日本的儿童结核病和卡介苗。

IF 3.5
Vaccine Pub Date : 2025-08-30 Epub Date: 2025-08-08 DOI:10.1016/j.vaccine.2025.127564
Yuho Horikoshi, Michiko Toizumi
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引用次数: 0

摘要

一个多世纪以来,结核病一直是日本一个重要的公共卫生问题。虽然考古证据表明它早在1800年前就存在了,但结核病在19世纪末日本现代化期间迅速传播。最初的控制措施侧重于隔离病人和建立疗养院,后来得到《结核病防治法》的支持。第二次世界大战后,公共卫生干预措施——如强制病例报告、大规模卡介苗接种和链霉素等抗细菌药物的引入——促成了结核病发病率和死亡率的显著下降。随着多药化疗的发展,治疗效果进一步改善。1949年开始大规模接种卡介苗,1974年开始普及儿童接种。日本采用独特的皮内“戳”法,多针注射卡介苗,以减少皮肤溃疡的并发症。目前的菌株BCG Tokyo-172-1于1981年开发,在全国使用,并通过世卫组织-联合国儿童基金会的规划在全球分发。儿童结核病已变得罕见,每年新发病例不到100例。大多数是通过成人接触调查发现的;另一些则是根据临床症状或筛查来诊断的。近年来,在日本以外出生的人,特别是来自高负担国家的人,结核病病例(包括儿科病例)的比例有所增加。随着日本向结核病低负担国家过渡,目前正在审查是否继续普遍接种卡介苗。高危婴儿的选择性疫苗接种和成人的加强筛查可能提供更有针对性和有效的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pediatric tuberculosis and BCG vaccine in Japan.

Tuberculosis (TB) was a significant public health concern in Japan for over a century. While archaeological evidence suggests its presence as early as 1800 years ago, TB spread rapidly during Japan's modernization in the late 19th century. Initial control measures focused on patient isolation and the establishment of sanatoriums, later supported by the Tuberculosis Prevention Law. After World War II, public health interventions-such as mandatory case reporting, mass BCG vaccination, and the introduction of antimycobacterial agents like streptomycin-contributed to a marked decline in TB incidence and mortality. Treatment outcomes further improved with the development of multidrug chemotherapy. Mass BCG vaccination began in 1949, with universal childhood vaccination implemented in 1974. Japan employs a distinctive intradermal "stamp" method with multiple needles of BCG administration for less complication of a skin ulcer. The current strain, BCG Tokyo-172-1, developed in 1981, is used nationally and distributed globally through WHO-UNICEF programs. Pediatric TB has become rare, with fewer than 100 new cases annually. Most are identified through adults contact investigations; others are diagnosed based on clinical symptoms or screening. In recent years, the proportion of TB cases-including pediatric cases-among individuals born outside Japan, particularly from high-burden countries, has increased. As Japan transitions to a low TB burden setting, the continuation of universal BCG vaccination is under review. Selective vaccination of high-risk infants and enhanced screening among adults may offer more targeted and effective approaches.

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