風疹の疫学的研究
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概要
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Since the development of simple and sensitive inethod(hemagglutination inhibition test ; HI-test) for detecting anti-rubella antibodies by Stewart et aI, many data have been accumulated concerning the susceptibility against rubella infection of inhabitants in particular areas throughout the world. Systematic surveillance for the same purpose in Japan has been puplished in a series of reports by the Ministry of Health and Welfare, Government of Japan since 1971. However, the similar data as to the rubella status in Hyogo Prefecture are very scanty. The present author carried out epidemiological studies on rubella, dealing with sera taken from inhabitants in various societies of Hyogo Prefecture, such as city, town, school, dormitory, class room, etc. Seroimmunological investigations on the effect of live attenuated rubella vaccines administered to young school girls were also performed. In addition, one case of congenital rubella syndrome (CRS)was examined clinically and immunologically. The results obtained are summarized as follows. (1) No significant difference in rubella susceptibility was noted between the males and females. The percentages of the susceptible persons decreased according to the increase of age. (2) As to the positive percentages of anti-rubella antibodies in test sera, the author proposed to classify the investigated groups into 3 types : Type I, in which more than 80% of susceptible individuals are found in the age groups less than 14 years ; type II, in which less than 50% of the susceptibles are found in the age groups less than 14 years ; and type III, intermediate of the above two. (3) In groups in which those who possess HI-values more than 1 : 512 are more than 1/3 of the whole population, the arithmetic means of HI-values usually exceeded 1 : 300. (4) Some groups which showed significantly small susceptibility compared with their surrounding groups were found; this suggested the comparatively low communicability of rubella virus. (5) Positive rates of anti-rubella antibodies among inhabitants along a national high way in the districts of Nishinomiya and Ashiya, i. e., belt "A" which is within 50 meter width from the way, and belt "B" which is in 150-200 meter from the same way. In the Nishinomiya district, no difference was found between the rubella susceptibilities of the A-and B-belts, while, in the Ashiya district, the susceptibilities of the two belts were different. B-belt was more susceptible than A-belt. Possible correlation between air pollution and the suppression of rubella antibody production is to be solved in the future. (6) Ninety-eight cases of high school students of Nepal were found to be immune to the rubella virus, possessing high HI-values, the arithmetic mean of which was 1:726. This was different from the results dealing with sera from girl students in the Hyogo Prefecture (arithmetic mean HI-titers was 1:97). (7) So far as concerning the samples from filipino outpatients of a hospital in Manila, a significant finding was that the positive rubella antibody rates were higher in males than in the females (P△0.01). (8) From the distribution of HI-values among the cases serologically diagnosed as rubella, it was concluded that all patients who were infected within recent 3 months showed HI-values over 1:512 in their convalescent sera. (9) IgM antibody against rubella virus was detected by the sucrose density gradient centrifugation (SDGC) method in the serum on the 63rd day of illness of a naturally acquired rubella case ; the same antibody was also detected in the 480th day sample from a mother who delivered a baby with CRS. However, these antibodies were not detected any more on the 600th day of infection. (10) HI-values per mg protein were measured in the present investigations. The titers of fetusplacenta (F/P) admixtures and of maternal blood showed no correlation. This suggested an existence of certain kinds of HA-inhibitor, and their "neutralizing activities" to rubella virus should be studied in the future. (11) Attempts to isolate rubella virus from F/P admixtures were negative in all the cases examined, that suggested low efficiencies of rubella virus detection from pregnant women. (12) On the other hand, the virus isolation from throat washings of outpatients of a hospital was achieved in comparatively high rates by applying RK/VSV interfering method in microplate. Steep rises of HI-values in the convalescent sera were noted in the most of cases. (13) Rubella virus was successfully isolated from persons possessing HI-values 1:32 and 1:16. (14) The incidences of inapparent infection of rubella was 38% for epidemic cases in a dormitory of a nursing school. The same incidences were: 37% for a group in the district of Kakogawa ; 11% for Toyooka; 1% for Tatuno ; and 7% for school children. (15) Good antibody production was attained after administration of Japan-made live rubella vaccines in groups having HI-values less than 1:32. The conversion rate was 550/551 (99%). On the contrary, in other groups having HI-values over 1:64, the booster effect of the same vaccines was very low, its seroconversion rate being 9%. (16) Side reactions of vaccine administration were examined by a questionaire method. The incidences were different according to lots of vaccines administered : arthralgia, 4-10% ; weak fever, 3-10 % ; and headache, 2-12%. Notable was that the values of mean HI in the vaccinees paralelled to the percentage of side reactions, particularly the rash.
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