New influenza What is the priority of vaccination?

The number of reports for each influenza fixed point of the 33rd week (10th - 16th in August) became 1.69. The majority were due to new influenza virus (A(H1N1)pdm), and it entered a real fashion period. How should the medical follower on the country, the provinces, and the site work on the influenza countermeasure now since a further fashion enlargement will be expected in the future?
It was a chief researcher of the National Institute of Infectious Diseases infectious disease information center until this June, and it explained the current state to the Touhoku University infection control and Mr. Keita, inspection diagnostics field lecturer Morikane to whom Minister of Health, Labour and Welfare Yoichi Masuzoe served as tela lingua "Advisory board of a new influenza".

 1.Trend of influenza fashion

The 32nd week (3rd - 9th in August) about will double this week of about 60,000 people, and about 110,000 person the 33rd week (10th - 16th in August) when the number of patients is guessed from the data of the influenza ocean weather ship observation of National Institute of Infectious Diseases. The number of patients to which the complete count is done until July 24 is 4986 people, and the number of patients of new influenzas has gone up by the 33rd week 200,000 people near when these are totaled. About 200,000 patients are generated on the week 34(17th - 23th in August) when assuming that this trend continues, and the number of presumption estimate patients is possible the perception of about 400,000 people in the future.

It is enumerated that the season changes as a raw material to make the fashion moderation predicted in autumn in summer, and an individual physical condition that has decreased because of summer heat etc. improves it though it is very difficult to guess the trend in the future. In autumn, the fashion that the seasonality influenza seen in Okinawa in recent years puts in summer in spring becomes small to some degree, too. On the other hand, it accounts for about 60 percent of the whole at the age of 5-19 when the number of patients of new influenzas is seen according to the age, and summer vacation ends, the risk of herd infection rises after the end of August that the school resumes, and the fashion enlargement is feared.

When share (strain) of a new influenza virus becomes popular, an old share is expelled sooner or later. Therefore, any certain thing cannot be said now though it is not amusing even if the seasonality influenza will be expelled to a new influenza this winter.  what fashion trend it becomes

 2.Priority subject of vaccination

There is the following two kinds of strategies of influenza prevention with the vaccine.
-      Individual defense
-      Win of herd immunity

An individual defense is an idea of giving priority over the high‐risk person with the influenza, inoculating, and preventing the deterioration into serious illness and the death. On the other hand, the herd immunity is an idea that aims to slow down the fashion as much as possible or to reduce the dimension of the fashion. Vaccination is given to priority by the person who has the pregnant woman, the infant, and the undorlying disease when seeing from the angle of an individual defense when new influenza this time, and vaccination is given to priority by the young in the point of the herd immunity.

This both are not exclusive in each other, and the latter also can indirectly decrease the occasion of the contraction of the high‐risk person, and, as a result, expect the effect that decreases the deterioration into serious illness and the death. However, it is necessary to stockpile an enough vaccine to the filling of two. U.S. Centers for Disease Control and Prevention (CDC) is provisionally calculating a number necessary to decrease "impact" and "spread" of a new influenza for about 100 million 6 thousand(half the number of the overall population of the United States)(CDC press release July 29, 2009 is seen). The priority subject that CDC recommends is as follows.
-      Pregnant woman
-      Person who lives to child of less than six months or is taking care of
-      Medical follower
-      Young of -24 year for six months
-      The person of the high‐risk of a new influenza according to the chronic case or the immunodeficiency by 25-64 years old.

In addition, CDC was assumed that only the vaccine of the limited quantity had the not available possibility in the initial stage, and, hereafter, assumed to be a priority subject of the Osono situation.
-      Pregnant woman
-      Person who lives to child of less than six months or is taking care of
-      Medical follower who receives patient directly
-      Infant of -4 year for six months
-      Young who has chronic case at age of 5-18

The vaccine of about 60 million is needed when assuming half of population as well as the United States though it is thought that the high‐risk person is less than the United States in Japan. However, the vaccines that can be produced within the year are made to 13 million-1700 Manmoto, stay in 3400 total Manmoto even if 2000 Manmoto can be imported, and it doesn't reach 6000 Manmoto. Therefore, I cannot help saying that it is current and it is impossible vaccination from both an individual defense and the herd immunity points. It is difficult to say that the affiliate carried out the argument though the opinion of the correct answer's there which it is necessary to value, and giving priority to an individual defense under the present situation is strong. Is because it is important to form the consensus after various data in respect like the medical treatment cost and cost-effectiveness, etc. is collected after all even if becoming the same conclusion, and the argument is piled up, it Hanai?

It was shown to connect with an optimal consequence to vaccinate to the adult of the assessment lingua situation, the school child, and 30-39 years old for five (death (deaths), infection (infections), biosis damage year Oshie (years of life lost), virtual assessment (contingent valuation), and health care cost (economic costs)) prior according to the research of the United States. The school child plays the main spread role of the influenza as the reason, and it is assumed that the parents become mediation to surroundings (ScienceXpress on August 20, 2009).

As for the first of the vaccine shipment, the start at about the end of October is scheduled. It is thought it is in time if it will be drawn a conclusion that it thinks about the supply and the system of inoculation of the vaccine by the end of September. Extra time is, and need not draw a conclusion to the rashness yet.

 3.System of vaccination

Outpatient's spurt is feared in the medical institution in the region when entering the real fashion period of a new influenza. The bewilderment is expected to happen on the medical treatment site when coming in succession to the vaccination of a new influenza there. There is a side reaction in the influenza vaccine for seasonality, and a polite clarification of this respect is indispensable. Especially, the inoculation of a new influenza vaccine is high the priority to the pregnant woman, and leaving guidance and the clarification to the obstetrics and gynecology not usually vaccinated is excessive the burden to the diagnosis and treatment. Therefore, it thinks vaccination to have to do in the institution of administration such as public health centers.

Next, there is a problem of voluntary inoculation or group inoculation. The problem of relating to the subject of the number of stockpiles and the vaccination of the vaccine, and this respect is requested to be discussed enough. It is reported that the senior citizen's excess death (excess death) increased after it discontinues it, and is (N Engl J Med. 2001;344(12):889-96.) in 1994 Japan worth ..care...  the group inoculation of the influenza vaccine to the school child

 4.Approach on clinical epidemiology

As for a new influenza, it risks, and a lot of unclear points like the effectiveness etc. of the effect, the side reaction, and Oseltamibil (full proprietary name Tami) of the vaccine have been left including the condition (risk factor etc. of the mortality and the deterioration into serious illness). The accumulation of those data is a pressing need when the future. It is likely to become then difficult work if it thinks greatly from three horn aspect of the outpatient, the inpatient, and the death case though holding a busy diagnosis and treatment though the valuable one for ..obtained information (formulation rate of full Tami and full Tami's formulation time and prognoses, etc.).. clinician in the outpatient first of all. An investigation at the public health center level and a clinical assessment are thought to be possible about the inpatient and the death case. I wonder whether it is Ichiho neither the capture to analyze information on each medical institution in some regions where the work of the country and administration these ,for instance, the fashion such as Okinawa Prefecture is active.

 5.Role that exoergic outpatient played

The exoergic outpatient is a system provided to treat the patient with a new influenza efficiently, and to reduce the occasion of the infection enlargement. There was a human human infection, and might have been a constant role at deterioration into serious illness Shite when the trouble from which the death case was seen went around newly. The problem is in the point that the switch of the system did not go smoothly when present new influenza A or less (H1N1) is understood that H5N1 or less assumed at first is a poison type. The government is enumerated as the reason and the enactment lingua is enumerated in shape "New influenza countermeasure action planning" in February this year. As a result, it has become difficult to take flexible correspondence according to the change though a new influenza is assumed to be a problem of the entire country and the capturing calositas is appreciable. Ministry of Health, Labour and Welfare first provided "Basic action policy" on May 1, and enabled flexible management corresponding to the facts of various places. This policy is revised on May 22 and June 19. As a result, it is expected that flexible correspondence that suits the situation can be done in the future.

 6.The country"What should be done now"

The difficulty that the country should discuss including the above-mentioned now at the end is brought together. The country decides a rough polarity because the system etc. of the medical treatment providing are different circumstances according to the region, and the detailed rule is thought to connect leaving to the autonomy in the region with the effective countermeasure.
-      Discontinuance of cluster surveillance
-      Discussion about vaccination object and method
-      Enrichment of medical practice epidemiology Freedom of Information Act
-      Problem concerning resource distribution(materials or employment cost etc. such as rapid diagnosis kits and face masks)

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