From recent readings and news reports, it seems as though vaccinating children is more of a choice given to parents here in the United States. In Japan where I was born, it is the law that every Japanese citizen is required to have certain vaccinations. There are a few interesting differences in how the two country’s carry out their vaccination procedure/requirements. I would like to put into perspective about the differences between the US and Japanese vaccination requirements.
Hepatitis B Vaccine (HepB):
HepB vaccine is only given to certain people in Japan. For instance, people who are eligible to receive HepB in Japan are either medical practitioner or infants whose mother responsed positively to Hepatitis B surface antigen. Different from Japan, most children in the US are vaccinated with HepB sometime during their primary education.
Diphtheria, Tetanus, and Pertussis Vaccine (DTP)
Diphtheria, Tetanus toxoid, and acelluar Pertussis vaccine (DTaP):
In the US, from 0-18 months, infants and toddlers receive 4 vaccinations (2, 4, 6, 15-18 months). Another time is at the age of 4-5 years old, and at 11-12 years old. After that, it is recommended that one receive the vaccination (aka booster shot) every 10 years.
In Japan, children are immunized 3 times. The first is when they are 3-12 months old. The second shot is at 12-18 months, and the last shot is at the age of 11 and only Diphtheria and Tetanus toxoid is given at this time.
Haemophilus Influenzae type B (Hib):
Hib disease was common bacterial meningitis in child under 5 years old. The word “Influenzae” came from back in 1892, there was pandemic of influenza. During the period, Germen bacteriologist Richard Pfeiffer found Bacillus influenzae. This RNA virus was considered the cause of influenza until 1933.[Kuhnert and Christensen]
Most children in the US are usually vaccinated 4 times. Vaccination occurs at the ages of 2, 4, 6-18 months, and 4-6 years old. In Japan however, this vaccination was given to Japanese children up until 2007. Now, the vaccination is optional and is dependent on the parent as to whether or not they would like their children vaccinated.
Polio Vaccine:
There are two different ways Polio vaccination was given, Oral polio vaccine (OPV) and inactivated poliovirus vaccine (IPV). OPV is known to be able to revert to a form that can achieve neurological infection and cause paralysis. In the US, after the year 2000, four vaccinations in the form of IPV are used for Polio vaccinations. In Japan, two vaccinations of OPV are used for Polio vaccinations.
Measles, Mumps, and Rubella (MMR) Vaccine:
In Japan, the MMR vaccine is no longer in use due to a series of health complications arising after receiving the Mumps vaccine. Since 2005, in place of the MMR vaccine, Measles and Rubella (MR) vaccine is mandatorily given. In addition, children are able to receive the Measles vaccine separate from the MR vaccine; but this is optional. In the US, Measles, Mumps, and Rubella vaccine with Varicella-zoster (Chickenpox) is still common.
Japanese encephalitis and Bacille de Calmette et Guérin (BCG) Vaccine:
In Japan, these vaccinations are mandatory. From my own experience, when I first came to the US, I had to get tested for tuberculosis by using the Mantoux test. Of course my result was positive. It was so hard to convince a doctor that I have received the BCG vaccination. There are a number of possible reasons that US is not giving Japanese encephalitis and BCG vaccinations. Both vaccinations have been proposed but none have been proven, and none can explain the lack of efficacy in both low TB burden country.
To sum it all up, it is quite interesting to see that there are some differences in how vaccinations are carried out in the US and Japan. Maybe one way worked better for an isolated island of a country, whereas the other method worked better for a larger country that is neighboring other countries. Since some of the vaccinations are mandatory in Japan, another interesting story I would like to share was when doctors and nurses from a public health department came to my elementary school to give out vaccinations. It was very random for the teacher to announce that a class was cancelled but actually, everyone in class had to head to the gym to receive a vaccination. Not only are certain vaccination requirements are different between the US and Japan, the delivery method is also a bit different in Japan as well.
Kuhnert P; Christensen H (editors). (2008). Pasteurellaceae: Biology, Genomics and Molecular Aspects. Caister Academic Press. ISBN 978-1-904455-34-9.
Centers for Disease Control and Prevention http://www.cdc.gov/vaccines/recs/schedules/default.htm
Infection Disease Surveillance Center
http://idsc.nih.go.jp/vaccine/dschedule.html
Naoko's post is very interesting, isn't it? There are large differences, and I wonder why. For example, hepatitis B is a predisposing risk factor for liver cancer, which is more common in East Asia, and yet the immunization coverage seems to be less than in the US, where liver cancer is relatively rare.
ReplyDeleteAlso note that they still use oral (live) polio vaccine, while in the US it was shown to cause more cases of vaccine-associated polio than it prevented (once natively-acquired polio had been eliminated), so its use was discontinued. Maybe the risk of imported polio is greater in Japan.
It is interesting to see the differences in the vaccination schedules of Japan and the US. The point that I find most interesting is the Japanese Encephalitis (JE) vaccine. The vaccine is mandatory in Japan, Taiwan, and I think China because JE circulates in these areas. The vaccine is not given in the US because we don’t naturally have JE; in fact JE is a select agent in the US. Vaccines are only given to travelers if they are going to an area where JE circulates for longer than a month or if they plan on going into rural areas and lab workers who may be exposed. There are two vaccines that can be given JE-VAX (the only one approved for children) and Ixiaro. I received the JE-VAX vaccine (I worked at the CDC with JE) it was a series of three subcutaneous shots spread over a month, and a booster is normally needed after two years. The vaccine can be very expensive; costs can range from $450 to $1,000. The cost probably discourages people from getting the vaccine unless they really need it, I was lucky, mine was paid for by CDC. What is the vaccine schedule in Japan for JE?
ReplyDeleteThis is really interesting post. I wonder what the ramifications of more abundant boosters have on the total disease prevalence in the country. Could we be over vaccinating (by means of boosters) if the Japanese show similar protection against these diseases? I think it would be ultimately interesting to see on a global scale (since I imagine there would be a whole spectrum of required vaccines) how widespread these diseases are relative to the mandate of the vaccine administration. I'm sure this would probably be a very hard study given that diseases are more prevalent in certain places. I still think it would be really interesting to see if anyone knows if there are any studies out there.
ReplyDeleteI agree that this is a very interesting contrast in the vaccination schedules of the two countries. Not that I want to fuel the "anti-vaccine" fire, but maybe there is evidence for less frequent vaccination here in the US; it would be interesting to see studies regarding the variations, if any, in the levels of protection provided to differently vaccinated populations. I think Joseph's point about the difficulty of studying the prevalence of disease amongst different areas is valid, but couldn't, and haven't, they studied the amount of antibody present in the serum of populations immunized on different schedules (as far as boosters go?)?
ReplyDeleteI found out interesting fact about Japanese Encephalitis (JE) vaccine. (thank you Shirstine great comment) Since it is mandatory to take a JE vaccine in Japan, a cost of vaccination is free. Now I really appreciate for Japanese government!! The children are scheduled to receive JE vaccine; 1st vaccination between 6-90 months (people usually take it 3 years old), 2nd shot year after 1st shot, 3rd one when they are 9 years old. I remember the random JE vaccine announcement when I was in 3rd grade. Between 1975-1991, NIH in Japan reported that in some year, there were more than 50 JE cases in a year. However, since 1992, there were less than 10 cases n a year. No one has been reported by August in this year.
ReplyDeleteAlso, I found that in 1960, there was polio out break in Japan. Almost 6500 people had polio. Most of them were found in Kyushu (southern island in Japan) After Japanese government imported 1.3 millions vaccinations from old Soviet Union and Canada, it was reduced to less than 100 cases in 1963. City of Kobe reported there are some cases of Poilo in a year, 4% of vaccinated people usually shows symptom like cold, less than 0.1% gets vaccine-associated polio.
I wish I were able to find actually number of people who have received vaccine preventable diseases in Japan and the US. So I would be able to give better picture of differences in countries.