Aizu Wakamatsu Immunization Handbook

 

Children are exposed to a large variety of diseases. It is possible to take measures to protect them from these diseases and it is hoped that this handbook will provide the information necessary to help you be prepared for such eventualities.

Please check the following before going to receive immunizations

1.	Is your child in good condition?
2.	Do you fully understand each immunization?
3.	Do you have your Maternal & Child Health Handbook and Health Insurance Card with you?
4.	Have you completed the questionnaire in the Form (Coupon)?
Now you are ready!

 

Contents:
	1.	Introduction
	2.	What is a Vaccine?
	3.	Type of Vaccine
	4.	Immunization Schedule
	5.	Effectiveness of Immunizations
	6.	Side Effects
	7.	Checks before Receiving Vaccinations
	8.	About Receiving Immunization Today (1) Polio (2) DTP (3) Measles & Rubella (4) Japanese Encephalitis (5) Tuberculosis (BCG)
	9.	Other information

 

 

1. Introduction

 

Immunity against diseases passed from mother to child is lost naturally in the first three months after birth in the case of Whooping Cough, and after about twelve months in the case of Measles. Therefore, babies need to be immunized against many common diseases.

As children grow up and start to go outside of the home, chance of exposure to disease increases. With the correct understanding of immunization programs, full participation in the programs must continue in order to retain control over these diseases and to protect your child from them.

 

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2. What is a Vaccine?

When we catch a disease, we usually produce antibodies to the organism which caused the disease. The antibodies can recognize and inactivate the organism when we come into contact with it again. Vaccines are chemicals that teach our body's immune system to produce antibodies and identify certain potentially infective organisms even though we have never come into contact them.

 

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3. Type of Vaccine

Vaccines take two forms:

Live vaccines are produced by weakening the ability of the organism to cause disease while retaining its ability to develop immunity. Polio, Measles & Rubella, and BCG are all types of live vaccines.

Inactivated vaccines are produced by chemically killing or inactivating bacteria or viruses. The harmless bacteria or virus, when injected several times, stimulate the body to produce antibodies without the individual having to suffer the disease. DTP and Japanese Encephalitis are types of inactivated vaccines.

 

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4. Immunization Schedule

Immunization		Age Range	Availability	Method		Notes
Tuberculin (TB) reaction test BCG		3 months-6 months	Year-round	Group	One injection
DTP Trivax (Diphtheria, Whooping cough, Tetanus)		3 months-90 months (It is suggested that three initial injections in the 1st term be taken by 12 months)	Year-round	Individual	・Initial set at the First Term: Three injections at 3-8 weeks' intervals. ・Booster at the First Term: One injection 12- 18 months after initial injections.	Second Term: 6th grade of elementary school. (Bivax)
Polio		3 months-90 months (It is suggested that two vaccinations be finished by 18 months)	Spring Autumn	Group	One injection each in spring and autumn respectively
MR Bivax (Measles & Rubella)	1st Term	12 months-24 months who have not yet contracted Measles or/and Rubella	Year - round	Individual	One injection/each term
	2nd Term	Pre-school age (the last grade in kindergarten) who have not yet contracted Measles or/and Rubella
Measles		Children applicable for MR Bivax who have already contracted Rubella	Year-round	Individual
Rubella		Children applicable for MR Bivax who have already contracted Measles	Year - round	Individual
Japanese Encephalitis		・3 years - 90 months who wish to take the vaccination for reasons such as going overseas where Japanese Encephalitis is epidemic. ・Please contact Kenko zoshin Division if the child is applicable.	Year-round	Individual	・Initial set at the First Term: Two injections at 1-4 weeks' intervals. (Possibly 1-2 weeks' interval) ・Booster at the First Term: One injection about one year after initial two injections.	Second Term: 4th grade of elementary school

*Things to bring: Immunization Form (Coupon), Maternal and Child Health Handbook, Health Insurance Card for individual vaccinations
*According to the amendment of the Preventive Vaccination Law and the Tuberculosis Prevention Law, age range and methods are subject to change.

Vaccination Intervals

Please observe the following precautions with regard to intervals between various immunizations. This scale excludes urgent cases, such as needing to immediately move to a foreign country.

 

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5. Effectiveness of Immunizations

 

Although the purpose of vaccinations is to prevent contracting diseases, resistance (immunity) might not appear effective depending on the person's physical constitution or their condition on the day of vaccination. Tests to assess immunity to diseases are available for a fee. Inactivated vaccines require boosters at regular intervals as the resistance (immunity) will decrease if left as is.

 

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6. Side Effects

 

Some people become negative about immunizations when they hear there are side effects associated with these immunizations. Japan uses the most up-to-date vaccination technology available, which is thought to have fewer side effects. However, the physical constitution of each child differs and side effects might appear differently. Please read the following information about each vaccination s, and please consult with your family doctor (or the attending doctor at the group vaccination) whether the vaccination can be taken or not.

 

 

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7. Checks before Receiving Vaccinations

(1) General notice

Vaccinations will only be administered to people in good health. If you have concerns about your child, please consult your family doctor. The following points will ensure safe vaccinations:

[1]	Read the information about immunizations and make sure you understand the need for the vaccination and the possible side effects. Do not hesitate to ask a doctor to clarify any information.
[2]	Please ensure your child is in good health on the day of the vaccination. If your child has something out of the ordinary, wait for her/his recovery before getting the vaccination.
[3]	A parent or guardian who knows her/his medical history must accompany the children.
[4]	The questionnaire in the form (Coupon) asks for important information allowing the doctor to judge whether to give the inoculation. Please fill in the questionnaire completely.
[5]	Please be sure to bring the Maternal and Child Health Handbook and Health Insurance Card.
[6]	Please refrain from drinking and eating at the immunization place. (Both Group vaccination and Individual vaccination)
[7]	Please refrain from giving your child something to eat or drink within 30minutes before and after receiving the polio vaccination.

(2) Immunizations cannot be administered to:

[1]	Those who have a fever (more than 37.5).
[2]	Those who have an acute disease requiring medication.
[3]	Those who have an anaphylaxis reaction to the ingredients of the inoculation. Anaphylaxis is a severe allergic reaction within thirty minutes after immunization. The symptoms of which are perspiration, swelling on the face, nettle rash, nausea, vomiting, inability to speak and difficulty in breathing turning into whole-body shock.
[4]	When taking BCG, those who contracted tuberculosis in the past, or those who have keloid scars due to vaccination, injury etc.
[5]	Those who already contracted the disease they are to be vaccinated against, or who are contracting the disease when taking the vaccine.
[6]	Those who the doctor judges are unable to have the vaccination.

(3) Safety margins

[1]	Vaccinations should be taken more than four weeks after suffering from: Measles, Rubella, Chicken Pox, Mumps, Whooping cough, Influenza etc.
[2]	Vaccinations should be taken more than two weeks after suffering from: Roseola (Exanthema Subitum) and Hand, foot and mouth Syndrome, Erythema Infectiosum (Fifth disease), Herpangina, Infantile Gastro enteritis, infectious gastro enteritis etc.

(4) When to check with your doctor

If any of the following apply, please consult with your doctor before taking any vaccinations.

[1]	Those who have been treated for heart, liver, kidney or blood disease or growth problems etc.
[2]	Those who reacted to a previous vaccination with fever, rash or hives within two days.
[3]	Those who have ever had convulsions. If your child has reacted to a previous vaccine with convulsions or fever, please consult carefully with your doctor before proceeding with further immunizations. If the cause of the convulsions can be clearly identified it will be possible to administer vaccinations at a later date.
[4]	Those who have been diagnosed with immune deficiency or whose family or close relatives have immune deficiency.
[5]	Those who are allergic to the following ingredients of the vaccines: antigen (a component from eggs), antibiotics and stabilizers.
[6]	When taking BCG, those who have been exposed for a long period of time to TB contracted family members or those who are feared to have contracted tuberculosis in the past.
[7]	Those who had rash or became unwell after taking medication.
[8]	Those who feel the start of a cold.
[9]	Those who are surrounded by family members or friends suffering from Measles, Rubella, Mumps or Chicken Pox etc and who have not yet contracted it themselves.

(5) General matters that require attention after receiving the vaccination

[1]	Please observe your child's condition at the place for 30 minutes after receiving the vaccination and prepare to keep in touch with the doctor as acute side effects may occur at this time.
[2]	Reaction to a live vaccine might occur within 4 weeks, and reaction to an inactivated vaccine might appear within 1week after immunization.
[3]	Make sure that taking a bath does not interfere with the wound, and avoid rubbing the area where the vaccination was given.
[4]	It is okay to go about your normal routine on the day of vaccination. However hard exercise should be avoided.
[5]	Please consult the doctor immediately if the injected part of the skin appears to have an unusual reaction or if your child becomes unwell after the vaccination.

If you find matters you do not understand, please contact Kenko Zoshin-ka.

 

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8. About Receiving Immunizations Today

(1) Polio

Although until early 1960's there were repeated Polio epidemics in Japan, no natural infection has been reported presently owing to the effects of vaccination. Many countries are recognized to be free of polio as a disease. However, with the extent of international travel, it is important for people to remain immune, to prevent it spreading and causing an epidemic.
The poliovirus is spread through the feces of carriers. It reaches a throat or intestines through the mouth and infects them. The incubation period from infection is 3-35 days with the average being from 7-14 days. 5-10% of carriers develop cold symptoms and/or fever, headache, vomiting, labored breathing (dysphea). A serious condition causes paralysis (1 in 1000-2000) and there may be a lingering paralysis for life. Difficulty in breathing might cause death.

Vaccine

Polio vaccine is given by mouth to protect (immunize) against Polio (or Poliomyelitis). Three types of poliomyelitis virus (Types 1, 2 and 3) are included in the vaccine. The vaccine is given twice in order to ensure the uptake of protection against all three types of virus. The vaccine should not be given if the person is suffering from diarrhea and/or vomiting.

〔Side effects〕

The vaccine is attenuated and safe, but it retains its ability in the body and might reach the brain and spinal cord, which causes paralysis (1 in 4.5 million).
The virus is eliminated in the stool of the vaccinated after 15-37 days, and if this virus infects those who are not yet vaccinated (who don't have immunity against the Polio virus) or who have a low-level antibody titer, it may cause paralysis (1 in 5.5 million though its frequency is not steady). There is a public scheme to relieve sufferers from a secondary infection of Poliovirus.

 

(2) DTP

Diphtheria

Diphtheria is an acute and highly contagious airborne bacterial infection that mainly affects the nose and throat. A high fever, a sore throat, yelping cough, and vomiting are the early symptoms. Then toxin or poison, caused by the bacteria, can lead to a thick coating in the nose, throat, or airway. This coating can cause breathing problems and suffocation.
Diphtheria toxin also spreads through the bloodstream and can lead to potentially life-threatening complications affecting the heart, kidneys, and the central nervous system. Only about 10% of carriers of diphtheria show symptoms, therefore the virus may be passed on through potential carriers.
Since the DTP vaccination was introduced in 1981, there has been 0-1case of Diphtheria every year. However, it is important for people to remain immune because the possibility of an epidemic still remains as there was in Russia in early 1990's.

Whooping cough

The whooping cough vaccination program in Japan started in 1956. It has had a dramatic effect in reducing incidences of the disease.
Whooping cough is an airborne infection of the lungs with a bacterium known as Bordetella Pertussis.
It can start off like an ordinary cold with no high fever, but tends to worsen with periods of uncontrolled coughing. These are associated with a "whooping" noise during breathing in between bursts of coughing. These episodes frequently cause the small child to go blue and convulse. Sometimes whooping cough may be complicated by brain damage or fits or pneumonia. When the vaccination rate went down in the late 1970's, many serious cases appeared. In order not to repeat this incident, it is recommended that people be vaccinated.

Tetanus

Tetanus is the result of an infection that affects the muscles and nerves. It is usually due to a wound contaminated by its bacterium in the ground. It is common for people to catch it from a small wound that they ignore. The virus is found throughout Japan. Tetanus often begins with muscle spasms in the jaw, together with difficulty in swallowing, and stiffness or pain in muscles, and a serious case might result in death. If a mother is immune, then she passes that immunity on to her newborn.

Vaccine (DTP)

The DTP trivax, an inactivated vaccine, protects against diphtheria, tetanus (lockjaw), and pertussis (whooping cough). At the First Term the initial three vaccinations are given, and then one booster vaccination is given 12 to 18 months after the first series. At the Second Term a TD bivax booster is given when a child reaches the 6th grade at elementary school.
The DTP vaccination program has quite a specific time schedule. If for some reason the child has to miss one injection, do not repeat the course and please consult the family doctor.

〔Side effects〕

There are few side effects associated with this vaccine. Some recipients experience redness, slight swelling, and a lump in the area where the injection was given, but usually with no high fever. Even if no serious side effect appears, if the child becomes unwell or the swelling becomes serious, please consult a doctor.

Vaccine (DT)

Those who have contracted pertussis (whooping cough) before taking the DTP vaccination are given a DT bivax. At the First Term two vaccinations are given, and 12 to 18 months after the first series, a booster is given.

 

 

(3)Measles and Rubella

Measles

Measles happens predominantly in childhood, causing fever and rash and leading to a very ill child. It is an airborne virus that is highly infectious. The incubation period, from exposure to the first symptoms is between 9 and 11days. The time from exposure to the appearance of the rash is about 14 days. The early symptoms for 3-4 days are fever at around 38, then a small, misleading reduction, followed by an increased fever up to 39-40 again accompanied by a rash. The high fever calms down in 3-4 days, and the rash disappears. The rash marks tend to last for a while. Complications of measles include: Ear infections (7-9%), Bronchitis Pneumonia (1-6%), Encephalitis (2 in 1000), Death (1 in thousands), or serious brain complications called SSPE-Subacute sclerosis pan encephalitis (1 in 50,000). There is no epidemic of Measles in the countries where the vaccination rate is high.

Rubella

Rubella is a mild viral illness caused by the airborne rubella virus. The incubation period, from exposure to the appearance of the rash, is usually 14 to 21 days. It causes a mild feverish illness associated with a rash, and there are often some enlarged glands (lymph nodes), especially behind the ears and on the back of the head. Children are not usually affected too badly, and often the first manifestation is the rash. This is a fine, pink rash spreading from the forehead and face, downwards. The rash and fever may last for about 3 days. Rubella can lead on to encephalitis (1 in 6000 risk) and thrombopenic purupura (1in 3000 risk).

The consequences to the unborn child if a mother catches rubella during pregnancy are potentially serious. Children are likely to be born with a deformation of the heart, a cataract or ear problems. For this reason mothers are strongly encouraged to check up on their immunity to rubella before becoming pregnant.

Vaccine (MR)

The vaccine combines Measles and Rubella vaccines and is attenuated. A program of two-time vaccinations has been introduced since 2006. As many children get the measles or rubella between 1-2 years old, it is recommended that the first vaccination be taken as soon as the child turns one year old. The second vaccination is given to the child within one year before he/she enters elementary school. Even if a child has taken the conventional Measles vaccination and Rubella vaccination as the first vaccination, he/she can take MR bivax as the second vaccination. If a child has a gamma globulin injection, please consult the family doctor as to when the child should take the vaccination.

〔Side effects〕

4-14 days after the vaccination a fever or a rash may appear. Possible symptoms due to overreaction to the vaccination are a fever, and a rash or itching, but they tend to heal in 1-3 days.
Rare cases include anaphylaxis, thrombopenic purupura, encephalitis, convulsions, etc.

Vaccine (Measles)

The Measles vaccine is an attenuated live-vaccine. Those who have contracted Rubella before taking the MR vaccination can take the Measles vaccination.
If a child has a gamma globulin injection, please consult the family doctor as to when the child should take the vaccination.
The rate of causing a fever after the vaccination is relatively high. About 5.4% suffer from a fever at 37.5-38.4, and about 8% at higher than 38.5. About 5.9% have a rash identical to Measles. Usually it disappears in 1-2 days.
Serious problems are febrile convulsion (1 in 300), encephalitis/encephalosis (less than 1in 1-1.5 million), Subacute sclerosis pan encephalitis (SSPE) (0.5-1 in 1 million).

Vaccine (Rubella)

The Rubella vaccine is an attenuated live-vaccine. Those who have contracted Measles before taking the MR vaccination can take the Rubella vaccination.
If a child has a gamma globulin injection, please consult the family doctor as to when the child should take the vaccination.
Because it is a live vaccine, about 1.9 % of those who receive it suffer from a fever around 37.5-38.4, about 2.6% at higher than 38.5, and about 1.3% suffer rash or about 0.55 swollen glands. People don't contract the disease from the recipients.

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(4) Japanese Encephalitis

Japanese Encephalitis (JE) is a mosquito-borne viral encephalitis. There is a 7-10 day incubation period. Symptoms include high fever, headache, vomiting, disturbance of consciousness, convulsions, and can eventually lead on to acute encephalitis. The virus is present throughout Japan, except for some regions such as Hokkaido. It is associated with the existence of farm pigs among which the epidemic starts in June and lasts until October every year. During the epidemic 80% of pigs become infected. The number of infected infants and school children has decreased as the vaccination has become common, but there is still an epidemic mainly among people in middle age and over who haven't taken the vaccination.
The rate of suffering from encephalitis is 1in 1000-5000 and can result in death (15%), or problems with the nervous system (50%).

Vaccine (JE)

The vaccine is an inactivated-vaccine; carefully refined by inactivating the artificially propagated virus. And yet the possibility that impurities are traced in the vaccine cannot be completely denied.

〔Side effects〕

Side effects can include fever (over 37.5) in 1.9% of recipients, redness and swelling at the injection site (8.9%), or rash (1.0%).
An extremely rare case is acute diffuse encephalomyelitis (ADEM) in 1 in the 0.7-2 million vaccinated.
*The JE vaccination has not been actively recommended since 2005. Those who wish to take the vaccine for such reasons as going overseas where Japanese Encephalitis is epidemic can take the vaccination.

 

(5) BCG (Tuberculosis)

Although Tuberculosis (popularly known as TB) has considerably decreased in Japan, more than 30,000 people still become infected each year. Tuberculosis is contagious when it is airborne and can be inhaled by others. Children in general are not considered contagious, and usually acquire the infection from infected adults. Babies do not inherit immunity from their mother, and catching TB in early childhood can lead to serious complications such as systemic tuberculosis or tubercular meningitis, which may cause aftereffects in the future.

Vaccine

The BCG vaccine is an attenuated vaccine. The vaccination method uses a stamp-like injector against two areas of the skin in the upper arm. It must not be injected in other parts of the body because side effects such as keloid may appear.

〔Side effects〕

About 10 days after the vaccination, reddish spots appear in the injected area. This reaction may intensify about 4 weeks after the vaccination, and a scab forms over the part, but it disappears in 3 months and only a small scar may remain. This proves the child acquired immunity against BCG. If the injected part remains oozing more than 3 months after the injection, please consult a doctor. Mild side effects can include: swelling of lymph glands in the armpit on the same side of the injected part, accumulation of pus; peeling or scaling of the skin; or sores at places of injection. Please consult a doctor if you have any concerns.

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9. Other Information

(1) Reactions that usually appear

Type of reactions depends on the vaccine. Fever, redness/swelling at the injected site, stiffness, and rash appear at relatively high rate (several %-over 10%). (Please refer to the side effects after page 6.) As these symptoms will usually disappear within a couple of days, there is no need to be seriously concerned.

(2) Serious side effects

If, after receiving a vaccination, the injected area swells severely, the child suffers from high fever or has a convulsive fit, please consult your doctor immediately. If the reaction is particularly severe, please contact Kenko zoushin-ka.

 

 If you have any concerns about immunization, please contact:
Prevention Group (Yobo Group),
Health Improvement Division (Kenko zoushin-ka),
Aizu Wakamatsu City Hall
TEL: 39-1111 (Switchboard) Ext (naisen) 2452
39-1245 (Direct)

 

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Contact Information

• Kikaku Chosei-ka (Planning and Coordination Division of Aizu-Wakamatsu City Hall)
• TEL:[ 0242-39-1201 ]
• FAX:[ 0242-39-1400 ]
• Email: Kikaku Chosei-ka