanitary conditions. Please selectsufficiently heated food, not cooled food,salad, or insufficiently heated meat or fish.
It is better to avoid having food from street
vender’s stalls because the food at thesestalls is often raw. Pay attention to dairy
products, since these are very likely to havea bacterial contamination. Boil milk before
drinking it. Don’t add milk when you drink
coffee or tea.

opportunistic infection
after long incubation period—

genital tumor, lymph nodes swelling
genital ulcer, rush—Caution――❸

gonorrhea

micturition pain, erosion or pus ofexternal urethral orifice—chlamydia

asymptomatic, mild micturition pain or
discomfort—

Thorough measures torepel mosquitoes

genitalherpes

genital itching and pain, ulcer witheruption of blistering—

hepatitis B

similar to hepatitis A, chronic course—

sexualAIDSintercourse
syphilis8

vaccination

Asia, Africa

choleraup, joint pain, eruption
chikungunya fever fever
aedes aegypti, aedes albopictus

water /
soil

high risk area

Caution――❶

yellow fever mosquito or Nettaishimaka),
anti-mosquito measures are important inregard to infection control. To avoid
mosquito bites, wear long sleeves and use
bug spray (moth-proofing spray) or cream.
Bug spray works even if you spray it on
clothes. At bedtime, use moth-proofing
spray and burn mosquito incense inside
the room. Mosquito mats are alsoa v a i l a b l e . In a r e a s w h e r e m a l a r i a i sprevalent, the use of bed nets is also aneffective measure.
● Be cautious of animals
Zoonotic infections exist, so be mindful of
your contact with animals. Avian influenza
induces a high fever and cough, thendyspnea and multiple organ failure. Thisdisease has a high mortality rate. It istransmitted by contact with infected birds
or inhalation of droppings. In countries
where the disease is prevalent, it isdangerous to visit bird markets, farms, orslaughterhouses.
Rabies is transmitted by wild animals,
including dogs, raccoons, and vampire
bats. Once clinical signs have onset, rabies
has an almost 100% mortality rate. In areasof high prevalence, keep away fromanimals, including pets and livestock. If
you get bitten, immediately wash theaffected area with running water and soap
and visit a medical facility as soon as
possible to receive a rabies vaccination.
Continuous vaccination after a bite injury,
five to six rabies shots, can suppress theonset of rabies.
Plague is transmitted by fleas that live as
parasites on rats and squirrels. This disease
is found in South America, Western China,
India, Madagascar, East Africa, and in themountains of the Southwestern U.S. In
prevalent areas, don’t feed or touchrodents. Plague is a disease with a highmortality rate if appropriate therapy is not
administered at an early phase.

Malaria, one of the world’s top three major
infectious diseases, is carried by Anopheles(shimadaraka) mosquitoes. Since dengue
fever is also carried by Aedes aegypti (the9Caution regarding tuberculosis
In Japan, the previous high rate ofmortality associated with tuberculosis
supported its status as “an incurable
disease.” After World War II, with thedecrease in the mortality rate, theprevalence of tuberculosis was considered
to be stable. However, the incidence oftuberculosis began to increase in 1997,
and a Declaration of a State of Emergency
Concerning Tuberculosis was declared by
the Japanese Minister of Health andWelfare in 1997. Then, the number ofpatients began to decrease. However,tuberculosis is now considered a
reemerging infectious disease, with
>20,000 new-onset cases per year and>2,000 deaths per year. Given theincreasing percentage of the young
generation without immunity totuberculosis, mass infections have also
been increasing. Therefore, you shouldhave basic knowledge of tuberculosis andits prevention. In particular, people with
HIV infection are at high risk of tuberculosis
infection owing to decreased immune
defenses.

Tuberculosis infection
and onset➡ English

Tuberculosis Telephone
Consultation Service➡ English

stop TB

When a patient with positive infectivity is
encountered on campus.
An interferon-γ release assay (IGRA)
examination is performed first.

Chest radiography
Patients with positive IGRA results should
undergo chest radiography. Patients withobvious symptoms such as cough andsneezing should immediately undergo
chest radiography before the IGRA results
are available.

Special health checks for people who had
contact with the patient also include an IGRA
exam and QuantiFERON and T-spot blood
tests.

IGRA examination● Establishment of infection(unapparent infection):tubercle bacilli enter the bodyand colonize → immune
mechanism is activated

Tuberculosis infection is not
the same as disease onset.

suspicious
symptoms

positive

negative

before result● Immune cells suppress the
tubercle bacilli:
tubercle bacilli surrounded byimmunocytes

10-15%● Onset:when the immune
defense is insufficient,
onset occurs.

● Spontaneous cure:a scar or calcification
remains at the area ofan immune reaction

Not all patients experience infectivity, withpositive and negative infectivity occurring.

10

Negative infectivity

Positive infectivity

When the patient’s sneezing contains notubercle bacilli, the patient cannot infectothers.

If the patient’s sn e e z i n g contains
numerous tubercle bacilli, the patient
can infect others. Approximately twomonths of therapy are typically sufficient
to result in negative sneezing results fortubercle bacilli; however, admission for
2–3 months is sometimes required.

annual healthcheckchest X-ray

latenttuberculosis
infection(LTBI)

onset

therapy with
INH

therapy with
first-line drugs

Newly diagnosed patients shouldbe immediately admitted to a
medical institution.

Newly diagnosed patients who are
identified during a special health checkshould be referred to a specialist of
tuberculosis therapy. Patients with latenttuberculosis infection, who have a positive
IGRA result but no symptoms, should also
be referred to a specialist and provided
anti-tuberculosis therapy in the form of
isoniazid for 6–9 months, which is effectivefor >10 years.

Therapy and daily life
Latent tuberculosis infection(LTBI) is
treated with isoniazid(INH) as preventive
treatment for 6 to 9 months, which effectlasts at least 10 years. During the period of
medication, the following are important:● Consume adequate nutrition● Get adequate rest and avoid overwork● Avoid tobacco and alcohol use

11

1
Infectious Diseases and Recommended Va ccinations ――●● Measles

The main symptoms of measles include ahigh fever and eruptions, and it canbecome pandemic without vaccination. In
Japan, the percentage of measles
vaccinations for the 1-year-old population
decreased after 1994. Recently, the onsetof measles in those over 15 years old has
been increasing.
Therefore, after June 2, 2006, two measles
and rubella (MR) vaccination systems werestarted: the first shot was administered at 1
year old, and the second shot wasadministered at 5–7 years old.
*Recently, the booster effect (whencontact with the real virus after vaccination
strengthens one’s immune defense) has
become very important. Consequently,
two MR vaccination systems were initiated.

● Rubella

Rubella is prevalent among elementary
school students, and it presents as
eruptions. Rubella infection after the
teenage years is associated with serious
symptoms and a high frequency ofarthritis. If a pregnant woman becomes
infected with rubella within 16 weeks ofpregnancy, the infant will also become
infected and have congenital rubella
syndrome with congenital heart disease,hearing disturbance, and cataracts.
To prevent rubella, a live vaccine is used.
Therefore, when young woman get the
rubella vaccination, they must use anticontraceptives starting 1 month before to
2 months after receiving the vaccination.
In Japan, the rubella vaccination wasprovided for all junior high school female
students from 1977 to 1994. In 1994, thetarget of the rubella vaccination changed
to boys and girls 12–90 months old.
Therefore, the rubella vaccination rate
among the generation born from April
1979 to October 1987 decreased, causing
nation-wide epidemic in 2013 among thisgeneration.

12

mother/child book
When woman is diagnosed her pregnancy,
City Hall provides them with a mother/child book. In this book, the mother’s andbaby’s health conditions and histories ofvaccination are recorded. If you are unsureof your vaccination history, please refer toyour book for this information. → See p16.

● Mumps

The mumps present with swelling of themaxillary glands and sometimes
meningitis, a hearing disability, testitis, andovaritis. To prevent the mumps, a live
vaccine is administered. Meningitis is apotential side reaction of the mumps
vaccination, and since it became a serious
problem, routine vaccination was
discontinued by the Japanese Ministry of
Health and Welfare. Therefore, it has beenvery difficult to prevent an outbreak of themumps, since more than 90% of children
have to have the mumps vaccination
around 1 year old to prevent an outbreak.

● Diphtheria

Since the main pathological foci ofdiphtheria are the pharynx and larynx,
hoarseness and a cough-like barking are its
main symptoms, and sometimes
laryngectomy is required because ofdyspnea. The toxoid vaccine is used toprevent diphtheria; usually the diphtheria,
pertussis, and tetanus (DPT) or diphtheria
and tetanus vaccination is administered.

● Pertussis

Pertussis is a respiratory disease induced
by Bordetella pertussis. In adults, a coughcontinues for more than 2 weeks, andvomiting and whoop- or whistle-likebreath sounds after coughing are typicalsymptoms. The strength and number ofcoughs gradually decrease within 2–4
weeks, and coughing disappears within
1–3 months. The DPT vaccination isprovided; however, after many years, thebenefits of the vaccination decrease.
Recently, cases of pertussis have been
increasing among university students.

● Tetanus

Clostridium tetani exists in soil worldwide
as a spore, which is hardy against heat anddryness. It is contracted through various
wounds and infections. A tetanus infection
induces serious symptoms in neurons andmuscles similar to convulsions. When you
have an injury, you should visit a clinic or
hospital to get a tetanus toxoid
vaccination. A tetanus vaccine is also
recommended before travel andperforming fieldwork.

● Chickenpox (Varicella Virus)

Varicella is transmitted by droplet andairborne infection, and it is establishedwhen the virus invades the throat mucosa.
The infection is also established by directcontact with a wet eruption before it forms
a crust. Eighty percent of the population
contracts the varicella infection before 5
years old, and anyone can acquire
permanent immunity to varicella. It always
presents with a serious condition in adultcases, so it is recommended that persons
who have never been infected withvaricella get the vaccination. Painful skinblisters in a belt-like fashion along then e r ve, i. e. , h e r p e s zos te r, ap p ear in➡ English

Adult Vaccination

immuno-compromised patients understress who have been infected by varicellabefore and reactivated.

● Typhoid

Typhoid is an oral infectious disease, and it
is prevalent in Asia, Africa, and middle
South America. Its main symptom is a highfever, and sometimes rose spots appear on
the chest or abdomen. If therapy isdelayed, intestinal perforation can occur,causing it to be a fatal disease. The vaccine
is not approved by the Pharmaceuticals
and Medical Devices Agency (PMDA) in
Japan. Its effect last 2–3 years.

● Hepatitis A

Hepatitis A is also an oral infectious
disease, and it is prevalent in Asia, Africa,
and middle South America. In Japan, it iscommonly contracted after eating raw
clams. When you visit a developing
country for more than 1 month, boiling thewater and washing your hands regularly
are important, and vaccination is strongly
recommended for the Japanese
population under 50 years old to get thevaccination since many of them do nothave immunity to hepatitis A. Vaccinationis required at least twice at intervals of 2–4
weeks. If you will be visiting a developing
country for more than 6 months, anadditional vaccination is recommended
after 24 weeks, and then immunity tohepatitis A will last for more than 5 years.

HIV Vaccine
Vaccines work by making antibodies
that are specific for the outer sheathof a virus. Since the outer sheath of
HIV changes very frequently, it is very
difficult to make an HIV vaccine. Thisis the most important factor
preventing the development of an
HIV vaccine.

132
Infectious Diseases and Recommended Vaccinations ――●

In the past, diarrhea resembling water left
over from washing rice was said to be themain symptom of cholera; however,currently, rare and varied symptoms such assoft stool and watery diarrhea are morecommon.
In cholera prevalent areas, such as SouthEast Asia, South Asia, and Africa, you should
avoid consuming unboiled water, ice, andraw seafood.
An inactivated vaccine is used for cholera
immunization. For adults over 13 years old,the vaccine is taken twice at a 5–7 day
14● Japanese Encephalitis

Japanese encephalitis is transmitted bymosquitos that have bitten infected pigs. It
is a very serious infectious disease with ahigh mortality rate. In the past, vaccination
was provided in three doses; however, toprevent serious side reac tions, a new
vaccine was introduced in 2010.

● Influenza

In Japan, several million people are infectedwith influenza every year and several
hundred people die. Influenza is● Routine immunization Calendar:

20

19

18

17

16

15

14

13

12

11

10

9

8

7

6

5

4

3

2

9

1

M

Ye

on

ar

s

th

s

Based on the routine immunization schedule from the National Institute of Infectious Diseases (NIID) (October 1, 2014)

6

Polio is transmitted from contaminatedfood and drinks; however, the virus issterilized through heating. Although there
were several outbreaks from poliomyelitis
in the 1960s, the introduction of the Salk
vaccine brought poliomyelitis completely
under control in developed countries.
However, it is still present in South Asia, theMiddle East, and Africa. Polio sometimes
leads to paralysis. A live vaccine waspreviously used for prevention, but aninactivated polio vaccine (IPV) was
introduced in 2012.

The vaccine for HPV, which leads to cervicalcancer and condylomata acuminate, hasbeen provided by public health services inJapan. However, this vaccine has beenreported to have side reactions, and it isbetter to understand the risks and benefits
before vaccination. Currently, a
Haemophilus influenzae b (Hib) vaccine anda Streptococcus pneumoniae vaccine areprovided as part of routine immunization.
However, vaccines for dengue fever andmalaria, which are transmitted bymosquitos, have not yet been developed.

Tuberculosis is transmitted by an air-borne
infection. It takes 6–8 weeks after
contagion for symptoms to develop andmore than 4 months for complete onset.

3● Poliomyelitis(epidemic poliomyelitis)● Others● Tuberculosis

DPT-IPV

Routine Vaccination● Cholera

Yellow fever is transmitted by mosquitos.
Early phase symptoms resemble thecommon cold and gradually become more
severe including nasal and gum bleedingand jaundice. Yellow fever mortality is very
high (more than 50% among tourists), but alive vaccine is used for prevention. The
vaccine is effective for 10 years, and healthofficials recommend obtaining avaccination at a quarantine office or theJapanese Quarantine Association in Tokyo.
All visitors to the endemic area and tourist
by way of endemic area, the certification of
vaccination (a yellow card) is required.

Preventive Vaccination Law

Once onset of rabies is complete, 100% of
those infected with this terrible disease die.
Symptoms in the early phase resemble thecommon cold. Later, pain around the site of
the animal bite and muscle spasms develop,
followed by abnormal tetanus that is
induced by cold air or from seeing water.
Although rabies was eradiated in Japanthrough dog vaccination and countermeasures against animal importation, manycases of infection exist worldwide. In
addition, rabies is transmitted through bites
not only from dogs but also from foxes,
raccoons, and bats. If you will travel to Asia,
Africa, or Middle/South America, rabies
vaccinations are recommended.

● Yellow fever

The tuberculosis onset peaks within 2 years
after contagion, but the risk of onset lasts
for a lifetime because tubercle bacilli arelatent in the body for life. In Japan, the BCG
vaccination is provided as the standard
universal vaccine for children aged 5–8
months old.

transmitted by droplets or through directcontact. An inactivated vaccine is used forprevention. Because vaccination isrecommended for elderly people, it has
been supported by the public funding since2001. Therefore, those who have a cardiac
or chronic lung disease, diabetes mellitus,
an immunodeficient condition, or are
engaged in medical and nursing careservices are also advised to get vaccinated.
However, the vaccine’s effects lasts lessthan a year; therefore, you should get a
vaccine every year before the high season(October to November).
In 2009, H1N1 was prevalent among
Japanese universities. In 2013, avian
influenza(H7N9) was prevalent in China.

rth● Rabies

interval and lasts for 6 months. If an
additional vaccine is received within the
6-month period, the duration will be
prolonged for an additional 6 months.

2

In the past, many people became infectedwith hepatitis B through blood transfusions;however, strict regulations has since been
established and no cases of infection byblood transfusion exist. However, infection
through sexual intercourse can still occur
and can develop into chronic hepatitis B .
Sometimes, one percent of acute hepatitis
B develops into fulminant hepatitis, which
is fatal. Therefore, the hepatitis B vaccine ishighly recommended for people at highrisk: those who will stay in high-prevalence
areas, family members of a virus carrier,
medical professionals, and baby of virus
carrier woman. Unfortunately, a hepatitis C
vaccine has not yet been developed.

Bi● Hepatitis B➡ English

Immunization Schedule, JapanDT
BCG
PhaseⅠ

PhaseⅡ

MR
VaricellaPhaseⅠ

Japanese
encephalitis

PhaseⅡ

Hib

Pneumococcal
HPVStandard schedule

Range of recommended ages

Vaccination

15

Immunization Records
Please have your immunization records with you.
You can find your records in your “motherand-baby notebook,” which includes your
medical and welfare records. These records
are very valuable for infection control on

campus, and are very important for issuingthe “Certificate of Immunization” prior to
studying abroad.

Immunization Records
times

date and year

hospital/clinic

company

Lot

１

DPT

Ⅰ

Regular Vaccination

D（Diphtheria）
P（whooping cough）
T（Tetanus）
Ⅱ

２
３
４
５

BCG
MR

１

M（Measles）
R（Rubella）

Japanese
encephalitis

Acute poliomyelitis
Recommended Immunization.

Varicella
Mumps
Hepatitis B

２

Ⅰ
Ⅱ

１
２
３
４
１
２
１
２
１
２
１
２
３
１

Hepatitis A

２
３

Influenza
Tuberculin skin test
Japanese version is produced by Japanese NationalUniversity Council of Health Administration Facilities,
Special Committee of Infectious Diseases and AIDS.
Isao Nakano (Nagoya Institute of Technology)
Hisamitsu Baba (Kobe University)
Reiko Uruma (Chiba University)
Hiroshi Kamano (Kagawa University)
Hideki Kishikawa (Kumamoto University)

Seiichi Kitani (Tokyo University of Marine Science and Technology)
Masae Haga (Hokkaido University of Education)
Fumio Imazeki (Chiba University)
English versions is translated by Mayumi Yamamoto (Gifu University)©2015 Special Committee of Infectious Diseases and AIDS.

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