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1 Infectious Agents Surveillance Report (IASR) EHEC 202 3, EHEC O57 : 4 O57 ISprinting system 5, 6, O57 : 20 7, O57 : 8, O26 : 9, O26 : 0, O26 : 2, O03 O : 3, O45 : 3, O57 : 4, EHEC 5, 202O57O26PFGE7, 202HUS : NESID8, 9, C. ulcerans : 2, CSLI 2, 203/4 : WHO 22, : 23, A 23 Vol. 34 No Vol.34 No. 5 No.399 ISSN Tel ,,, 2 :,,, EHEC, 2 3, mhlw.go.jp/bunya/kenkou/kekkakukansenshou/ html,,,, EHEC,, 999 4/ 2/3 3, / 2/3 3, / 2/3 4, / 2/3 3, / 2/3 2, / 2/3 3, / 2/3 3, / 2/3 3, / 2/3 4, / 2/3 4, / 2/3 3, / 2/3 4,35 20 / 2/3 3, / 2/3 3, / 4/ , IDSC 7 : 202 EHEC 2,362,,406, 3,768 EHEC 202, 0 9.2, 8.7, ,

2 224 Vol. 34 No O57 4 5,,,,, 69 8 : EHEC,, jp/stf/kinkyu/2r bbdz.html, EHEC O57, ,, O , O57, 02, EHEC,, 202 2,, /kodomo/pdf/hoiku02_.pdf,,, 203 : 5 EHEC 88 EHEC, O03:H2 VT 3 0 / O26:H VT / O2:H9 VT2 8 2 / O57:HNT VT&2 9 2 / O57:H VT&2 8 0 / O:H VT 5 7 / O26:H VT 26 / O26:H VT / O57:H7 VT& / O45:H VT2 4 / O26:H VT, VT() 62 6 / O57:H7 VT&2 4 4 / O03:H VT 9 29 / 94 3 O:H VT 2 / O57:H VT / O26:HNT VT 3 9 / O2:H9 VT2 5 7 / 598 0NT: Not typed IASR 4 0,,, 2, 30, 40, 50 3, HUS 94, 4.0 8HUS 70 O57 58, O 4, O26 2, O45 2, O25, O65, O74, O83, VT2 VT2 VT & 2, 70, HUS 3, 2 EHEC : 202 EHEC,957 EHEC,, 3, O57 53, O26 27, O VT, 202 O57 VT & O26 VT 94, O03 VT 97 O57,040, , 62, 46, 2 3 : 202 IDSC EHEC 23, 6 O , 0, 202 EHEC 7, , EHEC

3 , 202 Symptoms associated with EHEC infection, by serotype, 202 ) 2) 3) 4) 5) 6) 7) 8) 9) HUS 0) ) Total O57:H7:VT O57:H7:VT2 O57:H7:VT&VT2 O57:H7:VT2 O57:H:VT O57:H:VT2 O57:H:VT&VT2 O57:HUT:VT2 O57:HUT:VT&VT2 O57:HNT:VT O57:HNT:VT2 O57:HNT:VT&VT2 O57** O57 Subtotal O26:H2:VT O26:H:VT O26:H:VT2 O26:H:VT&VT2 O26:H5:VT O26:H:VT O26:H:VT2 O26:H:VT&VT2 O26:HUT:VT O26:HNT:VT O26:HNT:VT&VT2 O26 Subtotal O03:H2:VT O03:H:VT O03:HUT:VT O03:HNT:VT O03:HNT:VT&VT2 O03 Subtotal O:H2:VT O:H:VT O:H:VT&VT2 O:HUT:VT O:HUT:VT&VT2 O:HNT:VT O:HNT:VT&VT2 O Subtotal O2:H9:VT2 O2:HUT:VT2 O2:HNT:VT2 O2 Subtotal O45:H4:VT2 O45:H:VT O45:H:VT2 O45:HNT:VT2 O45:HNT:VT&VT2 O45 Subtotal O9:H4:VT O9:H26:VT&VT2 O9:H:VT O9:H:VT&VT2 O9:HUT:VT O9:HNT:VT O9:HNT:VT&VT2 O9 Subtotal O5:H:VT O8:H9:VT&VT2 O8:HUT:VT O8:HUT:VT2 O8:HNT:VT O8:HNT:VT&VT2 O25:H2:VT O25:H28:VT Others O28ac:HUT:VT2 O39:H49:VT O40:HUT:VT2 O40:HNT:VT2 O63:HNT:VT&VT2 O74:H20:VT2 O88:H25:VT&VT2 O96:H9:VT&VT2 O98:HNT:VT O05:H7:VT2 O2ac:H6:VT&VT2 O3:H:VT2 O5:H0:VT O5:HNT:VT O5:HNT:VT2 O8:H6:VT O9:H4:VT O9:HNT:VT O28:H2:VT2 O28:H2:VT&VT2 O28:H:VT&VT2 O30:H:VT2 O4:H:VT2 O46:H:VT&VT2 O48:H8:VT O48:HNT:VT O53:HUT:VT2 O65:H:VT2 O65:H:VT&VT2 O65:HNT:VT2 O65:HNT:VT&VT2 O69:H9:VT O74:H2:VT2 O74:H:VT O83:H8:VT O86:H:VT O untypable UT: Untypable, NT: Not typed, *2 5) nausea/vomiting, 6) bloody diarrhea, 7) abdominal pain, 8) disturbance of consciousness, 9) encephalopathy, 0) hemolytic uremic syndrome, ) renal failure (Infectious Agents Surveillance Report: Data based on the reports from public health institutes received before April, 203) Serotype * Symptoms* Cases *Including cases for which two or more symptoms were reported, **serodiagnosed by O57antibody,) no data, 2) no symptoms, 3) fever, 4) diarrhea, Vol. 34 No

4 426 Vol. 34 No O , O57 : H7 VT & 2, O , A 7,, 6, 5 B ,, O57, O57,,,, 69 2.,, O57 VT & 2,, 4,, 3. O57 69,. O57, O , 20, 3 O57 73 ISprinting system TOYOBO, IS IS st set Primer Mix2nd set Primer Mix 2 PCR 36 :, : 0 2 IS 76 st set Primer Mix PCR, IS 00 bp 5, 76 PFGE, Type No. h94 73, h94 2, 3, 76 4., IS 76,, IS PFGE, IS O57 2. O57 ISprinting system

5 Vol. 34 No O57 ISprinting system 202 8, O57 : H7 VT & 2, 4, ISprinting system A O57 : H7 VT 2, , 8 8 5, O57 : H7 ISprinting,,, 8 6 O57 : H7, ISprinting, ISprinting, O57 ISprinting 2 2 PCR 36 PCR, 2,, 00 bp PCR. ISprinting,, 2 : 8 5,, : 8, : O57 : H7 6 ISprinting. IS 00 bp eae 6 hly bp stx stx2 bp eae, hly, stx/stx2, (VT) 0, ;,

6 628 Vol. 34 No ,, O57 : H7 VT & 2 ISprinting, ISprinting, O57 ISprinting,, PCR, ISprinting, ISprinting,,, ISprinting,, O O57, 69, 8,,,,,, , A 7,,,, 8 8, B 4 A, B, 2, O57 VT & 2,, O57, O57 3, O57,, E,,, O57, 2.,, 24 0,, 3., 98 56, O ,,,,,

7 Vol. 34 No , 202 7,,, ,, NESID EHEC,, , NESID 0, NESID,, MeCab ver.0.994,,,,,, EHEC O57, k_yasai/index.html /202/ html O57 O , 20 00, , O57 O O EHEC, 20, , , , 20 0, 20 20, O57:

8 oro57830 Vol. 34 No , FETP , , , , 202 O57, 5,, O57,, O57 O57,,,,,,,,, : chudoku.pdf,,,,,, : O57 : H7 VT , O57, , A 2, 8 9,,, 8 22, 3, O57, 8 4 A, 4 2 3, 8 4 4,,, 4,,,, O57,, 7,. () O

9 Vol. 34 No Xba 579A6C 3D4S 0,, O57, 8 2, 4, 5, 6, 8 B, 5 O57 VT & 2, 8 3, 23 O57VT & 2, 4, 35, 25, O57 2, 3 3 O57, A 8, C, D 3,, H,, H7 3, XbaI PFGE, 2, 2, 3, PFGE,,,, 24, O57, O26, O 3,, 5 44,,,,,, U,, :, O , 2 3, 5 EHEC O26 VT 30,,,,,, 32, 27, ,, 6, 8,,,,, 2 EHEC O26 VT,, ,, 0

10 032 Vol. 34 No M 2 3 M M M 2 34M M M Xba I No.,2,4,5,7,8,,2,5,6,9,20 No.3,6,9,0,3,4,7,8,2,22 MSalmonella Braenderup H982. PFGE,, 32, 32, , 75, 5, 25, 5 68, , EHEC O26 VT, 2 ABPC, CTX, GM, KM, SM, TC, CPFX, NA, ST, AMPC/CVA, CP, FOM, 7 2, 53 3.,,,,,,, EHEC O26 VT,, ,,,, 25, 3, 3,, O ,, O26 : H VT EHEC O ,, EHEC O26 A, 3, 3, 3, EHEC O26, , 224,

11 Vol. 34 No PFGE,, ,, 5,,,,,,, PFGE, AC 3 53 A, B, C A,, X 2 E. coli O26 VT 3 3 EHEC O26 9 PCR, 3 eae, X asta, EHEC O26 eae, asta 3 EHEC O26 PFGE, asta X A, E. coli O26 EHEC O26 VT,,,, EHEC O26,, EHEC O26,,, 0, 20 EHEC O26 3 PFGE, A Y, EHEC O26, 0, PFGE,,,,,,, 4.9, 202,, : 3 O57, O26, O,,,,,, 24

12 234 Vol. 34 No O26 : H 202 7, 3, EHECO26 : H VT , 5 EHEC O26, A, B, C 3,, A, B, C,,,,,, A B, C,,,,, 3, 3, 265, 65, 208,, 7 27,, ,, 77, 7 3,.. O26:VT 2. PFGE 4 05, 3 EHEC PFGE, 2 05,, 43, 20, 2, 39, O26,,, 2,,,,,,,,, 9 5,, O26,,,,,,,,, :,

13 Vol. 34 No M M O03 O , O03, 6, 3, EHEC O03, 9 0, 3, O03, 2, 62 8, O03 : H VT 2, 2, 24,,,, 9, O : H VT 2 EHEC,, 2 9,,, STEC, CTSMAC DHL mec 42,, EHEC, Vero Vero,, STEC EHEC, Vero,, Vero, Vero. PFGEXbaI 0O03 O MS. Braenderup H982 EHEC 28, 5 EHEC, EHEC O O03 EHEC, EHEC STEC, STEC EHEC Vero 4, 30, XbaI PFGE O03 : H 28 25, 3 2 O : H 2, PFGE, PFGE,,,, O03 O 2 O EHECO45 : H stx2

14 436 Vol. 34 No , A, 9 9 B EHEC O45 2, 3 EHEC O45 2,,,,, 4 5 EHEC O , 2, 0 9, EHEC O45 : H stx2 O45 O45 4,,,,,,,, PFGE,,, O45, M* M*,, O45 5, O45, O45 6,,,,, O45 6, 8 28, 9 3 7, 8 2, , 8 28,,, EHEC,,,,,,,,,, Salmonella. Braenderup H982 No. A 9/0 2 BA 9/8 3 B 9/4 4 B 9/4 A5 5 B 6 CA 8/28 7 C 9/2 8 C 9/2 9 DA 9/3 0 D 9/0 D 2 EA 9/7 3 FA 9/8 4 F. PFGE O57 : H VT , A, EHECO57 29, , C 4,,,,, O57, Vero VT EHEC EHEC,, 0 4, B EHEC O57 VT2 B C, 2, A, 5, C VT2 9, A,

15 Vol. 34 No M M. 0, 2 77, 2 EHEC 2 00,, EHEC EHEC, 2, 2, 6 29, EHEC 29, 2, 8 2, 5, 6, 8 4, 4, 9 27, 28 2, 29 5, 30 2, 0 4, 2, 6, 9, 0 2,, 22 EHEC, 25 H, PFGE, H, 25, LIM,,, EHEC PFGE, XbaI, 25 DNA 2, 2,,, EHEC 4 3,,,,, PFGE, 25,, 202 2,, A, 2. PFGE Xba PFGE,, EHEC EHEC 40 0, hemolytic uremic syndrome; HUS,,,,, HUS, 6, 4 0, 3,,,,,,, EHECO, O45, O57, O65,,

16 638 Vol. 34 No EHEC O65 VT & 2, 5 7, 8,, , , 3 2, EHEC O65, EHEC O , EHEC O65, SorMAC,,, DHL, TSB 37,, CT CTSMAC PCR VT, 2 VT & 2, O65, O57 VT & 2 O45 VT2, O57 VT & 2, O VT, O45 VT2 3 EHEC, O65 00 O65, O57 O45, STEC CT RMAC, CTSorMAC, mec NmEC mec EHEC 2,, O VT 3 EHEC O65 M M 2 O57H7 3 VT& ONM 7 VT O45NM VT2. PFGE2025, 2, EHEC O57 : H7 VT & 2, O : NM VT, O45 : NM VT2 3 EHEC, NmEC mec 2,, EHEC O57 : H7 VT & 2, O : NM VT, O45 : NM VT2 3 EHEC, DHL, CTSMAC, STEC,, NmEC 37 42, mec 42,, STEC O : NM VT, O45 : NM VT2, DHL O45 : NM VT2, NmEC 37/42, mec42 O57 : H7 VT & 2, O : NM VT, O45 : NM VT2 EHEC, 3 XbaI PFGE,, 4 : CP, TC, SM, KM, ABPC, ST, NA, FOM, NFLX, CTX, AMK, CPFX, IPM, MEPM, O57 O, O45 TC.

17 病原微生物検出情報 Vol. 34 No の発生がみられ, その発生届に基づく集計により, 神 事例では, PCR 法によるスクリーニング検査が非常 奈川, 東京, 千葉, 静岡の 4 都県で発症者 5 名, 無症 に有効であったが, 今後, さらに効率的で汎用性の高 状者 名の合計 6 名から 4 血清型の EHEC が検出さ い検査方法の確立を目指していく必要がある れたことが明らかとなった 前ページ表 本事例の疫学調査は, 川崎市健康福祉局健康安全部 ツアーの旅程表などは入手できなかったが, ゴール 健康危機管理担当, 国立感染症研究所をはじめ, 多く デンウィーク中の 定番パッケージツアー で, ホテ の方の協力により行われた この種の事例の原因を明 ル 航空機などは微妙に異なるが, 行動や食事が一緒 らかにするためには, より迅速な自治体を越えた連携 のツアー客であった 食事はツアープランに付いてい が非常に重要である る 3 食 基本的に火が通った物 以外に各自, 屋台や 川崎市健康安全研究所 消化器 食品細菌担当 小嶋由香 現地レストランで食事をしていた 感染源としては旅 藤沢市保健所 衛生検査課 行先での食事が疑われたが, 特定はできなかった 今回の事例では, 検査依頼項目が EHEC O65 で 平井有紀 あったが, 実際には最初の発生届事例以外 O65 は検 松葉友美 石井 圭 千葉県衛生研究所 細菌研究室 出できず, 他の血清型で毒素型がすべて異なる 3 種類 平井晋一郎 の EHEC が検出された 検査開始が既に発症から0日 横山栄二 静岡市環境保健研究所微生物学担当 富田敦子 以上を経過し, 排菌量も少なかったことから検査では 東京都健康安全研究センター 微生物部 非常に苦労した EHEC で汚染されている食物や水を 摂取した場合, 必ずしも 種類の血清型菌に限らず, 尾畑浩魅 河村真保 複数菌が検出される場合もあり注意が必要である 本 仲真晶子 甲斐明美 高橋正樹 小西典子 図. 202年PFGEパターンの一致している事例の分布図 特集関連情報 202 年に人から広域に分離された腸管 出血性大腸菌 O57 および O26 の PFGE パ O57䠖g255 䖩䖩 ターンのクラスター解析 䖩 䖩 国立感染症研究所細菌第一部に送付され 䖩䖩 䖩 出血性大腸菌 EHEC は 2,340 株あり, そ 䖩 䖩䖩䖩䖩 O57䠖e807 䖩䖩䖩 䖩䖩䖩 䕦 のうち O57 は,422 株, O26 は 388 株あっ た 203 年 2 月現在 202 年には XbaI に 䕦䕦䕦 䕦 䕦 䕦䕦 O26䠖h3 䕦 よ る パ ル ス フ ィ ー ル ド ゲ ル 電 気 泳 動 䕦 䕦 年 に 初 め て 検 出 さ れ た パ タ ー ン は h 䕦 䕦䕦 䕦䕦䕦 PFGE パターンが O57 で69 種類 202 る 都 府 県 か ら 分 離 さ れ た 同 一 PFGE パ 䖩䖩 䖩䖩 解析を行った 202 年分離のヒト由来腸管 h628 みられ, 少なくとも 3 つ以上の異な 䖩䖩 䖩䖩 䕦 䕦 䕦䕦 䕦 䕦䕦䕦䕦 䕦䕦䕦䕦 䕦䕦䕦 䕦䕦 䕦 ターンが 32 種類あった このうち, 6 つ以 上の都府県から分離された O57 には 6 種 類の泳動パターンがあり Type No. TN e807, g255, h62, h88, h28, h50, 特に TN e807 および g255 を示す株は, それぞれ 9 府県, 2 都府県の広域で分離されていた M 䕦䖩 䕔 䖃䕺䖂 M M 䕦 Type No.e807, Jul. Oct. 䖩 Type No.g255, May Nov. 䕔 Type No.h28, Jul. Oct. 図 また, O26 では, 202 年に XbaI に 䖃 Type No.h50, Jul. Sep. 䕺 Type No.h62, Jun. Aug. よる PFGE パターンが 88 種類 このうち 䖂 Type No.h88, Jun. Aug. 202 年 に 初 め て 分 離 さ れ た も の は h h99 みられ, 8 府県から分離された同一 PFGE パターン TN h3 があった TN e807 は 2009 年に初めて分離された後, 20 年にも分離されているパターンであり, TN g255 は 20 年に初めて分離されたパター ンである それぞれのパターンを示す株は, O26 Type No.h3, May Jun.

18 840 Vol. 34 No EHEC O57MLVA Minimum Spanning Tree h28 h88, 202 h94 h50 e807 g255 h Multiplelocus variablenumber tandem repeat analysis MLVA, O57 9, O26 8, TN h94,, MLVA Minimum Spanning Tree 2, TN h88 h94,, ; TN h94,,,,, TN e807 g255,,, O26, PFGE,, MLVA,, hemolytic uremic syndrome: HUS, EHEC,, EHEC, HUS HUS,,,, IASR 30: 22 23, 2009, 3: 7072, 200, 32: 443, 20, 33: 2830, 202, 202 HUS HUS EHEC, ,766 2,362 : , HUS , 55 :.4 5 : 89, HUS 38, , HUS, , , , EHEC, 70 74, 9 20, Vero 5 5. HUS202

19 Vol. 34 No HUS , O57 83,, VT2 66, 94, 9, O57, 49 52, 5 5, ,,,, 2, 2, 564, 65, 5,, 85, 7, 55 : 55/9459, HUS , 0/l 55 00, 4 75, 50 9, 48 87, 47 85, , HUS 34 62, , 2 35, 8 24, 8 24, 5 5, , 5 9, 33 60, 23 42, 54 : 54/9457, 39 72, 7 3, 4 7, 3 6, 2, HUS, 3 3.2, 4, , 202 HUS, 0 4, 7 5, 20,, 65 6, 5.2, 8,, 65 HUS 5,, 0, 202 2,, 20, 20 0, 202 7,, :, ,,. 202/3, A

20 2042 Vol. 34 No A(HN)pdm09 A(H3N2) B(Yamagata) B(Victoria) 5% 2% 95% 98% 00% 00%. 202/3 A(HN)pdm09A(H3N2)BYamagataBVictoria 202/3A/California/7/2009 (HN)pdm09A/Victoria/36/20 (H3N2)B/Wisconsin//200 (Yamagata) 20/2B(Victoria)B/Brisbane/60/2008 H3N ,533 /, AHpdm , AH3 85 3,86, B B Yamagata Victoria 2,, 3 : 2, 2., AH3N2 B,, IASR 33: , 202, MDCK,,,, MDCK 2 202/3,, A/ California/7/2009HNpdm09, A/Victoria/36/ 20H3N2, B/Wisconsin//200Yamagata, B/Brisbane/60/2008Victoria HI, B, NESID, NESID, AHpdm , AH3 : 0 225, B/Yamagata : 50 26, B/Victoria : HI, 202/3 A/California/7/2009HNpdm09, A/Victoria/36/20H3N2, B/Wisconsin//200 Yamagata, 95, 98, 00,, B Victoria, 00 20/2 B/ Brisbane/60/ AHNpdm09 44, AH3N2 33, B 58,,, AHNpdm09 2 2,,, ,, A, B WHO

21 Vol. 34 No Corynebacterium ulcerans 200, Corynebacterium ulcerans C. ulcerans,, : 57 : : 2 : 4 7, 2 : 20 38,, 2,,,, C. ulcerans EM,, 4, 7, 2 : C. ulcerans, PCR, : C. ulcerans 928 GilbertStewart,,,,,,,,, 4 3 Corynebacterium, C. ulcerans, C. ulcerans,, , , C. ulcerans,,, C. ulcerans, CLSI 202 Clinical and Laboratory Standards Institute CLSI,,, Minimum Inhibitory Concentration: MIC CPFX, MIC 4 mg/l, 2 mg/l, mg/l, mg/l, mg/l, 0.06mg /l,,,. CPFX Year MIC Interpretive Criteria [mg/l ] S I R MICsensitiveSintermediateI resistantr

22 2244 Vol. 34 No ,, CLSI CLSI20, CPFX, A 4 CLSI202, CPFX, 203/4 WHO :,,,,, AHNpdm09, AHNpdm09,,,, AH3N2, AH3N2,,, B, B,, AH5N, A H3N2variant v, AHNv, AHN2v, A H7N3, AH9N2 : , AH5N, AH5N,,, , AH3N2v 202,, AHNv, AHN2v, AH7N3AH9N : AHNpdm09 : AHN A HNpdm09 HI,, A/California/7/2009HA, 6 7, HA S85T S45N AH3N2: , HI A/Victoria/36/20 A/Texas/50/202 HA 3C, 3A, 3B, 5, 6, HI B : B/Victoria/2/87VictoriaB/Yamagata/6/88, Victoria, HA B/ Brisbane/60/2008, B/Brisbane/60/ , 2 HI : : AHNpdm09, H275Y, A H3N2 B,,, M2 : AHNpdm09 AH3N2 M, M2 M2 S3N, AH3N2 :, 3,,, HI AH3N2 A/California/7/2009 HI, AHNpdm09 A/Victoria/36/20

23 Vol. 34 No HI, AH3N2, AH3N2 B/Wisconsin//200 HI,, 3 2 Victoria 203/4 : A/California/7/2009HNpdm09 A/Victoria/36/20 AH3N2 B/Massachusetts/2/202 B 2 4 B/Brisbane/60/2008 WHO, WER, 88, No. 0, 04, 203,, Salmonella Typhimurium, Pusle Net , 4, 202 8, , 9, 3 4, 5 4,,,, 5,,, CDC, MMWR, 62, No. 4, 73, 203 : IASR Vol. 34, No. 2 p.20 8 : : A E NA E NA 39 DVS UVS2 UVS4 6 DVS: Degraded Vi positive strain UVS2: Untypable Vi strain group2 UVS4: Untypable Vi strain group4 NA: CPFX: CPFX, NA CPFX, NA CPFX, NA NA

24 2446 Vol. 34 No Verotoxinproducing E.coli 7 ( ) ( ) Enterotoxigenic enic E.coli 3 ( ) 2 ( ) ( ) 3 Enteropathogenic E.coli Enteroaggregative E.coli ( ) 2 6 ( 2) 3 Other diarrheagenic E.coli 3 5 ( 2) 4 0 ( 4) Salmonella Typhi 2 ( 2) Salmonella Paratyphi A ( ) ( ) ( ) ( ) 2 ( ) Salmonella O Salmonella O Salmonella O Salmonella O Salmonella O3,0 3 ( ) Salmonella O,3,99 Salmonella O Salmonella O3 Salmonella O6 Salmonella O7 Salmonella O8 2 Salmonella O35 Salmonella O39 Salmonella group unknown Vibrio cholerae O:El Tor Ogawa awa,ct+ ( ) ( ) ( ) ( ) Vibrio cholerae nono&o39 2 Vibrio parahaemolyticus 8 4 Vibrio furnissii Aeromonas sobria Plesiomonas shigelloides Campylobacter jejuni ( 4) Campylobacter coli Staphylococcus aureus Clostridium perfringens Clostridium botulinum A Bacillus cereus 2 2 Listeria monocytogenes Yersinia enterocolitica 3 Shigella dysenteriae 4 Shigella flexneri b Shigella flexneri 2 a ( ) 2 ( 2) Shigella flexneri 2b 2 2 Shigella flexneri 3 a ( ) Shigella flexneri 4 a ( ) Shigella flexneri 6 ( ) Shigella flexneri other serovars Shigella flexneri untypable Shigella boydii 2 ( ) Shigella boydii 4 Shigella boydii 9 ( ) Shigella sonnei 7 ( 4) 3 ( 3) 3 ( ) 4 ( 2) 2 ( 2) 22 ( 2) 2 ( ) Kudoa septempunctata Streptococcus tococcus group A Streptococcus group B Streptococcus group C Streptococcus tococcus group G Streptococcus tococcus other groups S.dysgalactiae subsp.equisimilis Streptococcus tococcus group unknown Streptococcus pneumoniae Bordetella pertussis Clostridium tetani Legionella pneumophila Mycobacterium tuberculosis Mycobacterium bovis MAC Mycoplasma pneumoniae Haemophilus influenzae b 2 Haemophilus influenzae nonb Klebsiella pneumoniae Neisseria meningitidis Enterococcus faecalis 3 Enterococcus faecium 2 Enterococcus gallinarum Enterococcus casseliflavus Pseudomonas aeruginosa Leptospira interogans Cryptococcus neoformans 555 ( 8) 480 ( 5) 336 ( 3) 372 ( 5) 290 ( 3) 327 ( 24) 26 ( 4) 409 ( 3) 64 ( 7) 595 ( )

25 Vol. 34 No ( ) 0 62 ( 2) ( 2) 389 ( 7) Verotoxinproducing E.coli ( 2) 7 ( 5) Enterotoxigenic enic E.coli Enteropathogenic E.coli ( 3) Enteroaggregative E.coli ( 6) Other diarrheagenic E.coli 3 ( ) 2 ( 2) ( ) 2 ( 2) 3 ( 8) Salmonella Typhi ( ) 2 ( 2) ( ) ( ) 3 ( 0) Salmonella Paratyphi A ( ) 284 ( ) Salmonella O ( ) ( 2) 284 ( 3) Salmonella O Salmonella O ( 2) 267 ( 2) Salmonella O ( ) Salmonella O3,0 2 Salmonella O,3,99 Salmonella O 5 Salmonella O3 Salmonella O6 Salmonella O7 6 Salmonella O8 Salmonella O35 2 Salmonella O Salmonella group unknown 4 ( 4) Vibrio cholerae O:El Tor Ogawa,CT+ 3 Vibrio cholerae nono&o Vibrio parahaemolyticus Vibrio furnissii Aeromonas sobria Plesiomonas shigelloides ( 4) Campylobacter jejuni Campylobacter coli Staphylococcus aureus Clostridium perfringens 2 Clostridium botulinum A Bacillus cereus 2 Listeria monocytogenes Yersinia enterocolitica ( ) ( ) Shigella dysenteriae 4 ( ) ( ) 3 ( 2) Shigella flexneri b 3 7 ( 3) Shigella flexneri 2a ( ) 5 ( ) Shigella flexneri 2b 4 ( ) Shigella flexneri 3a ( ) Shigella flexneri 4a ( ) Shigella flexneri 6 ( ) 2 ( ) Shigella flexneri other serovars ( ) ( ) Shigella flexneri untypable ( ) Shigella boydii 2 Shigella boydii 4 ( ) Shigella boydii 9 ( ) 3 ( 8) 2 ( 2) 3 ( 2) 2 ( 2) ( ) 3 ( ) 70 ( 32) Shigella sonnei 2 Kudoa septempunctata Streptococcus tococcus group A Streptococcus group B 2 2 Streptococcus group C Streptococcus tococcus group G 2 3 Streptococcus tococcus other groups 4 S.dysgalactiae subsp.equisimilis Streptococcus tococcus group unknown Streptococcus pneumoniae Bordetella pertussis Clostridium tetani Legionella pneumophila Mycobacterium tuberculosis Mycobacterium bovis MAC Mycoplasma pneumoniae 2 Haemophilus influenzae b Haemophilus influenzae nonb 0 2 Klebsiella pneumoniae 2 4 Neisseria meningitidis 7 Enterococcus faecalis 7 Enterococcus faecium 3 Enterococcus gallinarum Enterococcus casseliflavus Pseudomonas aeruginosa Leptospira interogans Cryptococcus neoformans 807 ( 2) 622 ( 2) 50 ( 4) 344 ( 4) 339 ( 5) 82 ( 5) 53 ( 5) 6 ( 0) 7348 ( 0)

26 2648 Vol. 34 No Verotoxinproducing E.coli 2 2 Enterotoxigenic E.coli 2 ( 2) Enteropathogenic E.coli Enteroaggregative E.coli Other diarrheagenic E.coli Salmonella T yphi ( ) ( ) Salmonella Paratyphi A ( ) Salmonella O ( ) 3 Salmonella O 7 7 ( 2) Salmonella O8 Salmonella O 9 3 ( ) ( ) Campylobacter jejuni Campylobacter coli Staphylococcus aureus 8 Clostridium perfringens Bacillus cereus Yersinia enterocolitica Shigella flexneri Shigella sonnei Streptococcus group A Bordetella pertussis Mycobacterium tuberculosis Mycoplasma pneumoniae 22 ( ) ( ) 6 32 ( 5) 5 ( 2) ( ) Salmonella O4 Typhimurium 2 O4 Agona O4 Stanley O4 Saintpaul O4 Schwarzengrund O4 Bradford O 4 Schleissheim ( ) O4 I 4:i: O4 Others O7 Infantis 2 O7 Montevideo O7 Virchow O 7 Mbandaka 3 ( 2) O7 Not typed O8 Manhattan O8 Bardo O 9 Enteritidis 3 ( ) ( ) Shigella Shigella flexneri 2a Shigella sonnei T T2 T4 T6 T2 T28 TB3264 Untypable

27 Vol. 34 No Verotoxinproducing E.coli 3 ( 2) Enterotoxigenic E.coli Enteropathogenic E.coli 3 3 Enteroaggregative E.coli 3 4 Other diarrheagenic E.coli 2 ( 2) Salmonella Typhi ( ) Salmonella Paratyphi A 4 ( ) Salmonella O4 0 ( 2) Salmonella O7 2 Salmonella O8 5 ( 2) Salmonella O Campylobacter jejuni Campylobacter coli 7 8 Staphylococcus aureus 2 Clostridium perfringens 2 Bacillus cereus Yersinia enterocolitica 3 3 Shigella flexneri Shigella sonnei 3 32 Streptococcus group A 2 Bordetella pertussis 6 6 Mycobacterium tuberculosis Mycoplasma pneumoniae ( 0) Salmonella 3 O4 Typhimurium O4 Agona O4 Stanley O4 Saintpaul 4 O4 Schwarzengrund O4 Bradford ( ) O4 Schleissheim O4 I 4:i: O4 Others 4 O7 Infantis O7 Montevideo O7 Virchow 3 ( 2) O7 Mbandaka O7 Not typed O8 Manhattan O8 Bardo 5 ( 2) O9 Enteritidis Shigella 3 3 Shigella flexneri 2a Shigella sonnei 3 T 2 T2 3 T4 T6 3 T2 3 T28 4 TB Untypable

28 2850 Vol. 34 No Verotoxinproducing E.coli 0 0 Enterotoxigenic E.coli 2 2 Enteropathogenic E.coli Enteroaggregative E.coli 3 3 Salmonella Typhi Salmonella Paratyphi A 2 2 Salmonella O4 3 4 Salmonella O9 Campylobacter jejuni 3 4 Staphylococcus aureus 3 Yersinia pseudotuberculosis Shigella flexneri 2a 3 3 Shigella flexneri 6 Shigella sonnei Streptococcus pyogenes 0 0 Streptococcus agalactiae Bordetella pertussis 2 Mycoplasma pneumoniae Verotoxinproducing E.coli Enterotoxigenic E.coli 2 2 Salmonella Paratyphi A 2 Campylobacter jejuni Shigella flexneri 6 Influenza virus A H3 2 Measles virus genotype D8 Measles virus genotype H Dengue virus 2 Dengue virus 2 2 Dengue virus 3 2 Dengue virus Chikungunya virus Adenovirus 6 Hepatitis A virus NT Dengue virus NT Dengue virus 2 Chikungunya virus 2 2 / NT :

29 Vol. 34 No Picornavirus NT Enterovirus NT Coxsackievirus A NT 2 2 Coxsackievirus A Coxsackievirus A Coxsackievirus A Coxsackievirus A Coxsackievirus A7 2 Coxsackievirus A Coxsackievirus A Coxsackievirus A Coxsackievirus A Coxsackievirus A Coxsackievirus A Coxsackievirus B Coxsackievirus B Coxsackievirus B Coxsackievirus B Coxsackievirus B Coxsackievirus B6 Echovirus 2 Echovirus Echovirus Echovirus Echovirus Echovirus 4 6 Echovirus 4 Echovirus Echovirus Echovirus Echovirus 20 Echovirus 2 2 Echovirus Echovirus 30 Poliovirus Poliovirus Poliovirus Enterovirus 68 Enterovirus Parechovirus NT Parechovirus Parechovirus 3 Rhinovirus Aichivirus 2 3 Influenza virus A not subtyped Influenza virus A Hpdm Influenza virus A H Influenza virus B NT Influenza virus B/Victoria Influenza virus B/Yamagata Influenza virus C Parainfluenza virus Respiratory syncytial virus Human metapneumovirus Other coronavirus Mumps virus Measles virus genotype NT Measles virus genotype A Measles virus genotype D4 4 6 Measles virus genotype D Measles virus genotype D Measles virus genotype H 4 9 Rubella virus genotype NT Rubella virus genotype a 2 Rubella virus genotype E Rubella virus genotype 2B Dengue virus Chikungunya virus 2 7 Rotavirus group unknown 2 Rotavirus group A Rotavirus group C Astrovirus Norovirus genogroup unknown Norovirus genogroup I Norovirus genogroup II Sapovirus genogroup unknown Sapovirus genogroup I Sapovirus genogroup II Sapovirus genogroup III 2 2 Sapovirus genogroup IV Sapovirus genogroup V Adenovirus NT Adenovirus Adenovirus Adenovirus Adenovirus Adenovirus Adenovirus Adenovirus 7 2 Adenovirus Adenovirus 3 Adenovirus 9 Adenovirus Adenovirus 33 Adenovirus 34 Adenovirus 35 Adenovirus Adenovirus 40/ Adenovirus Adenovirus 53/ Adenovirus Adenovirus Herpes simplex virus NT Herpes simplex virus Herpes simplex virus Varicellazoster virus Cytomegalovirus Human herpes virus Human herpes virus EpsteinBarr virus Hepatitis A virus NT Hepatitis A virus IA Hepatitis A virus IB 2 Hepatitis A virus IIIA 3 4 Hepatitis E virus 2 Human papilloma virus B9 virus Human bocavirus Human immunodeficiency virus 2 Virus NT Chlamydophila pneumoniae Orientia tsutsugamushi Rickettsia japonica NT :

30 Picorna NT Picorna NT Entero NT Entero NT Coxsackie A2 Coxsackie A2 6 2 Coxsackie A4 Coxsackie A4 Coxsackie A5 Coxsackie A5 Coxsackie A Coxsackie A Coxsackie A8 Coxsackie A8 Coxsackie A9 Coxsackie A9 2 Coxsackie A2 Coxsackie A2 Coxsackie A4 Coxsackie A4 Coxsackie A6 Coxsackie A6 2 2 Coxsackie B Coxsackie B Coxsackie B2 Coxsackie B2 2 Coxsackie B Coxsackie B3 2 Coxsackie B4 Coxsackie B4 Coxsackie B5 Coxsackie B5 Echo 3 Echo cho E Echo 7 Echo 7 5 Echo 9 Echo 9 2 Echo Echo Echo 8 Echo 8 Echo 25 Echo 25 Entero 7 Entero Parecho NT Parecho NT 3 Parecho Parecho hino R 6 6 Aichi Aichi Influenza A not subtyped Influenza A not subtyped 3 Influenza A Hpdm0 Influenza A Hpdm Influenza A H Influenza A H Influenza B NT Influenza B NT Influenza B/Victoria Influenza B/Victoria Influenza B/Yamagat Influenza B/Yamagata Parainfluenza Parainfluenza Respiratory syncytial Respiratory syncytial Human metapneum Human metapneumo Other corona Other corona Mumps Mumps Measles genotype NT Measles genotype NT 3 Measles genotype A Measles genotype A 2 Measles genotype D8 Measles genotype D8 Measles genotype D9 Measles genotype D9 Measles genotype H Measles genotype H Rubella genotype NT Rubella genotype NT Rubella genotype a Rubella genotype a Rubella genotype E Rubella genotype E 2 3 Rubella genotype 2B Rubella genotype 2B Dengue Dengue 2 2 Chikungunya Chikungunya Rota group unknown Rota group unknown Rota group A Rota group A Astro Astro Noro genogroup unknown Noro genogroup unknown Noro genogroup I Noro genogroup I Noro genogroup I Noro genogroup II Sapo genogroup unknown Sapo genogroup unknown Sapo genogroup I Sapo genogroup I Sapo genogroup II Sapo genogroup II 2 2 Sapo genogroup IV Sapo genogroup IV Adeno NT Adeno NT deno A deno A Adeno 3 Adeno Adeno 4 Adeno 4 9 Adeno 5 Adeno Adeno 6 Adeno 6 Adeno 8 Adeno Adeno Adeno Adeno 3 Adeno 3 Adeno 37 Adeno 37 Adeno 40/4 Adeno 40/4 Adeno 4 Adeno 4 2 Adeno 53/22 Adeno 53/22 Adeno 54 Adeno 54 Adeno 56 Adeno 56 Herpes simplex NT Herpes simplex NT 4 Herpes simplex Herpes simplex Herpes simplex 2 Herpes simplex 2 Varicellazoster Varicellazoster 8 Cytomegalo Cytomegalo Human herpes Human herpes Human herpes Human herpes EpsteinBarr EpsteinBarr Hepatitis A NT Hepatitis A NT 2 2 Hepatitis A IA Hepatitis A IA 2 2 Hepatitis E Hepatitis E Human papilloma Human papilloma 30 B9 B9 Human boca Human boca 4 3 Chlamydophila pneumoniae Chlamydophila pneumoniae Orientia tsutsugamushi Orientia tsutsugamushi NT : Vol. 34 No

31 Picorna NT Picorna NT Entero NT Entero NT Coxsackie A2 Coxsackie A2 4 Coxsackie A4 Coxsackie A Coxsackie A5 Coxsackie A Coxsackie A6 Coxsackie A Coxsackie A8 Coxsackie A Coxsackie A9 Coxsackie A9 8 8 Coxsackie A2 Coxsackie A2 Coxsackie A4 Coxsackie A Coxsackie A6 Coxsackie A6 2 Coxsackie B Coxsackie B 4 Coxsackie B2 Coxsackie B2 6 Coxsackie B3 Coxsackie B Coxsackie B4 Coxsackie B Coxsackie B5 Coxsackie B5 2 Echo 3 Echo Echo 6 Echo Echo 7 Echo 7 6 Echo 9 Echo 9 2 Echo Echo Echo 8 Echo 8 2 Echo 25 Echo Entero 7 Entero Parecho NT Parecho NT 7 Parecho Parecho Rhino Rhino Aichi Aichi 2 8 Influenza A not subtyped Influenza A not subtyped Influenza A Hpdm09 Influenza A Hpdm Influenza A H3 Influenza A H Influenza B NT Influenza B NT Influenza B/Victoria Influenza B/Victoria Influenza B/Yamagata Influenza B/Yamagata Parainfluenza Parainfluenza Respiratory syncytial Respiratory syncytial Human metapneumo Human metapneumo Other corona Other corona Mumps Mumps 3 Measles genotype NT Measles genotype NT Measles genotype A Measles genotype A Measles genotype D8 Measles genotype D8 3 Measles genotype D9 Measles genotype D9 2 2 Measles genotype H Measles genotype H Rubella genotype NT Rubella genotype NT Rubella genotype a Rubella genotype a 7 Rubella genotype E Rubella genotype E Rubella genotype 2B Rubella genotype 2B Dengue Dengue 3 Chikungunya Chikungunya 2 Rota group unknown Rota group unknown Rota group A Rota group A Astro Astro Noro genogroup unknown Noro genogroup unknown Noro genogroup I Noro genogroup I Noro genogroup II Noro genogroup II Sapo genogroup unknown Sapo genogroup unknown Sapo genogroup I Sapo genogroup I Sapo genogroup II Sapo genogroup II Sapo genogroup IV Sapo genogroup IV Adeno NT Adeno NT Adeno Adeno Adeno 2 Adeno Adeno 3 Adeno Adeno 4 Adeno Adeno 5 Adeno Adeno 6 Adeno 6 6 Adeno 8 Adeno 8 Adeno Adeno 3 8 Adeno 3 Adeno Adeno 37 Adeno Adeno 40/4 Adeno 40/ Adeno 4 Adeno 4 Adeno 53/22 Adeno 53/ Adeno 54 Adeno Adeno 56 Adeno Herpes simplex NT Herpes simplex NT Herpes simplex Herpes simplex Herpes simplex 2 Herpes simplex Varicellazoster Varicellazoster Cytomegalo Cytomegalo Human herpes 6 Human herpes Human herpes 7 Human herpes EpsteinBarr EpsteinBarr 4 Hepatitis A NT Hepatitis A NT 5 Hepatitis A IA Hepatitis A IA Hepatitis E Hepatitis E Human papilloma Human papilloma B9 B Human boca Human boca Chlamydophila pneumoniae Chlamydophila pneumoniae 7 7 Orientia tsutsugamushi Orientia tsutsugamushi NT: NT: Vol. 34 No

32 Picornavirus NT Picornavirus NT Enterovirus NT Enterovirus NT Coxsackievirus A2 Coxsackievirus A Coxsackievirus A4 Coxsackievirus A Coxsackievirus A5 Coxsackievirus A Coxsackievirus A6 Coxsackievirus A Coxsackievirus A8 Coxsackievirus A Coxsackievirus A9 Coxsackievirus A Coxsackievirus A2 Coxsackievirus A2 7 8 Coxsackievirus A4 Coxsackievirus A4 Coxsackievirus A6 Coxsackievirus A Coxsackievirus B Coxsackievirus B 2 Coxsackievirus B2 Coxsackievirus B2 2 4 Coxsackievirus B3 Coxsackievirus B3 3 6 Coxsackievirus B4 Coxsackievirus B Coxsackievirus B5 Coxsackievirus B Echovirus 3 Echovirus Echovirus 6 Echovirus Echovirus 7 Echovirus Echovirus 9 Echovirus Echovirus Echovirus 2 2 Echovirus 8 Echovirus Echovirus 25 Echovirus Enterovirus 7 Enterovirus Parechovirus NT Parechovirus NT 4 7 Parechovirus Parechovirus Rhinovirus Rhinovirus Aichivirus Aichivirus Influenza virus A not subtyped Influenza virus A not subtyped 8 8 Influenza virus A H Influenza virus A Hpdm09 dm Influenza virus A H3 Influenza virus A H Influenza virus B N Influenza virus B NT Influenza virus B/Victori Influenza virus B/Victoria Influenza virus B/Yama Influenza virus B/Yamagat ata Parainfluenza virus Parainfluenza virus Respiratory syncytial virus Respiratory syncytial virus Human metapneumovirus Human metapneumovirus Other coronavirus Other coronavirus Mum Mumps virus s virus Measles virus genotype NT Measles virus genotype NT 2 3 Measles virus genotype A Measles virus genotype A 8 9 Measles virus genotype D8 Measles virus genotype D8 Measles virus genotype D9 Measles virus genotype D9 3 3 Measles virus genotype H Measles virus genotype H 2 2 Rubella virus genotype NT Rubella virus genotype NT Rubella virus genotype a Rubella virus genotype a Rubella virus genotype E Rubella virus genotype E 7 7 Rubella virus genotype 2B Rubella virus genotype 2B Dengue virus Dengue virus Chikungunya viru Chikungunya virus 2 3 Rotavirus group unknown Rotavirus group unknown 2 Rotavirus group A Rotavirus group A Astrovirus Astrovirus Norovirus Norovirus geno enogrou roup unknown unknown Norovirus genogroup I Norovirus genogroup I Norovirus genogroup II Norovirus genogroup II Sapovirus genogroup unknown Sapovirus genogroup unknown Sapovirus genogroup I Sapovirus genogroup I Sapovirus genogroup II Sapovirus genogroup II Sapovirus genogroup IV Sapovirus genogroup IV 5 5 Adenovirus NT Adenovirus NT Adenovirus Adenovirus Adenovirus 2 denovirus Adenovirus 3 denovirus Adenovirus 4 denovirus Adenovirus 5 denovirus Adenovirus 6 denovirus 6 8 Adenovirus 8 denovirus Adenovirus denovirus Adenovirus 3 denovirus Adenovirus 37 denovirus Adenovirus 40/4 denovirus 40/ Adenovirus 4 denovirus Adenovirus 53/22 denovirus 53/22 Adenovirus 54 denovirus Adenovirus 56 denovirus Her Herpes sim es simplex virus NT lex virus NT Her Herpes sim es simplex virus lex virus Herpes simplex virus 2 Herpes simplex virus 2 0 Varicellazoster virus Varicellazoster virus Cytomegalovirus Cytomegalovirus Human her Human herpes virus 6 es virus Human her Human herpes virus 7 es virus EpsteinBarr virus EpsteinBarr virus Hepatitis A virus N Hepatitis A virus NT 4 4 Hepatitis A virus I Hepatitis A virus IA 5 5 Hepatitis E viru Hepatitis E virus Human papilloma virus Human papilloma virus B9 virus B9 virus 3 5 Human bocavirus Human bocavirus Chlamydophila pneumoniae Chlamydophila pneumoniae Orientia tsutsugamushi Orientia tsutsugamushi NT NT Vol. 34 No

33 Vol. 34 No IASR Vol. 34 No. 5 May 203 Infectious Agents Surveillance Report Symptoms associated with EHEC infection, by serotype, EHEC O57 food poisoning caused by lightly pickled Chinese cabbagesapporo City Large scale EHEC O57:H7 food poisoning outbreak in Hokkaido in August 202; ISprinting analysis of the isolates obtained outside of Hokkaido On revision of hygienic standards of pickled vegetables in response to several food poisoning incidents related to lightly pickled vegetables Epidemiology of EHEC O57 food poisoning in 20202; possible influence of the tightened hygienic regulation of marketed beef and cattle liver for eating raw Food poisoning caused by VT&2 producing strain of EHEC O57:H7 in a restaurantaomori EHEC O26 VT outbreak in a nursery schoolosaka City... 3 EHEC O26 VT outbreak, which was attributed to contaminated water of a padding poolnagano EHEC O26:H VT outbreaks in nursery schoolskurashiki City ISSN National Institute of Infectious Diseases and Tuberculosis and Infectious Diseases Control Division, Ministry of Health, Labour and Welfare EHEC outbreak in a nursery school caused by serogroups O03 and ONiigata City EHEC O45 VT2 outbreak in a nursery schoolfukuoka City EHEC O57:H VT2 outbreak in a nursery schoolaomori Multiple EHEC cases among participants in a Beijing sightseeing tour Cluster analysis of the PFGE patterns exhibited by O57 and O26 isolated in various places in Japan, Hemolytic uremic syndrome that appeared in NESID: trends in Antigenic and drugresistance types of the epidemic influenza viruses in Japan in 202/3 season (progress report)... 4 Toxinproducing Corynebacterium ulcerancs isolated from a patient with diphtheria symptoms; the first report in Shiga Prefecture CLSI s modified criteria for evaluating clinical efficacy of fluoroquinolone antibiotics in terms of MIC for Salmonella Typhi and parenteral isolates of Salmonella <THE TOPIC OF THIS MONTH> Enterohemorrhagic Escherichia coli infection in Japan as of April 203 Enterohemorrhagic Escherichia coli (EHEC) infection is a category III notifiable infectious disease in the National Epidemiological Surveillance of Infectious Diseases (NESID) under the Law Concerning the Prevention of Infectious Diseases and Medical Care for Patients of Infections (Infectious Diseases Control Law). All the cases must be notified by a physician who has made the diagnosis ( When an EHEC infection is notified as food poisoning by physicians or judged as such by the director of the health center, the local government investigates the incident and submits the report to the Ministry of Health, Labour and Welfare (MHLW) in compliance with the Food Sanitation Law. Accordingly, there are two related but independent systems of notification, the one in compliance with the Infectious Diseases Control Law and the other in compliance with the Food Sanitation Law. Prefectural and municipal public health institutes (PHIs) conduct isolation of EHEC, serotyping, and verotoxin (VT) typing and report the result to Infectious Disease Surveillance Center (IDSC) in National Institute of Infectious Diseases (NIID). The Department of Bacteriology I, NIID conducts molecular epidemiological analysis, whose result is made available through the PulseNet Japan (see p. 39 of this issue). Cases notified under NESID: In 202 (JanuaryDecember), total 3,768 EHEC infections, 2,362 symptomatic and,406 asymptomatic, were reported (Table ). Asymptomatic infections are detected during the active surveillance of outbreaks or regular stool test of cooks. As in previous years, a large peak of epidemics occurred in summer (see weekly reports summarized in Fig. ). The incidence (cases per 00,000 population) was highest in Saga Prefecture (9.2) followed by Okayama (8.7) and Iwate Prefecture (8.4) (Fig. 2, left). As in previous years, incidence of EHEC infection was highest among the age group of 04 years followed by 59 year age group (Fig. 3). When prefectures were compared for the EHEC incidence (cases per 00,000 population) among 04 year age group, Okayama, Kagoshima and Miyazaki Prefectures were the highest (Fig. 2, right). Symptomatic cases were relatively high in young and aged groups and relatively low in population in their 30 s, 40 s and 50 s (Fig. 3). Total 94 hemolytic uremic syndrome (HUS) cases, corresponding to 4.0% of symptomatic cases, were reported in 202 (see p. 40 of this issue). Among 94 HUS cases, EHEC were isolated from 70 cases (the remaining 24 cases were EHEC isolation negative but LPS antibody positive or VT positive). Among the 70 cases, there were 58 O57, four O, two O26, two O45 and one each for O25, O65, O74 and O83. Sixtysix isolates among 70 were positive for VT2 or VT&2 (94%). Fifteen fatal cases were reported, among which three were HUS and two EHECrelated encephalopathy. EHEC isolated in PHIs: In 202, number of EHEC isolates that PHIs reported to the IDSC, NIID, was,957, which was far less than the reported number of EHEC infection cases, 3,768 (Table ). This discrepancy is due to the current situation where isolates in clinical or commercial settings are not always sent to PHIs. The most frequent Oserogroup was O57 (53%), followed by O26 (27%) and O03 (5.2%) (see Table on p. 25 of this issue). Among the O57 isolates double positives for VT and Table. Notified cases of EHEC infection Year Period Cases 999 Apr. Dec. 3 3, Jan. Dec. 3 3, Jan. Dec. 3 4, Jan. Dec. 3 3, Jan. Dec. 3 2, Jan. Dec. 3 3, Jan. Dec. 3 3, Jan. Dec. 3 3, Jan. Dec. 3 4, Jan. Dec. 3 4, Jan. Dec. 3 3, Jan. Dec. 3 4,35 20 Jan. Dec. 3 3, Jan. Dec. 3 3, Jan. Apr Including symptomatic and asymptomatic cases National Epidemiological Surveillance of Infectious Diseases Data based on the reports as of April 7, 203 Figure. Weekly incidence of EHEC infection from week of 2007 to week 5 of 203, Japan 350 Symptomatic and asymptomatic cases Week Year Week of diagnosis (National Epidemiological Surveillance of Infectious Diseases: Data based on the reports received before April 7, 203) 23 Continued on page 24

34 56 Vol. 34 No THE TOPIC OF THIS MONTHContinued Figure 2. Incidence of EHEC infection by prefecture, 202, Japan All ages Symptomatic and asymptomatic cases per 00,000 population (No. of prefectures) 0.0 (2).0 (3) 2.0 (9) 4.0 (0) 8.0 (3) 04 years Symptomatic and asymptomatic cases per 00,000 population (No. of prefectures) 0.0 (7) 8.0 (3) 6.0 (9) 32.0 (5) 64.0 (3) (National Epidemiological Surveillance of Infectious Diseases: Data based on the reports received before April 7, 203) Figure 3. Age distribution of cases of EHEC infection, JanuaryDecember 202, Japan % Rate of symptomatic cases 90 Males Females Females Males Symptomatic and asymptomatic cases 00 0 IASR Vol. 34 No. 5 May Age group (National Epidemiological Surveillance of Infectious Diseases: Data based on the reports received before April 7, 203) 0 0 Rate of symptomatic cases VT2 genes were predominant (68%) as in previous years (5378% in 99720). Among O26 and O03, 94% and 97%, respectively, were single positive for VT. Information on clinical symptoms were available for 973 cases among,040 cases of O57. Major symptoms were abdominal pain (64% of the cases), diarrhea (62%), bloody diarrhea (46%), and fever (2%) (see Table on p. 25 of this issue). Outbreaks: In 202, PHIs reported to IDSC twentythree EHEC outbreaks, including six outbreaks caused by O57. Sixteen outbreaks involving ten or more EHECpositive cases are shown in Table 2. Five outbreaks were suspected to be foodborne, and ten were suspected for persontoperson transmission. In 202, prefectures reported 7 EHEC incidents with 398 symptomatic patients (isolation negative cases included) in compliance with the Food Sanitation Law (25 incidents and 74 patients in 20). In 202, there was an EHEC O57 outbreak caused by lightly pickled vegetables (see pp. 26 & 27 of this issue). The outbreak mainly affected an elderly facility in Sapporo City, but as the product was distributed to supermarkets, hotels and restaurants as many as 69 persons fell ill and eight died. Prevention an measures to be implemented: The basics for preventing EHEC infections are to observe the principles of food poisoning prevention and to avoid consumption of raw or undercooked beef. In response to persistent food poisonings caused by raw beef, MHLW revised the standards of the beef marketed for eating raw and put it into operation by issuing the MHLW notice No. 32 on October 20. Further, upon the detection of EHEC O57 in the inner part of cattle livers, MHLW banned marketing of the cattle liver for eating raw (notice No. 404 in July 202). As a consequence, the incidence of O57 cases related to consumption of raw beef or raw cattle liver significantly decreased in one year from 20 to 202 (see p. 29 of this issue). In response to O57 outbreaks caused by pickled vegetables, MHLW modified the hygiene standards of pickled vegetables (ShokuAnKanHatsu 02 No., 2 October 202) (see p. 28 of this issue). Like dysentery bacilli, EHEC establishes infection even at minute doses and can spread from person to person rather easily. The year 202 experienced several EHEC outbreaks in nursery schools (Table 2). Preventing such outbreaks needs appropriate hygienic practice, such as routine hand washing and sanitary use of children s padding pools during summer (see Infection Control Guidelines for Nurseries revised in November 202 that recommends confirmation of appropriate concentration of chloride ions and disinfection of water used for swimming baths). To prevent spread of EHEC within patients families, the health center should give full instructions to the families concerning prevention of secondary infections. Update 203: In 5 weeks of 203, 88 EHEC infections have been reported (Table ). As EHEC infection increases in summer season, increased level of vigilance is necessary. Table 2. Outbreaks of EHEC infection, 202 (Data based on the reports from public health institutes received before March 25, 203 and references in IASR) Prefecture Suspected route Symptomatic Positives Familial No. Period Setting of outbreak Serotype VT type Consumers /City of infection cases /examined infection Reference in IASR Saga P. May 23Jun. 6 Person to person Welfare facility O03:H2 VT 3 0 / 620 Yes 2 Osaka C. May 24 Foodborne* Nursery school O26:H VT / 404 Yes p.3 of this issue 3 Iwate P. May 28Jun. Foodborne Hotel O2:H9 VT2 8 N.D. 2 / 57 Yes 4 Chiba P. May 729 Person to person Nursery school O57:HNT VT&2 9 2 / 7 Yes 5 Fukuoka C. Jul. 09 Foodborne*2 Luncher O57:H VT&2 8 N.D. 0 / 42 No 6 Gifu P. Jul. 6Aug. 5 Person to person Day nursery O:H VT 5 7 / 23 Yes 7 Saga P. Jul. 23Aug. 5 Person to person Nursery school O26:H VT 26 / 20 Yes 8 Kurashiki C. Jul. 3Aug. 24 Unknown Three nursery schools O26:H VT 66 N.D. 05 / 533 Yes p. 34 of this issue 9 Hokkaido P.&O* Aug. 2 Foodborne*3 Welfare facility** O57:H7 VT&2 69 N.D. 73 / 65 Yes p. 26 of this issue 0 Fukuoka C. Aug. 0Sep. 4 Person to person Nursery school O45:H VT2 4 / 382 Yes p. 35 of this issue Nagano P. Aug. 028 Person to person*4 Nursery school O26:H VT, VT() 62 6 / 330 Yes p. 32 of this issue 2 Aomori P. Aug. 530 Foodborne Restaurant O57:H7 VT&2 4 N.D. 4 / 40 Yes p. 30 of this issue 3 Niigata P. Aug. 30Oct. 0 Person to person Nursery school O03:H VT 9 29 / 94 Yes p. 35 of this issue O:H VT 2 / 94 4 Aomori P. Oct. 36 Person to person Kindergarten O57:H VT / 286 Yes p. 36 of this issue 5 Chiba P. Oct. 27Feb. 28 Person to person Nursery school O26:HNT VT 3 9 / 32 Yes 6 Saitama C. Oct. 29Dec. 2 Person to person Nursery school O2:H9 VT2 5 7 / 598 Yes Including 0 or more EHECpositives, P.: Prefecture, C.: City, NT: Not typed, N.D.: No data, No information was entered because persontoperson infection was suspected. *Other prefectures, **for the elderly, * School lunch, *2 Catered lunch, *3 Lightly pickled Chinese cabbage, *4 Pool water The statistics in this report are based on ) the data concerning patients and laboratory findings obtained by the National Epidemiological Surveillance of Infectious Diseases undertaken in compliance with the Law Concerning the Prevention of Infectious Diseases and Medical Care for Patients of Infections, and 2) other data covering various aspects of infectious diseases. The prefectural and municipal health centers and public health institutes (PHIs), the Department of Food Safety, the Ministry of Health, Labour and Welfare, and quarantine stations, have provided the above data. Infectious Disease Surveillance Center, National Institute of Infectious Diseases Toyama 23, Shinjukuku, Tokyo , JAPAN Tel (+83)5285