Jpn. J. Infect. Dis., 54, 2001

Laboratory and Epidemiology Communications

Autism and Infection/Immunization Episodes in Japan
Hiroshi Takahashi*, SatoruArai, Keiko Tanaka‑Taya and Nobuhiko Okabe
lnfectious Disease Surveillance Center; National Institute of Infectious Diseases,
Toyama 1‑23‑1, Shinjuku‑ku, Tokyo 162‑8640

Communicated by Nobuhiko Okabe(Accepted May 1, 2001)

immunization has been reported since the 1970S. Tanoue etrubella (MMR) vaccinatiPn in autism has been raised (1‑3)･The MMR vaccine was lntrOduced in 1989 in Japan. The

The possible association of autism with infection oral. reported, on the basis of their birth cohort, that the births

vaccination program was unsuccessful on account of theof autistic children were more frequent among those bom inhigher incidence of the associated aseptlC menlngltlS, and, in

April‑June, and that more frequent bronchitis/pneumonia

1 993, the Ministry of Health and Welfare dissuaded continu‑
ation ofMMR vaccination (10)･ In 198911992, 2･2 million
doses of MMR vacclne and 3.0 million doses ofmonovalent

hospitalization occu汀ed when a higher prevalence of autistic

children was re?orded (4)･ Kawashima et al･ reported thatmeasles vaccine (MMV) were distributed in Japan ( 1 I). The
sale ofMMR and MMV vaccines and its relationship to thethree of nine autlStic children bom in United Kingdom werepositive for measles H gene as determined by RT‑PCR (5).
The prevalence of autism in Japan during the 1 980s was 5‑reported prevalence of autism in Japan is shown in Fig. 1.

16 per 10,000, and 2日in 1996 (7)･ This apparent inFrease

Kawashima et al. claimed that the symptoms developed soonof autism in 1996 was difficult to interpret, because lt may

after MMR vaccination in the mgority of autistic cases (5)･

have been due to the recent improved screenlng ln routine

Tanoue et al. reported 90% of autlStic children are diagnosed

health checkups, the existence of atyplCal or "temporary"by the age oreight (4).

autism and other pervasive developmental disorders (e.g.,

The 1988/89‑birth cohort received approximately l.3

DSM III, ⅠⅠⅠ‑良, IV) (8), or increased awareness of highmillion doses ofMMR vaccine and 1.7 million doses ofMMV

function autism (i.e., IQ>70) (6). No conclusion has yet been

vaccine. A case‑Control study of this population will be ofobtained (9).

value for elucidating a possible relation between autism andMore recently,the possibleinvolvement of mumps‑measles‑

the vaccination. It should be noted, however, that a matched

5.0(Hoshino,'82)13.8(Tanoue,'88)
16.0(ⅠSⅠlii,'83) 劔3.0(Sugiyama,'89)21.I(Honda,'96

SaSOPuOニ!u田MMR
田MMVl白181 8283

鳴l

鳴848586ii8788

鳴89

鳴鳴l909192鳴鳴9394l｢9596l唯I

9798

9900

year

MMR: mumps‑measles‑rubella vaccine
MMV: monovalent measles va(:cineFig･ I I Measles vaccine sales and reported prcvalencc ofautismper 10,000, 198 1‑2000, Japan.
*Corresponding author: Fax: +8 1 ‑3‑5285‑ 1 1 29, E‑mail: hiroshit@nih.gojp

78

Laboratory and Epidemiology Communications

Tertian Malaria Outbreak Three Decades after its Eradication
Dimitar Vutchev *Departmen i ofParasitology and TTropical Medicine,National Center of lnfectious and Parasitic Diseases,
26, Y Sakazov BIvd., 1504 Sojia, Bulgaria

Communicated by Takuro Endo

(Accepted May 1, 2001)

In the past, Bulgaria, situated in Southeastem Europe, hasdiagnosed as having lmpOrted malaria caused mainly bybeen heavily affected by malaria known as "thracian fever"

Plasmodium vivax and P･falclbarum and at a lesser frequency(1). The highest incidence rate‑2066% (144,632 cases)‑wasby P. ovale and P. malariae (3,4).

recorded in 1 946. Conventional anti‑epidemic actions have

For the first time after the malaria eradication in 1995‑

been coordinated since 1 955 through the strategy of the World
Health Organization (WHO). Since 1 962, a diminishment of

1996, Some cases have been fわund in southeast Bulgaria, near

the border with Greece and Macedonia‑18 local cases of

the number of the autochthonous cases has been achieved,

tertian malaria ofP. vivax. In August 1995, eight cases ofand in 1 965 the WHO announced the eradication of the local

malaria were found, and three cases more in September. The

malaria (2). In the following years, cases of imported malaria

sick people range in the age from 5‑60 years, and are residents

by Bulgarian and forelgn People from endemic countries haveof fわur rural areas in the neighborhood of the town of Sandanski,

been recognized, e.g., nine lethal cases from malignant

situated in the valley of the Stmma river. The climate of thismalaria. During the period 1965‑2000, 2,850 people have been

reglOn is strongly influenced by the Mediterranean Sea, andhas been highly hyperendemic in the past, with the malaria*Corresponding author: Tel: +35912‑43471, Fax: +359‑2‑943‑

and its vector, Anopheles macullbennis seasons lastlng from
April to October. Most probably the orlgln Of the parasite

3075, E‑mail: ncipd@ncipd.netbg.com

79