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Abstract [Objectives] In Japan, infants ranging from 3 to 4 months of age were excluded from the stan-dard vaccination period for Bacillus Calmette-Guérin in 2013. The aim of this study was to evaluate the contri-bution of immunization methods and the means of communication employed by municipalities to inform the parents of infants about this revision on the shift in the immunization age. [Methods] In 35 municipalities, I assessed the monthly proportion of infants vaccinated between 3 and 4 months of age relative to all infants in 2013, in reference to the immunization method (group or individual immunization) and the application of two-way communication (TWC) between the municipalities and parents. The types of communication that were defi ned as TWC were as follows: home guidance and face-to-face explanation at the health examination for the infants. [Results] In most municipalities, the proportion of infants vaccinated between 3 and 4 months of age relative to all infants gradually decreased after following revision of the vaccination period. No signi-fi cant differences were observed in these proportions between the municipalities with group immunization and those with individual immunization; however, the variability of these proportions among the municipal-ities with group immunization increased with duration. In the municipalmunicipal-ities with individual immunization schedules, the application of TWC to parents promoted the decrease of infants vaccinated between 3 and 4 months of age, as compared to that seen in the other municipalities. [Conclusions] The municipalities with group immunization were characterized by variation in the shift of the immunization age. TWC with parents accelerated this shift in the municipalities with individual immunization.

Key words : Bacillus Calmette-Guérin, BCG, Vaccination, National immunization program, Group immu-nization, Individual immuimmu-nization, Communication

Child Health Center, Aichi Children’s Health and Medical Center, Aichi, Japan

あいち小児保健医療総合センター保健センター

Correspondence to : Kemal Sasaki, 7_426 Morioka, Obu-shi, Aichi 474_8710 Japan. (E-mail: kemal-s@umin.ac.jp)

連絡先：佐々木渓円，あいち小児保健医療総合センター保健セ ンター，〒 474_8710 愛知県大府市森岡町 7_426

(Received 18 Jan. 2016 / Accepted 28 Mar. 2016) Kekkaku Vol. 91, No. 7 : 561_567, 2016

−−−−−−−−Original Article−−−−−−−−

SHIFT IN THE BCG VACCINATION AGE REGARDING

THE 2013 REVISION OF

THE JAPANESE VACCINATION SCHEDULE

Kemal SASAKI

Introduction

 The Japanese national immunization program (JNIP) includes Bacillus Calmette-Guérin (BCG) vaccination as a regular vaccine, as the overall incidence of tuberculosis is higher than that observed in other developed countries1)2)_.

Although BCG vaccination decreased the tuberculosis incidence among Japanese infants, this vaccination in early infants rarely causes severe complications, such as osteo-myelitis3)_{. The JNIP has been regarded as delayed in}

comparison to similar programs in Western countries, which has limited the available combination vaccine delivered in early childhood4)_{. Finally, Haemophilus infl uenzae type b}

vaccine and pneumococcal conjugate vaccine were approved as separate regular vaccines in April 20135)_{. Due to this}

his-tory, some Japanese parents tend to hesitate to receive simul-taneous vaccination6)_{, and their infants thus have to be}

vac-cinated at short intervals. As a result of this situation, the revision of Order for Enforcement of the Preventive Vaccina-tion Law and the related Notice from Director-General were established in 2013 (revision 2013), which refers to the routine BCG vaccination schedule, as follows: the limit of months for regular vaccinations was expanded from 6 months to 1 year of age and the number of months of standard vac-cination was revised to between 5 and 8 months (formerly, between 3 and 6 months)5)7)_.

 In the JNIP, all municipalities implement an immunization plan for regular vaccines and individually determine whether they should provide group and/or individual immunization8)9)_.

The municipalities have the responsibility to provide adequate information about the immunization plan for citizens9)_{. As}

individual immunization provides parents with a higher degree of freedom to decide the day of immunization in comparison to group immunization, the related information has a greater

VNTR in Fukuoka Prefecture / A. Oishi et al. 577

Abstract [Aim] To determine genotypes of Mycobacterium

tuberculosis strains in Fukuoka Prefecture, Japan.

 [Methods] A total of 296 isolates from 296 tuberculosis patients is tested using 24-locus variable-number tandem-repeat (VNTR) typing. We also determined whether these isolates and a further 10 were Beijing lineage.

 [Results] The 296 isolates were classifi ed into 264 VNTR types, and re-classifi ed into 25 clusters when each cluster was defi ned as isolates being identical to VNTR types in 24 regions, or in 23 regions with the exception of one hypervariable region. Two clusters were shown to be identical to that of the Kansai regional epidemic. Regarding regional diversity, hypervariable regions showed relatively higher variation of isolate types. The Beijing lineage accounted for 78.1％ of all isolates, which was similar to the value obtained from Kobe (78.5％ in 2009) in the Kansai region.

 [Discussion] Six isolates from Fukuoka Prefecture over-lapped with those from Kansai region with respect to

domi-nant VNTR type, while clusters from Fukuoka Prefectural isolates were unique, which may be a feature of Fukuoka prefectural isolates.

 [Conclusion] These data are likely to be useful for public health measures in the area.

Key words : Mycobacterium tuberculosis, Variable-number tandem-repeat (VNTR), Molecular epidemiology, Beijing lineage

Department of Health Science, Fukuoka Institute of Health and Environmental Sciences

Correspondence to: Akira Oishi, Health Promotion Division, Fukuoka Prefectural Government, 7_7 Higashi-Koen, Hakata-ku, Fukuoka-shi, Fukuoka 812_8577 Japan.

(E-mail: ooishi-a9130@pref.fukuoka.lg.jp) −−−−−−−−Original Article−−−−−−−−

TYPING OF MYCOBACTERIUM TUBERCULOSIS STRAINS

IN FUKUOKA PREFECTURE, JAPAN,

USING 24-LOCUS VARIABLE-NUMBER TANDEM-REPEAT TYPING

Clinical Study of EBTB / T. Maekura et al. 583 14） 三木啓資, 横田総一郎, 平賀 通, 他：気管支結核症に 対するINH（イソニアジド）吸入療法の効果につい て. 日呼吸会誌. 1999 ; 37 : 31 35. 15） 村上真也, 渡辺洋宇, 小林弘明, 他：結核性気管支狭窄 の外科治療. 結核. 1986 ; 61 : 385 391. 16） 宮澤輝臣, 岩本康男, 宮津由香, 他：結核性気管気管支 狭 窄 に 対 す る 気 管 支 鏡 イ ン タ ー ベ ン シ ョ ン . 呼 吸 . 2003 ; 22 : 140 145.

Abstract [Background] Endobronchial tuberculosis (EBTB) is defi ned as a tuberculosis infection of the tracheobronchial tree and is often misdiagnosed as bronchial asthma or bron-chitis owing to a lack of typical imaging fi ndings.

 [Aim] The aim of this study was to elucidate the clinical characteristics of EBTB.

 [Method] We retrospectively studied EBTB patients hos-pitalized at the National Hospital Organization Kinki-chuo Chest Medical Center (Sakai City, Japan) between January 2005 and April 2014.

 [Result] A total of 29 patients (8 men and 21 women) were enrolled in this study. The patients’ ages ranged from 17 to 86 years. Cough was the most frequently reported symptom. The interval between the appearance of symptoms and an EBTB diagnosis was signifi cantly longer than usual when there was an initial misdiagnosis of bronchial asthma. The most frequent fi nding of fi ber-optic bronchoscopy performed after more than 1 month of treatment was a V-type scar based on Arai’s

classifi cation system.

 [Conclusion] A misdiagnosis of EBTB as bronchial asthma leads to a signifi cant delay in correct diagnosis and treat-ment. EBTB must be included in the differential diagnoses of chronic cough and airway constriction sound.

Key words : Tuberculosis, Endobronchial tuberculosis, Bron-choscopy, Bronchial asthma, Bronchostenosis

1_{Department of Internal Medicine,} 2_{Clinical Research Center,} 3_{Department of Surgery, National Hospital Organization}

Kinki-chuo Chest Medical Center

Correspondence to: Katsuhiro Suzuki, Department of Internal Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-shi, Osaka 591_8555 Japan. (E-mail: ksuzuki@kch.hosp.go.jp) −−−−−−−−Original Article−−−−−−−−

CLINICAL STUDY OF 29 CASES OF ENDOBRONCHIAL TUBERCULOSIS

1_{Toshiya MAEKURA,} 2_{Kazunari TSUYUGUCHI,} 1_{Yohei KIMURA,} 1_{Taro KOBA,} 1_{Shoko SONOBE,} 1_{Taisuke TSUJI,} 3_{Akihide MATSUMURA,} 1_{Seiji HAYASHI,}