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Original Article
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Volume 344:889-896 March 22, 2001 Number 12
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The Japanese Experience with Vaccinating Schoolchildren against Influenza
Thomas A. Reichert, Ph.D., M.D., Norio Sugaya, M.D., David S. Fedson, M.D., W. Paul Glezen, M.D., Lone Simonsen, Ph.D., and Masato Tashiro, M.D., Ph.D.

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ABSTRACT

Background Influenza epidemics lead to increased mortality, principally among elderly persons and others at high risk, and in most developed countries, influenza-control efforts focus on the vaccination of this group. Japan, however, once based its policy for the control of influenza on the vaccination of schoolchildren. From 1962 to 1987, most Japanese schoolchildren were vaccinated against influenza. For more than a decade, vaccination was mandatory, but the laws were relaxed in 1987 and repealed in 1994; subsequently, vaccination rates dropped to low levels. When most schoolchildren were vaccinated, it is possible that herd immunity against influenza was achieved in Japan. If this was the case, both the incidence of influenza and mortality attributed to influenza should have been reduced among older persons.

Methods We analyzed the monthly rates of death from all causes and death attributed to pneumonia and influenza, as well as census data and statistics on the rates of vaccination for both Japan and the United States from 1949 through 1998. For each winter, we estimated the number of deaths per month in excess of a base-line level, defined as the average death rate in November.

Results The excess mortality from pneumonia and influenza and that from all causes were highly correlated in each country. In the United States, these rates were nearly constant over time. With the initiation of the vaccination program for schoolchildren in Japan, excess mortality rates dropped from values three to four times those in the United States to values similar to those in the United States. The vaccination of Japanese children prevented about 37,000 to 49,000 deaths per year, or about 1 death for every 420 children vaccinated. As the vaccination of schoolchildren was discontinued, the excess mortality rates in Japan increased.

Conclusions The effect of influenza on mortality is much greater in Japan than in the United States and can be measured about equally well in terms of deaths from all causes and deaths attributed to pneumonia or influenza. Vaccinating schoolchildren against influenza provides protection and reduces mortality from influenza among older persons.


Source Information

From Becton Dickinson and Entropy Limited, Upper Saddle River, N.J. (T.A.R.); the Department of Pediatrics, Nippon Kokan Hospital, Kawasaki, Japan (N.S.); Aventis Pasteur–MSD, Lyons, France (D.S.F.); the Influenza Research Center, Baylor College of Medicine, Houston (W.P.G.); the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (L.S.); and the National Institute of Infectious Diseases, Tokyo, Japan (M.T.).

Address reprint requests to Dr. Reichert at 262 W. Saddle River Rd., Upper Saddle River, NJ 07458, or at doctom_us{at}yahoo.com.

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