1 Japan Pediatric Society, Japanese Society of Child Health, Japan Pediatric Association A written request for implementation of effective control measures of measles epidemics. Submitted to the Ministry of Health, Labor and Welfare in. , 2 Nakatani H

Sano T

Iuchi T Development of vaccination policy in Japan: current issues and policy directions. 3 Centers for Disease Control and Prevention Measles—United States 2000. Japan has been confronting the problems of uncontrolled measles for more than a decade now, and WHO has taken the initiative to eliminate measles worldwide. Despite these global efforts, however, measles is still endemic in Japan: there were an estimated 200 000 cases and 88 deaths (mainly in children) in 2000.But measles is not only a domestic problem. The US Centers for Disease Control and Prevention has reported that Japan is the country that exports measles to the USA most frequently.

Japan has contributed a great deal financially to the global movement to eliminate measles through the United Nation Children's Fund (UNICEF), and infant mortality in Japan is among the lowest in the world. Nevertheless, many Japanese children still die from a vaccine-preventable disease. Why is that?

4 Ueda K

Miyazaki C

Hidaka Y

Okada K

Kusuhara K

Kadoya R Aseptic meningitis caused by measles-mumps-rubella vaccine in Japan. The measles vaccine was first introduced in Japan in 1966, and the measles, mumps, and rubella (MMR) vaccine followed in 1989. Subsequently, in 1993, the MMR vaccine used in Japan was withdrawn owing to unexpectedly high rates of aseptic meningitis associated with the mumps Urabe AM 9 strain.In 1994, major changes were made to the country's immunisation law, such that all childhood immunisations were no longer mandatory. Individuals would be given “strong recommendations” to get the vaccine, but ultimately it would be their choice.

Since 1994, the Japanese government has played a very passive part in the formulation of vaccine policies, mainly because of strong public opposition to the reinforcement of mandatory vaccination. As a consequence, the general public has not been well educated on vaccine-preventable diseases and is not aware of the significance of those diseases. Measles vaccine coverage rates are lower than in other countries such as the USA, where domestic measles has been almost eliminated. Moreover, even though many countries have already implemented a two-dose regimen of measles vaccine, Japan has not. Until January, 2004, administration of measles vaccine was recommended between 12 and 24 months of age, instead of between 12 and 15 months when children have the greatest risk of contracting measles. There is no established system to check vaccination status on entry to the school systems.

5 de Quadros CA

Olive JC

Hersh AS

et al. Measles elimination in the Americas: evolving strategies. Strong political and social desire has to be inspired, and vigorous educational campaigns for policy makers and the general public are required. If there are clear strategies and prioritisation on vaccine policies, and a strong will to combat the disease, measles in Japan can be controlled. The great success of near elimination of measles on the American continents is strong encouragement.It is time for the Japanese government to regain leadership on this issue.