- Email: [email protected]
Symposium report of the 17th annual meeting of the Japanese Society for Vaccinology, 2013
G Model
ARTICLE IN PRESS
JVAC-16960; No. of Pages 2
Vaccine xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Symposium report of the 17th annual meeting of the Japanese Society for Vaccinology, 2013 Bacterial vaccines: Effectiveness and issues
tuberculosis greatly varies among regions in Japan; thus, indication criteria for and timing of BCG should be reconsidered [6].
Keywords:
2. Effectiveness and issues of Hib vaccine and PCV in children
BCG vaccine Hib vaccine Pneumococcal conjugate vaccine Pneumococcal polysaccharide vaccine Acellular pertussis vaccine Japan
Among protective immunizations, bacterial vaccines in Japan differ from those in foreign countries. While the Bacille CalmetteGuerin (BCG) vaccine is administered only to high-risk children in the United States, it is routinely immunized for all children in Japan. Conjugate vaccines are highly effective in preventing invasive bacterial infections in children; however, the Haemophilus influenzae type b (Hib) vaccine was introduced in Japan 20 years after its introduction in Europe and the United States, and the pneumococcal conjugate vaccine (PCV) was 10 years after their introduction. The rate of immunization with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) among elderly people was also much lower in Japan than those in the other countries. A high incidence of pertussis in adolescents and adults is a global issue. The acellular pertussis vaccine currently and widely used in advanced nations was developed in Japan in 1981. A symposium titled “Effectiveness and issues of bacterial vaccines” was held at the 17th annual meeting of the Japanese Society for Vaccinology, which took place from November 30 to December 1, 2013 in Tsu City, Mie prefecture, Japan.
1. BCG vaccine administration in Japan and overseas The BCG vaccine has an 80-year history and remains one of the most widely used vaccines in the world [1]. There are various data on its efficacy, particularly in preventing severe disseminated infection such as tuberculous meningitis in infants [2]. However, it is believed that there is a limitation in preventing initial tuberculous infection and onset of tuberculosis. In the United States, the BCG vaccine is administered to individuals whose family members suffer from tuberculosis and high-risk children such as immigrants from the foreign countries where tuberculosis is prevalent [3]. In Japan, on the other hand, the vaccine is administered as a routine immunization to all children for the reason that Japan has a medium prevalence of tuberculosis (approximately 18 patients per 100,000 population) [4]. Currently, the standard immunization period is from 5 to 8 months of age [5]. Adverse reactions of BCG vaccine include osteitis, osteomyelitis, and regional lymph node swelling [1]. Although recombinant vaccines are currently under development, the incidence of
A Health and Labour Sciences Research Study group has conducted active surveillance on invasive bacterial infections in children in 10 prefectures in Japan since 2007. A prospective notifiable disease survey was conducted to monitor the incidences of invasive Hib infection and invasive pneumococcal diseases (IPD) for 5 years from 2008 to 2012, corresponding to vaccine pre- and post-introduction periods. The number of patients with meningitis and other invasive infections caused by the two bacteria markedly decreased in the <5-year age group, demonstrating the effectiveness of these vaccines. Forthcoming challenges regarding serotype replacement were also pointed out in Japan. This reported issues were similar to those observed in other countries where these vaccines were introduced earlier than in Japan [7–13]. There were increased cases of IPD caused by Streptococcus pneumoniae serotype 19A, which is not contained in the 7-valent PCV (PCV7), underscoring the potential for serotype replacement. Although this type of serotype replacement has not been reported in H. influenzae, encapsulated strains other than serotype b and non-typable (non-encapsulated) H. influenzae (NTHi) should be monitored.
3. Pneumococcal infection and preventative vaccination in adults Pneumonia is the third leading cause of death in Japan. The mortality rate due to pneumonia significantly increases in elderly people ≥80 years of age. A majority of cases of community-acquired pneumonia in adults are pneumonia without bacteremia, 20–40% of which might reportedly be caused by S. pneumoniae. S. pneumoniae is also a cause of secondary pneumonia in patients with influenzavirus infections in the elderly people. Like infants, the burden of IPD and pneumococcal pneumonia is also large in elderly population. IPD was designated a notifiable disease by the Infectious Disease Control Law, and its occurrence trend is gradually becoming more clear. PPSV23 is effective in preventing pneumococcal pneumonia, and PPSV23 vaccination has been reported to reduce pneumoniarelated medical costs in elderly individuals in Japan [14,15]. A sustained functional serotype-specific IgG after the primary and the secondary vaccinations with PPSV23 was demonstrated in elderly patients with chronic lung disease in Japan [16]. Studies on the effectiveness of vaccine diffusion associated with the start of routine immunization and differential use of PPSV23 and PCV13 are anticipated.
0264-410X/$ – see front matter http://dx.doi.org/10.1016/j.vaccine.2015.09.084
Please cite this article in press as: Nakano T, et al. Symposium report of the 17th annual meeting of the Japanese Society for Vaccinology, 2013. Bacterial vaccines: Effectiveness and issues. Vaccine (2015), http://dx.doi.org/10.1016/j.vaccine.2015.09.084
G Model JVAC-16960; No. of Pages 2
ARTICLE IN PRESS Meeting report / Vaccine xxx (2015) xxx–xxx
2
4. Current pertussis status and evaluation of the acellular pertussis vaccine Neonates and infants with pertussis do not show the typical symptoms along with the course. Apneic attacks and/or convulsions may occur, resulting in sudden death in some patients. Furthermore, the symptoms in older children and adults are commonly atypical, pertussis cannot easily be differentiated from pathological conditions such as prolonged cough or normal cold in some cases [17]. When patients do not present with typical symptoms, they are not diagnosed as having pertussis and remained to be a source of infection. Because the infection can cause severe complications and severe disease in neonates and infants, preventative measures are important in the community. While the whole-cell pertussis vaccine, which was developed first, had favorable prophylactic effects, and substantially reduced the number of patients with pertussis, serious adverse reactions such as encephalopathy led to discontinuation of the vaccine in Japan. Consequently, the number of pertussis patients and the pertussis-associated deaths increased again. Against this background, the acellular pertussis vaccine was developed in Japan and introduced in 1981. The diffusion of this vaccine resulted in decreased number of the pertussis patients again. Recently, reemergence of pertussis outbreak in older children and adults, including those who had been vaccinated previously, has become an issue not only in Japan, but also in oversea countries; the immunization efficacy duration induced by the acellular pertussis vaccine is believed to be 4–12 years [18,19]. In order to prevent young children from being suffered from the serious pertussis, it is important that they should be vaccinated as early as possible when they reached the age for vaccination [20]. The recommended age for children to be vaccinated with pertussis vaccine in Japan is 3-month, which is 1 month later than those in Europe and the United States. The recommended age should be harmonized. The combined tetanus, diphtheria, and pertussis vaccine is used overseas as a pertussis control measure in older children (often a source of infection) as well as adults. Evaluation of the disease burden and countermeasures in Japan are also required. Conflict of interest statement The authors declare that they have no financial or nonfinancial conflicts of interest related to the contents in the manuscript. References [1] Plotkin SA, Orenstein WA, Offit PA. Vaccines. 6th ed. Philadelphia, Pa.: Saunders/Elsevier; 2012. [2] Colditz GA, Brewer TF, Berkey CS, Wilson ME, Burdick E, Fineberg HV, et al. Efficacy of BCG vaccine in the prevention of tuberculosis Meta-analysis of the published literature. JAMA 1994;271(9):698–702. [3] American Academy of Pediatrics, Committee on Infectious Diseases. Report of the Committee on Infectious Diseases. 29th ed. Evanston, Ill.: American Academy of Pediatrics; 2012. [4] World Health Organization. Global tuberculosis report 2013. Available from: http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656 eng.pdf [Internet]. [5] Japan Pediatric Society. Vaccination schedule recommended by the Japan Pediatric Society. Available from: https://www.jpeds.or.jp/uploads/files/ JPS%20Vaccine%20Schedule%20English%2020140317.pdf [Internet]. [6] Saitoh A, Okabe N. Recent progress and concerns regarding the Japanese immunization program: addressing the “vaccine gap”. Vaccine 2014;32(34):4253–8. [7] Poehling KA, Talbot TR, Griffin MR, Craig AS, Whitney CG, Zell E, et al. Invasive pneumococcal disease among infants before and after introduction of pneumococcal conjugate vaccine. JAMA 2006;295:1668–74. [8] Singleton RJ, Hennessy TW, Bulkow LR, Hammitt LL, Zulz T, Hurlburt DA, et al. Invasive pneumococcal disease caused by nonvaccine serotypes among Alaska native children with high levels of 7-valent pneumococcal conjugate vaccine coverage. JAMA 2007;297:1784–92.
[9] Byington CL, Samore MH, Stoddard GJ, Barlow S, Daly J, Korgenski K, et al. Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the intermountain west: emergence of nonvaccine serogroups. Clin Infect Dis 2005;41:21–9. [10] Hicks LA, Harrison LH, Flannery B, Hadler JL, Schaffner W, Craig AS, et al. Incidence of pneumococcal disease due to non-pneumococcal conjugate vaccine (PCV7) serotypes in the United States during the era of widespread PCV7 vaccination, 1998–2004. J Infect Dis 2007;196:1346–54. [11] Pelton SI, Huot H, Finkelstein JA, Bishop CJ, Hsu KK, Kellenberg J, et al. Emergence of 19A as virulent and multidrug resistant pneumococcus in Massachusetts following universal immunization of infants with pneumococcal conjugate vaccine. Pediatr Infect Dis J 2007;26:468–72. [12] Miller E, Andrews NJ, Waight PA, Slack MP, George RC. Herd immunity and serotype replacement 4 years after seven-valent pneumococcal conjugate vaccination in England and Wales: an observational cohort study. Lancet Infect Dis 2011;11:760–8. [13] Pilishvili T, Lexau C, Farley MM, Hadler J, Harrison LH, Bennett NM, et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis 2010;201:32–41. [14] Maruyama T, Taguchi O, Niederman MS, Morser J, Kobayashi H, Kobayashi T, et al. Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial. BMJ 2010;340:c1004. [15] Kawakami K, Ohkusa Y, Kuroki R, Tanaka T, Koyama K, Harada Y, et al. Effectiveness of pneumococcal polysaccharide vaccine against pneumonia and cost analysis for the elderly who receive seasonal influenza vaccine in Japan. Vaccine 2010;28:7063–9. [16] Ohshima N, Nagai H, Matsui H, Akashi S, Makino T, Akeda Y, et al. Sustained functional serotype-specific antibody after primary and secondary vaccinations with a pneumococcal polysaccharide vaccine in elderly patients with chronic lung disease. Vaccine 2014;32:1181–6. [17] Horiba K, Nishimura N, Gotoh K, Kawaguchi M, Takeuchi S, Hattori F, et al. Clinical manifestation of children with microbiologically confirmed pertussis infection and antimicrobial susceptibility of isolated strains in a regional hospital in Japan, 2008–2012. Jpn J Infect Dis 2014;67:345–8. [18] Hewlett EL, Edward KM. Pertussis – not just for kids. N Engl J Med 2005;352:1215–22. [19] Cherry JD. Epidemic pertussis in 2012 – the resurgence of a vaccine-preventable disease. N Engl J Med 2012;367:785–7. [20] Amirthalingam G. Strategies to control pertussis in infants. Arch Dis Child 2012;98:552–5.
Takashi Nakano ∗ Kawasaki Medical School, Department of Pediatrics, Okayama, Japan Masahiro Watanabe Suzuka Pediatrics, Suzuka, Japan Akihiko Saitoh Niigata University Graduate School of Medical and Dental Sciences, Department of Pediatrics, Niigata, Japan Shigeru Suga National Hospital Organization Mie Hospital, Department of Pediatrics, Tsu, Japan Kazunori Oishi National Institute of Infectious Diseases, Infectious Disease Surveillance Center, Tokyo, Japan Naoko Nishimura Konan Kosei Hospital, Department of Pediatrics, Konan, Japan ∗ Corresponding author at: Department of Pediatrics, Kawasaki Hospital, Kawasaki Medical School, 2-1-80, Nakasange, Kita-ku, Okayama 700-8505, Japan. Tel.: +81 086 225 2111; fax: +81 086 232 8343. E-mail address: [email protected] (T. Nakano)
11 March 2015 Available online xxx
Please cite this article in press as: Nakano T, et al. Symposium report of the 17th annual meeting of the Japanese Society for Vaccinology, 2013. Bacterial vaccines: Effectiveness and issues. Vaccine (2015), http://dx.doi.org/10.1016/j.vaccine.2015.09.084
ARTICLE IN PRESS
JVAC-16960; No. of Pages 2
Vaccine xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Symposium report of the 17th annual meeting of the Japanese Society for Vaccinology, 2013 Bacterial vaccines: Effectiveness and issues
tuberculosis greatly varies among regions in Japan; thus, indication criteria for and timing of BCG should be reconsidered [6].
Keywords:
2. Effectiveness and issues of Hib vaccine and PCV in children
BCG vaccine Hib vaccine Pneumococcal conjugate vaccine Pneumococcal polysaccharide vaccine Acellular pertussis vaccine Japan
Among protective immunizations, bacterial vaccines in Japan differ from those in foreign countries. While the Bacille CalmetteGuerin (BCG) vaccine is administered only to high-risk children in the United States, it is routinely immunized for all children in Japan. Conjugate vaccines are highly effective in preventing invasive bacterial infections in children; however, the Haemophilus influenzae type b (Hib) vaccine was introduced in Japan 20 years after its introduction in Europe and the United States, and the pneumococcal conjugate vaccine (PCV) was 10 years after their introduction. The rate of immunization with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) among elderly people was also much lower in Japan than those in the other countries. A high incidence of pertussis in adolescents and adults is a global issue. The acellular pertussis vaccine currently and widely used in advanced nations was developed in Japan in 1981. A symposium titled “Effectiveness and issues of bacterial vaccines” was held at the 17th annual meeting of the Japanese Society for Vaccinology, which took place from November 30 to December 1, 2013 in Tsu City, Mie prefecture, Japan.
1. BCG vaccine administration in Japan and overseas The BCG vaccine has an 80-year history and remains one of the most widely used vaccines in the world [1]. There are various data on its efficacy, particularly in preventing severe disseminated infection such as tuberculous meningitis in infants [2]. However, it is believed that there is a limitation in preventing initial tuberculous infection and onset of tuberculosis. In the United States, the BCG vaccine is administered to individuals whose family members suffer from tuberculosis and high-risk children such as immigrants from the foreign countries where tuberculosis is prevalent [3]. In Japan, on the other hand, the vaccine is administered as a routine immunization to all children for the reason that Japan has a medium prevalence of tuberculosis (approximately 18 patients per 100,000 population) [4]. Currently, the standard immunization period is from 5 to 8 months of age [5]. Adverse reactions of BCG vaccine include osteitis, osteomyelitis, and regional lymph node swelling [1]. Although recombinant vaccines are currently under development, the incidence of
A Health and Labour Sciences Research Study group has conducted active surveillance on invasive bacterial infections in children in 10 prefectures in Japan since 2007. A prospective notifiable disease survey was conducted to monitor the incidences of invasive Hib infection and invasive pneumococcal diseases (IPD) for 5 years from 2008 to 2012, corresponding to vaccine pre- and post-introduction periods. The number of patients with meningitis and other invasive infections caused by the two bacteria markedly decreased in the <5-year age group, demonstrating the effectiveness of these vaccines. Forthcoming challenges regarding serotype replacement were also pointed out in Japan. This reported issues were similar to those observed in other countries where these vaccines were introduced earlier than in Japan [7–13]. There were increased cases of IPD caused by Streptococcus pneumoniae serotype 19A, which is not contained in the 7-valent PCV (PCV7), underscoring the potential for serotype replacement. Although this type of serotype replacement has not been reported in H. influenzae, encapsulated strains other than serotype b and non-typable (non-encapsulated) H. influenzae (NTHi) should be monitored.
3. Pneumococcal infection and preventative vaccination in adults Pneumonia is the third leading cause of death in Japan. The mortality rate due to pneumonia significantly increases in elderly people ≥80 years of age. A majority of cases of community-acquired pneumonia in adults are pneumonia without bacteremia, 20–40% of which might reportedly be caused by S. pneumoniae. S. pneumoniae is also a cause of secondary pneumonia in patients with influenzavirus infections in the elderly people. Like infants, the burden of IPD and pneumococcal pneumonia is also large in elderly population. IPD was designated a notifiable disease by the Infectious Disease Control Law, and its occurrence trend is gradually becoming more clear. PPSV23 is effective in preventing pneumococcal pneumonia, and PPSV23 vaccination has been reported to reduce pneumoniarelated medical costs in elderly individuals in Japan [14,15]. A sustained functional serotype-specific IgG after the primary and the secondary vaccinations with PPSV23 was demonstrated in elderly patients with chronic lung disease in Japan [16]. Studies on the effectiveness of vaccine diffusion associated with the start of routine immunization and differential use of PPSV23 and PCV13 are anticipated.
0264-410X/$ – see front matter http://dx.doi.org/10.1016/j.vaccine.2015.09.084
Please cite this article in press as: Nakano T, et al. Symposium report of the 17th annual meeting of the Japanese Society for Vaccinology, 2013. Bacterial vaccines: Effectiveness and issues. Vaccine (2015), http://dx.doi.org/10.1016/j.vaccine.2015.09.084
G Model JVAC-16960; No. of Pages 2
ARTICLE IN PRESS Meeting report / Vaccine xxx (2015) xxx–xxx
2
4. Current pertussis status and evaluation of the acellular pertussis vaccine Neonates and infants with pertussis do not show the typical symptoms along with the course. Apneic attacks and/or convulsions may occur, resulting in sudden death in some patients. Furthermore, the symptoms in older children and adults are commonly atypical, pertussis cannot easily be differentiated from pathological conditions such as prolonged cough or normal cold in some cases [17]. When patients do not present with typical symptoms, they are not diagnosed as having pertussis and remained to be a source of infection. Because the infection can cause severe complications and severe disease in neonates and infants, preventative measures are important in the community. While the whole-cell pertussis vaccine, which was developed first, had favorable prophylactic effects, and substantially reduced the number of patients with pertussis, serious adverse reactions such as encephalopathy led to discontinuation of the vaccine in Japan. Consequently, the number of pertussis patients and the pertussis-associated deaths increased again. Against this background, the acellular pertussis vaccine was developed in Japan and introduced in 1981. The diffusion of this vaccine resulted in decreased number of the pertussis patients again. Recently, reemergence of pertussis outbreak in older children and adults, including those who had been vaccinated previously, has become an issue not only in Japan, but also in oversea countries; the immunization efficacy duration induced by the acellular pertussis vaccine is believed to be 4–12 years [18,19]. In order to prevent young children from being suffered from the serious pertussis, it is important that they should be vaccinated as early as possible when they reached the age for vaccination [20]. The recommended age for children to be vaccinated with pertussis vaccine in Japan is 3-month, which is 1 month later than those in Europe and the United States. The recommended age should be harmonized. The combined tetanus, diphtheria, and pertussis vaccine is used overseas as a pertussis control measure in older children (often a source of infection) as well as adults. Evaluation of the disease burden and countermeasures in Japan are also required. Conflict of interest statement The authors declare that they have no financial or nonfinancial conflicts of interest related to the contents in the manuscript. References [1] Plotkin SA, Orenstein WA, Offit PA. Vaccines. 6th ed. Philadelphia, Pa.: Saunders/Elsevier; 2012. [2] Colditz GA, Brewer TF, Berkey CS, Wilson ME, Burdick E, Fineberg HV, et al. Efficacy of BCG vaccine in the prevention of tuberculosis Meta-analysis of the published literature. JAMA 1994;271(9):698–702. [3] American Academy of Pediatrics, Committee on Infectious Diseases. Report of the Committee on Infectious Diseases. 29th ed. Evanston, Ill.: American Academy of Pediatrics; 2012. [4] World Health Organization. Global tuberculosis report 2013. Available from: http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656 eng.pdf [Internet]. [5] Japan Pediatric Society. Vaccination schedule recommended by the Japan Pediatric Society. Available from: https://www.jpeds.or.jp/uploads/files/ JPS%20Vaccine%20Schedule%20English%2020140317.pdf [Internet]. [6] Saitoh A, Okabe N. Recent progress and concerns regarding the Japanese immunization program: addressing the “vaccine gap”. Vaccine 2014;32(34):4253–8. [7] Poehling KA, Talbot TR, Griffin MR, Craig AS, Whitney CG, Zell E, et al. Invasive pneumococcal disease among infants before and after introduction of pneumococcal conjugate vaccine. JAMA 2006;295:1668–74. [8] Singleton RJ, Hennessy TW, Bulkow LR, Hammitt LL, Zulz T, Hurlburt DA, et al. Invasive pneumococcal disease caused by nonvaccine serotypes among Alaska native children with high levels of 7-valent pneumococcal conjugate vaccine coverage. JAMA 2007;297:1784–92.
[9] Byington CL, Samore MH, Stoddard GJ, Barlow S, Daly J, Korgenski K, et al. Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the intermountain west: emergence of nonvaccine serogroups. Clin Infect Dis 2005;41:21–9. [10] Hicks LA, Harrison LH, Flannery B, Hadler JL, Schaffner W, Craig AS, et al. Incidence of pneumococcal disease due to non-pneumococcal conjugate vaccine (PCV7) serotypes in the United States during the era of widespread PCV7 vaccination, 1998–2004. J Infect Dis 2007;196:1346–54. [11] Pelton SI, Huot H, Finkelstein JA, Bishop CJ, Hsu KK, Kellenberg J, et al. Emergence of 19A as virulent and multidrug resistant pneumococcus in Massachusetts following universal immunization of infants with pneumococcal conjugate vaccine. Pediatr Infect Dis J 2007;26:468–72. [12] Miller E, Andrews NJ, Waight PA, Slack MP, George RC. Herd immunity and serotype replacement 4 years after seven-valent pneumococcal conjugate vaccination in England and Wales: an observational cohort study. Lancet Infect Dis 2011;11:760–8. [13] Pilishvili T, Lexau C, Farley MM, Hadler J, Harrison LH, Bennett NM, et al. Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis 2010;201:32–41. [14] Maruyama T, Taguchi O, Niederman MS, Morser J, Kobayashi H, Kobayashi T, et al. Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial. BMJ 2010;340:c1004. [15] Kawakami K, Ohkusa Y, Kuroki R, Tanaka T, Koyama K, Harada Y, et al. Effectiveness of pneumococcal polysaccharide vaccine against pneumonia and cost analysis for the elderly who receive seasonal influenza vaccine in Japan. Vaccine 2010;28:7063–9. [16] Ohshima N, Nagai H, Matsui H, Akashi S, Makino T, Akeda Y, et al. Sustained functional serotype-specific antibody after primary and secondary vaccinations with a pneumococcal polysaccharide vaccine in elderly patients with chronic lung disease. Vaccine 2014;32:1181–6. [17] Horiba K, Nishimura N, Gotoh K, Kawaguchi M, Takeuchi S, Hattori F, et al. Clinical manifestation of children with microbiologically confirmed pertussis infection and antimicrobial susceptibility of isolated strains in a regional hospital in Japan, 2008–2012. Jpn J Infect Dis 2014;67:345–8. [18] Hewlett EL, Edward KM. Pertussis – not just for kids. N Engl J Med 2005;352:1215–22. [19] Cherry JD. Epidemic pertussis in 2012 – the resurgence of a vaccine-preventable disease. N Engl J Med 2012;367:785–7. [20] Amirthalingam G. Strategies to control pertussis in infants. Arch Dis Child 2012;98:552–5.
Takashi Nakano ∗ Kawasaki Medical School, Department of Pediatrics, Okayama, Japan Masahiro Watanabe Suzuka Pediatrics, Suzuka, Japan Akihiko Saitoh Niigata University Graduate School of Medical and Dental Sciences, Department of Pediatrics, Niigata, Japan Shigeru Suga National Hospital Organization Mie Hospital, Department of Pediatrics, Tsu, Japan Kazunori Oishi National Institute of Infectious Diseases, Infectious Disease Surveillance Center, Tokyo, Japan Naoko Nishimura Konan Kosei Hospital, Department of Pediatrics, Konan, Japan ∗ Corresponding author at: Department of Pediatrics, Kawasaki Hospital, Kawasaki Medical School, 2-1-80, Nakasange, Kita-ku, Okayama 700-8505, Japan. Tel.: +81 086 225 2111; fax: +81 086 232 8343. E-mail address: [email protected] (T. Nakano)
11 March 2015 Available online xxx
Please cite this article in press as: Nakano T, et al. Symposium report of the 17th annual meeting of the Japanese Society for Vaccinology, 2013. Bacterial vaccines: Effectiveness and issues. Vaccine (2015), http://dx.doi.org/10.1016/j.vaccine.2015.09.084