ReviewRecent progress and concerns regarding the Japanese immunization program: Addressing the “vaccine gap”
Introduction
Recent progress in the immunization program of Japan has begun to close the “vaccine gap,” a term used during the last two decades to refer to the deficiencies of that program relative to programs in other developed countries [1]. Seven new vaccines (12 new products, excluding influenza vaccines) have been introduced in Japan since 2008 (Table 1): a Haemophilus influenzae type b (Hib) vaccine, 7- and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13), rotavirus vaccines (monovalent [RV1] and heptavalent [RV5]), human papillomavirus (HPV) vaccines (bivalent [HPV2] and quadrivalent [HPV4]), an inactivated Salk-derived polio virus vaccine (wIPV), diphtheria, tetanus toxoid, acellular pertussis, and inactivated Sabin-derived polio vaccines (DTaP-sIPV, 2 products), and inactivated Vero cell-derived Japanese encephalitis vaccines (JE, 2 products). Among them, after licensure, the wIPV, DTaP-sIPV, and JE vaccines were introduced to the National Immunization Program (NIP) as routine immunizations to replace the oral polio vaccine, DTaP, and inactivated mouse brain-derived JE vaccine, respectively. In January 2011, a temporary national budget was created to support the costs of the Hib, PCV7, and HPV vaccines, and they have been included in the NIP since April 2013. Later, PCV7 was uneventfully replaced by PCV13 in November 2013. Five of the seven vaccines (8 of the 12 products) are produced in foreign countries, which is a new development in the licensing and support of imported vaccines in Japan.
Vaccine availability is improving, recognition of vaccine-preventable diseases (VPD) is increasing, and more vaccines are now included in the NIP; however, some concerns remain regarding immunization, which indicates that the current Japanese immunization system needs further improvement. The Japanese rubella epidemic in 2012–2013, which mainly affected adults [2], resulted in more than 40 cases of congenital rubella syndrome, as of March 2014. Most of the people who developed rubella were men aged 20–40 years, as this group had not received the rubella vaccine during their youth [3]. Vaccination rates among the susceptible population remain low because catch-up vaccines for targeted individuals are categorized as voluntary and are an out-of-pocket expense. Many local governments offered financial support for vaccines in targeted populations, which increased vaccination rates. However, the shortage of vaccines developed after the demand increased for rubella vaccine and measles and rubella (MR) vaccine. Another important problem is that, due to reports of more than 30 cases of chronic pain syndrome, the government temporarily withdrew its active recommendation for HPV vaccines, beginning in June 2013. Unsurprisingly, immunization rates for HPV vaccines decreased sharply due to fears that the vaccines might cause adverse reactions/events.
In this review, we summarize recent progress and discuss current concerns regarding the Japanese immunization program.
Section snippets
Revision of the immunization law
In April 2013, the Japanese Immunization Law underwent major revision. The most important changes were (1) the inclusion of three new vaccines (the Hib, PCV7, and HPV vaccines) in the NIP and continuing discussion of including the remaining important vaccines in the NIP, (2) further government financial support for immunization, (3) changes in the timing of Bacille de Calmette et Guérin (BCG) vaccination, (4) establishment of a new committee for national immunization policy, (5) legislative
Current concerns
Although there has been substantial progress in the Japanese immunization program, some important concerns remain.
Acknowledgment
We would like to thank David Kipler for editing this manuscript.
References (28)
- et al.
Current issues with the immunization program in Japan: can we fill the “vaccine gap”?
Vaccine
(2012) - et al.
Causes of a nationwide rubella outbreak in Japan, 2012–2013
J Infect
(2014) - et al.
Live vaccine used to prevent the spread of varicella in children in hospital
Lancet
(1974) - et al.
Bacillus Calmette–Guerin (BCG) complications associated with primary immunodeficiency diseases
J Infect
(2012) - et al.
Leadership in immunization: the relevance to Japan of the U.S.A. experience of the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP)
Vaccine
(2009) - et al.
Aseptic meningitis caused by measles–mumps–rubella vaccine in Japan
Lancet
(1995) - et al.
Macrophagic myofasciitis: an emerging entity. Groupe d’Etudes et Recherche sur les Maladies Musculaires Acquises et Dysimmunitaires (GERMMAD) de l’Association Francaise contre les Myopathies (AFM)
Lancet
(1998) - et al.
Is there an association between psychological factors and the Complex Regional Pain Syndrome type 1 (CRPS1) in adults? A systematic review
Pain
(2009) - et al.
Human papillomavirus vaccine introduction—the first five years
Vaccine
(2012) Varicella vaccination in Japan: necessity of implementing a routine vaccination program
J Infect Chemother
(2013)
Varicella zoster exposure on paediatric wards between 2000 and 2007: safe and effective post-exposure prophylaxis with oral aciclovir
J Hosp Infect
Nationwide rubella epidemic—Japan, 2013
MMWR Morb Mortal Wkly Rep
Effectiveness of introduction of Haemophilus influenzae type b vaccine and 7-valent conjugate pneumococcal vaccines on invasive bacterial diseases
Infect Agents Surveill Rep
Cited by (49)
Factors associated with knowledges and attitudes about measles and rubella immunization in a non-health care occupational setting in Japan
2021, Journal of Infection and ChemotherapyComparison of virological and serological methods for laboratory confirmation of rubella
2020, Journal of Clinical Virology