untitled

Transcription

1 Infectious Agents Surveillance Report (IASR) : 3, : 5, NESID 6, : 7, : 9, L. pneumophila SG3 ST93 : 0,, ATP 3, 4, 5, Human coronavirus : 6, AH7N9 : 8, A H7N9 : 9, HIV AIDS 9 Vol. 34 No Vol.34 No. 6 No.400 ISSN Tel ,,, :,,, Legionella spp.,,,,, , 7 iasr/34/400/graph/f400aj.gif,, , 7.5, 0 03, , ; MMWR 60: , 0,,, 045, : kenkou/kekkakukansenshou/ html , 3 4, * *

2 56 Vol. 34 No ,, 9, 90, 48, 44, , 9.8, 8.5, 700.5, 3, , 95.3, : 4,08, 3,98 96, 3.8, 69.7, PCR LAMP 6.5, Legionella pneumophila SG, LAMP 0 0, 0 LAMP 5 34, 4,03 9, 4, 5 7, 8,.8, 4., 5.3, : 3,, 7, 6 L. pneumophila SG 6 5, L. feeleii, L. rubrilucens, 3 SG SGSG6, SG, 6, 9, 4 SG L. pneumophila 4 SG, SG3 6, SG6 4, SG5, SG0, SG, SG9, SG5 L. londiniensis, L. longbeachae, 9 : 008, IASR 9: 39330, 008, 008 7, IASR 9: 33033, 008, , IASR 3: 07 09, 00, 0 9 9, 0 3, 5, 0 9, 3, 008 0,, 5 3, 0 3,,, IASR 3: 3333, 00 & 3: 33333, 00,,, 5, IASR 3: 35, 0, IASR 6:, 005 IASR 9: 9394, 008,,, 3, 4,, 4, 00 ml 0 CFU ATP, 3 3 4,, mhlw.go.jp/bunya/kenkou/seikatsueisei09/03. html, 3,,, sequencebased typing 7, 6 :

3 Vol. 34 No , 8,,,, 30,,,,, 8 5,,, 8, 8, 3 Legionella Legionella pneumophila SG,.0 0 CFU/00 ml 0, L. pneumophila SG, L. pneumophila SG PFGE, 8,,, 5, L. pneumophila SG, PFGE, PFGE, 0 5, PFGE, 8 99,,, 7, Table. Methods of diagnosis for legionellosis, 0080 Methods of diagnosis A. A. Isolation and/or identification of Legionella B. B. Fluorescent antibody detection of Legionella antigens (including immunoenzayme method) C. C. Detection of Legionella antigens in urine D. PCRLAMP D. PCR detection of the bacterial genome (including LAMP method) E. E. Detection of serum antibodies by indirect immunofluorescence assay Year Total 6 (7) 3 () (8) (6) 3 () 45 (3) () 3 (3) () () 4 (8) 858 (879) 674 (695) 70 (70) 77 (790) 83 (844) 3,835 (3,98) (9) 6 (0) 9 () 8 () 7 (0) 4 (6) 9 () 4 (7) 7 (8) 9 () 5 (5) 54 (6) F. F. Detection of serum antibodies by microplate agglutination test () () 4 (4) 7 (7) AC Methods A and C ACD Methods A, C, and D 3 ACE Methods A, C, and E AD Methods A and D BC Methods B and C 4 CD Methods C and D CE Methods C and E 6 CDE Methods C, D, and E Total ,08 ( ): ( ): Total number of cases including those diagnosed by more than one method. (National Epidemiological Surveillance of Infectious Diseases: Data based on the reports as of May 5, 03)

4 458 Vol. 34 No (kb) M M. PFGE Sfi I, ,, 6 9, 5080, 6, 3, 004 6, 800,,, 6, 6 4, ph 8.,,,,, 5, 7,,,,,,, L. pneumophila SG, PFGE,,,,,,,,, L. pneumophila SG, PFGE, EWGLI European Working Group for Legionella Infections, org sequence basedtyping: SBT, PFGE 3, 7, 7, 6, 7, 5, 3, 9,, SBT, ST45, PFGE, ST89,, PFGE SBT,,, PFGE,,,,, 4, 53 AmemuraMaekawa J, et al., Appl Environ Microbiol 78: , 0 Vol.34 No.4, p.7 5 9,, GAVI03 4, 04

5 Vol. 34 No ,, 6, 3 5,, ,,,,, 3,,,, 3,,,, 7,,,,,,,,,,,,, 3,. H4..8 CFU/00ml 4,300 5,700 3,500 3,300,, 4,,,, 38, 460,, 8 0 mg/l, 5, Legionella pneumophila, SG, SG6, UT,,,,,,, L. pneumophila SG,,,, 4,, PFGE L. pneumophila SG, SG6, UT SGPFGE Legionella pneumophila

6 660 Vol. 34 No , 6,,,,, L. pneumophila SG, SG,, PFGE,,,,, 8,,,,,,,,,,,,,,,,,, 0 3,,,,,, ,,,,,,,, 8, ,,, , , 5,, 3 : 37.5, 0 3 4,,, 4 3, ,,,, 4, 3, 3,. n=8

7 Vol. 34 No , 33 3, 75 4, No., No.3 3 3, Legionella pneumophila Stenotrophomonas maltophilia, Burkholderia cepacia, Pseudomonas aeruginosa 33 No., Stenotrophomonas maltophilia 87, 86,,, 4 75, Escherichia coli,,,,, 004,, X,, 5 underreporting,,,,,,,, WHO, 0 3,,,, WHO 3 4,,, 4 4,,,,,,,,,,,, p00,, 0,, Inoue, et al., Tsunami lung, J Anesth 6 : 46 49, 0 4Ebisawa, et al., Internal Medicine 509: 33 36, 0 5Maegele, et al., Critical Care 0: R50, 006 doi:0.86/cc4868, , , 009 8, 00 33, 0 39, ,,,,,, 9 Legionella pneumophila SG 65, SG 4, SG3 8, SG5, SG6 5, SG9, SG0,

8 86 Vol. 34 No L. pneumophila ST0080 ST ( SG) 3 ST3 (S), ST38* (B3) 0 ST0 (S) 8 ST (C), ST93 (SG3) 6 ST384* (S) 5 ST609 (U) 4 ST4 (N), ST89 (S), ST644* (B) 3 ST3* (B), ST3* (S), ST353* (S), ST077 * (U) ST (B), ST39 (SG), ST59 (B), ST68 (SG6, SG), ST (U), ST4 (S3), ST56 (B), ST354* (SG), ST505* (B), ST530* (B), ST537* (SG6), ST550* (S), ST566 * (B), ST679* (S), ST687* (B), ST850* (S), ST876* (S), ST36* (SG9, UT) S, S3:B, B, B3:C: U:N: *03 5 SG, SG5,, Legionella feeleii, Legionella londiniensis, Legionella longbeachae, Legionella rubrilucens L. pneumophila, EWGLI European Working Group of Legionella Infections SBT sequencebased typing, flaa, pile, asd, mip, momps, proa, neua, php/sbt_homepage.php L. pneumophila 9 00 ST, , SBT, ST, ST3 ST38 3, ST0 0, ST ST93 8 ST3, ST ST38 3, ST ST0, 9 ST,, ST, ST93 0 L. pneumophila SG 50, 50, 34 SBT, 8 B, B, B3, C, C, S, S, S3 ST, ST, SG, S 63 ST3, ST0, B 67 ST38, C 0 ST, 5 8 ST, U 0, B 75,,,, S 30, U 7, C 0, ST,,,,, 4 3 ST S,,,,, L. pneumophila SG,,,,,, AmemuraMaekawa J, et al., Appl Environ Microbiol 78: , 0

9 Vol. 34 No , 90 Legionella pneumophila SG, L. pneumophila SG,,,,, 000,, ml, GVPC, L. pneumophila SG,, European Working Group for Legionella Infections EWGLI, sbt_homepage.php sequencebased typing SBT /34, 54, 099 CFU/ 00ml 34, CFU/00ml 8,,000 CFU/00ml 8, , 4/ , 30/74, P0.05, SD log0 CFU/00ml , t, P , 4, 54 40, 90 L. pneumophila SG , 8 L. pneumophila SG, SBT 44 ST, ST48 ST0 8,, ST48 5, 44 ST, ST ST, ST48,, ST0,, EWGLI ST0, ST0 6 ST0, 5.3 7,,, 7, L. pneumophila SG 8, L. pneumophila SG,, ST0 L. pneumophila SG,, Kanatani JI, et al., J Infect Chemother 0 Epub, ahead of print Sakamoto R, et al., Emerg Infect Dis 5:

10 064 Vol. 34 No , 009 3IASR 9: 3738, 008 4IASR 9: 3333, 008 5AmemuraMaekawa J, et al., Appl Environ Microbiol 78: , 0 6Kanatani JI, et al., Appl Environ Microbiol 03 Epub, ahead of print 7Wallensten A, et al., Eur J Epidemiol 5: , 00 8Palmer ME, et al., Eur J Epidemiol 7: 667, 0 Legionella pneumophila 3 sequence type 93, L. pneumophila SG3 sequence type ST93,,., , ,,, L. pneumophila SG3 7, sequencebased typing SBT, ST PFGE, IASR 9: , 008,. : 6 L. pneumophila, SG 6, SG, SG3 8, SG0, SG,,,,,,,, SG3,, SG, SBT SG ST, SG3 8 ST93, PFGE 7 : L. pneumophila SG3 7, SBT 8 7, PFGE 7 7, SBT 7, ST PFGE ST PFGE, ST37, PFGE : b ST38, PFGE : a 3, ST 7 PFGE 5,, PFGE, 7 PFGE, 3., , L.

11 Vol. 34 No L. pneumophila 3 pneumophila SG, 9 L. pneumophila, SG 6, SG3 8, SG SG0 SBT, L. pneumophila SG ST, L. pneumophila SG3 8 ST93 PFGE, L. pneumophila SG3, ST93,,, 0 4, ST93 L. pneumophila SG3 3,,, 8 ST93 ST93,, L. pneumophila SG3, ST93 L. pneumophila SG, ST93 L. pneumophila SG3,,, 3 6, 3, LAMP PCR,,,,,, DNA EMA ethidium monoazide, PCR, DNA EMAqPCR,, EMA,,, 8 PCR Liquid Culture LCRTqPCR LC RT, EMAqPCR EMA LC EMAqPCR LC EMA

12 66 Vol. 34 No RNA60 RTqPCR90 5* 368 EMA30 DNA30 qpcr90 CFU/00ml) LC viable (log y R² = plate count (log CFU/00ml) y = 0.704x R² = CFU/00ml CFU/00ml Plate count Plate count LC RT Viable LC Legionella EMAqPCR ,, , LC RTqPCR 83.3%, 96.6% (a) LC RTqPCR 95.5%, 75.4% (b) LC EMAqPCR,,,,000, MWY 36 8,, 00 total RNA, Diederen qpcr RTqPCR 5S rrna, rrna Acanthamoeba castellanii, Legionella pneumophila S rrna, CFU , 5S rrna CFU rrna Total Legionella, rrna Viable Legionella, Ct, CFU/00 ml Viable Legionella, Ct CFU/00 ml, , LC RT, Total Legionella 90.0, 8.9, 8 Viable Legionella 83.3, 96.6 Viable Legionella R 0.80, a. LC EMAqPCR, EMA, LC RT, EMA 5, 5 DNA EMA DNA, 6S rrna DNA 8 EMA 6S rrna, CFU 00, CFU 4 3 LC EMA, LC EMA 5 CFU/00 ml 95.5, 75.4, b ph 8.8, 0.8 mg/l, 0 CFU/00 ml L. pneumophila SG9LC RT Total Legionella 00 CFU/00 ml, Viable Legionella 0 CFU/00 ml, LC EMA 9 CFU/00 ml, LC RT Total Legionella 00 CFU/00 ml, Viable Legionella 88 CFU/00 ml, LC EMA 47 CFU/00 ml, 40 CFU/00 ml L. pneumophila SG, 9,,, log CFU/00ml) LC EMAqPCR (l 5 )y = 0.957x plate count (log CFU/00ml)

13 Vol. 34 No ,, LC RT, LC EMA,,,, Chang B, et al., Appl Environ Microbiol 75: 47 53, 009 Diederen BM, et al., J Med Microbiol 56: 940, 007 ATP,, ,, HACCP HACCP,,,,, ATP 008 0,,,,,,,, 9, 8 54,,,,, ph, ATP , 5, : , : 43., 5 7,000 CFU/00 ml, Legionella pneumophila, L. dumoffii L. micdadei, L. pneumophila SG SG 39, SG6 3, SG5 6, SG4 0 SG3 8 0 CFU/ml95,000,000 CFU/00 ml 0 CFU/ml40,000,000 CFU/ 00 ml 37, ppm, ph ATP , , 0.3,63. 3 RLU/0. ml,,,,, ph ATP,,,, ph,, 8.4,,,,,, 7,, ATP

14 468 Vol. 34 No , ATP, 7., ATP, ATP 30 RLU,, ATP,, ATP ATP,. ATP, ATP 00 ATP 7. ATP, ATP ATP,, ATP ATP, 0cm,,000 RLU, 3,, 0. mg/l0.4 mg/l,.0 mg/l, 5 7,,,, 7,, /,,,,, 3 6, 3 mg/l, m 3,, ph , mgn/l : 3,,,,, : 3 mg/l,,,, 3 :,,,.94.6g/l

15 Vol. 34 No /00 4 :.94.3 mgn/l,,, DPD, 0. mg/l,,, ph 9.0, 3 mg/l,,,,,, ph,,,, ,,, : 008, 8 Legionella pneumophila,, CFU/l SG, SG3 8, 8 9/3 6 3, 33 3/9L. pneumophila SG ST, Oxford/ OLDASG3 ST93 8/9, 996, IASR 9: 90, ,,,,,.50 3 CFU/l, dental unit waterline CFU/l L. pneumophila SG, ST593, Benidorm,, StokeonTrent spa pool, 3 L. pneumophila SG, ST68,, 00 3

16 670 Vol. 34 No , 3, 3,,.4,.5, 008, 4,00 CFU/00 ml, L. pneumophila SG,,, 0 7 8,, 0, , 3 6 9, 9 L. pneumophila SG 997,,,, ; 53, 48, 3 7 Yiallouros PK, et al., Clin Infect Dis, Epub ahead of print, 03 Ricci ML, et al., Lancet : 684, 0 3Coetzee N, et al., Euro Surveill 7 37: 68, 0 4Haupt TE, et al., Infect Control Hosp Epidemiol 33: 859, 0 5Chicago Tribune NEWS, Sep, 0; CNN.com Sep, 0 6CBC News Dec 6, 0; The Montreal Gazette Aug 6, 0; ProMed Sep 9, 0 7McCormick D, et al., Euro Surveill 7 8: 69, 0 Human coronavirus 03 4,, C,, RS,,,, Human coronavirus: HCoV HCoV HCoV, 78 HCoV 4, 5 RTPCR 6, 7 HCoV HCoV HCoV, 8, 3 5, 4 4,, 9E NL63, OC43 HKU SARS 0 Middle East respiratory syndrome coronavirus MERSCoV 8, 9 HCoV OC43 8, NL63 OC43 RS, MERS CoV HCoV 9 0. HCoV034

17 Vol. 34 No HCoV , , , , , , 6 0.7, 6.9, RS 3.4, /030/3 HCoV 8 0,, 03 4 HCoV ,.8,.8, 5.3 3, 7.5 0, 3.5,.8, , 7.0 4,.8, 8.8 5, 0,, HCoV,, IASR 33: 99, 0. HCoV,, IASR 33: 4445, pref.mie.jp/byougentai/kenshutu.htm 4,, IASR 9: 83, 008 5Kon M, et al., Jpn J Infect Dis 65: 707, 0 6Lau SKP, et al., J Clin Microbiol 44: 06307, 006 7Lam WY, et al., J Clin Microbiol 45: , 007 8Centers for Disease Control and Prevention CDC html 9,, IASR 33: , 0 0

18 87 Vol. 34 No nesid3g.mhlw.go.jp/byogentai/pdf/data95j.pdf AH7N9, CDC 3 AH7N9, 3 3 IHR WHO ARDS,, : , 4 9 8,, 8, , 0 3, , 7 75, 58 7, 4 PCR rrtpcr 7, , 7 8,689,, ILI, 0 CDC, , AH7N9 : Global Initiative on Sharing All Influenza Data GISAID 9, 5,, H7N3, H7N9, H9N3, WHO CDC,,, PFU BALB/c CDC, H75Y,, H7N9 H7N9, CDC rrtpcr H7 H7, 4 FDAEUA in vitro, : 4 6, 68,060, H7N9, USDA ARS,,, MMWR : H7N9 6, 7,, CDC, MMWR, 6, No. 8, 36637, 03

19 Vol. 34 No AH7N9, AH7N9 5 0 AH7N9, 9 /9 RTPCR,,, 7 60,,, 9 7,, RTPCR AH7N9 RNA 4, 8, 4 30, 4,, 4 60 : 38, n=9 50, 0,,, 9 0 0, ,, 9 AH7N9 RNA 9, 35, 38, AH7N9 RNA 7 75, 3 RNA 339,,, AH7N9 Euro Surveill. 03;8 0:pii=048 :, HIV AIDS HIV 7 57, 46 6,, 46 3,, 5 3. AIDS 07 4, 05 05,, 07, 0, HIV AIDS 334. HIV : 5 HIV HIV 9 35, 9, 030. AIDS : 63 AIDS 59 3 AIDS, 0, HIV,58 6,597, 5,05, 6,769 7,3, 7,7. 3,940 37,3, 39, ,,304,48,35,793. HIV 3 40,.763

20 074 Vol. 34 No , HIV, AIDS. HIV,, 3.,, HIV

21 Vol. 34 No

22 76 Vol. 34 No Verotoxinproducing E.coli ( ) Enterotoxigenic enic E.coli ( ) 9 ( ) 3 5 Enteroinvasive E.coli Enteropathogenic E.coli Enteroaggregative E.coli ( ) 6 ( ) 3 Other diarrheagenic E.coli 5 ( ) 4 0 ( 4) 6 Salmonella Typhi ( ) 3 Salmonella Paratyphi A ( ) ( ) ( ) ( ) Salmonella O Salmonella O Salmonella O Salmonella O Salmonella O3,0 ( ) Salmonella O,3,99 Salmonella O Salmonella O3 Salmonella O6 Salmonella O8 Salmonella O35 Salmonella O39 Salmonella group unknown 4 Vibrio cholerae O:El Tor Ogawa awa,ct+ ( ) ( ) ( ) ( ) Vibrio cholerae nono&o39 Vibrio parahaemolyticus Vibrio furnissii Aeromonas sobria Plesiomonas shigelloides Campylobacter jejuni ( 4) Campylobacter coli Staphylococcus aureus Clostridium perfringens Clostridium botulinum A Bacillus cereus Listeria monocytogenes Yersinia enterocolitica 3 Shigella dysenteriae 4 Shigella flexneri b ( ) Shigella flexneri a ( ) ( ) Shigella flexneri b Shigella flexneri 3 a ( ) Shigella flexneri 6 ( ) Shigella flexneri other serovars Shigella flexneri untypable Shigella boydii ( ) Shigella boydii 4 Shigella boydii 9 ( ) Shigella sonnei 3 ( 3) 3 ( ) 4 ( ) ( ) ( ) ( ) ( ) 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 4 5 Mycobacterium tuberculosis Mycobacterium bovis MAC Mycoplasma pneumoniae Haemophilus influenzae b Haemophilus influenzae nonb Klebsiella pneumoniae Neisseria meningitidis Enterococcus faecalis 3 Enterococcus faecium Enterococcus gallinarum Enterococcus casseliflavus Pseudomonas aeruginosa Leptospira interogans Cryptococcus neoformans 480 ( 5) 336 ( 3) 37 ( 5) 90 ( 3) 37 ( 4) 6 ( 4) 409 ( 3) 64 ( 7) 595 ( ) 807 ( )

23 Vol. 34 No ( ) 0 6 ( ) ( ) 3 ( ) 85 ( 7) Verotoxinproducing E.coli ( ) 5 73 ( 4) Enterotoxigenic enic E.coli Enteroinvasive E.coli ( ) 63 ( ) Enteropathogenic E.coli ( ) 49 ( 4) Enteroaggregative E.coli ( 6) Other diarrheagenic E.coli ( ) ( ) ( ) ( ) 3 ( 8) Salmonella Typhi ( ) ( ) ( ) ( ) ( 9) Salmonella Paratyphi A ( ) 3 6 ( ) Salmonella O4 6 ( ) ( ) 57 ( 3) Salmonella O Salmonella O ( ) 7 ( ) Salmonella O9 3 0 ( ) Salmonella O3,0 Salmonella O,3,99 Salmonella O 4 Salmonella O3 Salmonella O6 6 Salmonella O8 Salmonella O35 Salmonella O39 3 Salmonella group unknown 4 ( 4) Vibrio cholerae O:El Tor Ogawa awa,ct+ Vibrio cholerae nono&o39 3 Vibrio parahaemolyticus Vibrio furnissii Aeromonas sobria Plesiomonas shigelloides ( 4) Campylobacter jejuni 5 65 Campylobacter coli Staphylococcus aureus Clostridium perfringens Clostridium botulinum A 7 0 Bacillus cereus Listeria monocytogenes 4 57 Yersinia enterocolitica ( ) ( ) Shigella dysenteriae 4 ( ) 3 ( ) Shigella flexneri b 3 8 ( 3) Shigella flexneri a ( ) 5 ( ) Shigella flexneri b 3 ( ) Shigella flexneri 3a ( ) Shigella flexneri 6 ( ) 3 ( ) Shigella flexneri other serovars ( ) ( ) Shigella flexneri untypable ( ) Shigella boydii Shigella boydii 4 ( ) Shigella boydii 9 3 ( 8) ( ) 3 ( ) ( ) ( ) 3 ( ) 64 ( 8) Shigella sonnei Kudoa septempunctata Streptococcus tococcus group A 7 44 Streptococcus group B Streptococcus group C 8 Streptococcus tococcus group G 4 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 Haemophilus influenzae b Haemophilus influenzae nonb 0 Klebsiella pneumoniae 4 Neisseria meningitidis 7 Enterococcus faecalis 7 Enterococcus faecium Enterococcus gallinarum Enterococcus casseliflavus Pseudomonas aeruginosa Leptospira interogans Cryptococcus neoformans 6 ( ) 50 ( 4) 344 ( 4) 339 ( 5) 8 ( 5) 6 ( 5) 74 ( 0) 36 ( 3) 7050 ( 05)

24 478 Vol. 34 No Verotoxinproducing E.coli ( ) 3 Enterotoxigenic E.coli 5 Enteroinvasive E.coli Enteropathogenic E.coli ( ) Enteroaggregative E.coli ( ) Other diarrheagenic E.coli Salmonella Typhi Salmonella O4 Salmonella O8 Salmonella O9 Salmonella group unknown Campylobacter jejuni Staphylococcus aureus 6 Clostridium perfringens 4 Yersinia enterocolitica 0 Shigella flexneri Shigella sonnei Streptococcus group A 7 5 Streptococcus group B Streptococcus group G Streptococcus pneumoniae 9 Bordetella pertussis Legionella pneumophila Mycobacterium tuberculosis Mycoplasma pneumoniae Haemophilus influenzae nonb Pseudomonas aeruginosa ( 3) Salmonella O4 Typhimurium O4 Bredeney O4 Saintpaul O8 Kottbus O9 Javiana Shigella Shigella flexneri a Shigella flexneri others Shigella sonnei T T4 T T5 T8 TB364 3 Untypable

25 Vol. 34 No ( ) Verotoxinproducing E.coli 5 Enterotoxigenic E.coli Enteroinvasive E.coli 3 ( ) Enteropathogenic E.coli ( ) Enteroaggregative E.coli 3 Other diarrheagenic E.coli Salmonella Typhi 3 Salmonella O4 Salmonella O8 Salmonella O9 Salmonella group unknown 4 40 Campylobacter jejuni Staphylococcus aureus 4 Clostridium perfringens Yersinia enterocolitica Shigella flexneri Shigella sonnei 3 8 Streptococcus group A Streptococcus group B Streptococcus group G 9 Streptococcus pneumoniae Bordetella pertussis Legionella pneumophila Mycobacterium tuberculosis 4 4 Mycoplasma pneumoniae Haemophilus influenzae nonb 63 Pseudomonas aeruginosa ( 3) Salmonella O4 Typhimurium O4 Bredeney O4 Saintpaul O8 Kottbus O9 Javiana Shigella Shigella flexneri a Shigella flexneri others Shigella sonnei T 4 T4 4 T T5 T8 4 TB364 Untypable

26 680 Vol. 34 No Verotoxinproducing E.coli 3 3 Enteroaggregative E.coli Other diarrheagenic E. coli Salmonella Paratyphi A Salmonella O4 Salmonella O7 Campylobacter jejuni Staphylococcus aureus Shigella flexneri 6 Shigella sonnei Streptococcus pyogenes 3 Streptococcus group G Bordetella pertussis Mycoplasma pneumoniae Salmonella Paratyphi A Shigella flexneri 6 Shigella sonnei Coxsackievirus A4 Influenza virus A Hpdm Influenza virus A H3 5 7 Influenza virus B/Yamagata 3 Measles virus ge B3 Dengue virus NT Dengue virus Dengue virus 3 Dengue virus 4 Chikungunya virus Hepatitis A virus NT Dengue virus NT Dengue virus 3 / NT :

27 Vol. 34 No Picornavirus NT Enterovirus NT Coxsackievirus A NT Coxsackievirus A Coxsackievirus A Coxsackievirus A Coxsackievirus A Coxsackievirus A7 Coxsackievirus A Coxsackievirus A Coxsackievirus A Coxsackievirus A Coxsackievirus A4 0 Coxsackievirus A Coxsackievirus B 7 3 Coxsackievirus B Coxsackievirus B Coxsackievirus B Coxsackievirus B Coxsackievirus B6 Echovirus Echovirus 3 3 Echovirus Echovirus Echovirus Echovirus 4 6 Echovirus 4 Echovirus 7 Echovirus Echovirus Echovirus 0 Echovirus Echovirus 5 7 Echovirus 30 Poliovirus 5 3 Poliovirus Poliovirus Enterovirus rus 68 Enterovirus Parechovirus NT Parechovirus Rhinovirus Aichivirus 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 ge NT 6 Measles virus ge A Measles virus ge B3 Measles virus ge D4 4 6 Measles virus ge D Measles virus ge D9 5 4 Measles virus ge H 4 9 Rubella virus ge NT Rubella virus ge a Rubella virus ge E Rubella virus ge B Dengue virus Chikungunya virus 7 Rotavirus group unknown Rotavirus group A Rotavirus group C 7 Astrovirus Norovirus genogroup unknown Norovirus genogroup I Norovirus genogroup II Sapovirus genogroup unknown Sapovirus genogroup I Sapovirus genogroup II Sapovirus genogroup III 3 Sapovirus genogroup IV 3 8 Sapovirus genogroup V Adenovirus NT Adenovirus Adenovirus Adenovirus Adenovirus Adenovirus Adenovirus Adenovirus 7 Adenovirus Adenovirus 4 Adenovirus 9 Adenovirus Adenovirus 33 Adenovirus 34 Adenovirus Adenovirus 40/ Adenovirus Adenovirus 53/ 3 8 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 Hepatitis A virus IIIA 3 4 Hepatitis E virus 3 Human papilloma virus B9 virus Human bocavirus Human immunodeficiency virus Virus NT Chlamydophila pneumoniae Orientia tsutsugamushi Rickettsia japonica NT :

28 Picorna N Picorna NT Entero N Entero NT 88 Coxsackie A Coxsackie A 4 Coxsackie A Coxsackie A4 Coxsackie A Coxsackie A5 Coxsackie A Coxsackie A Coxsackie A Coxsackie A8 Coxsackie A Coxsackie A9 Coxsackie A Coxsackie A Coxsackie A Coxsackie A4 Coxsackie A Coxsackie A6 Coxsackie B Coxsackie B Coxsackie B Coxsackie B 5 5 Coxsackie B Coxsackie B3 Coxsackie B Coxsackie B4 Coxsackie B Coxsackie B5 3 cho E cho E 7 cho E cho E cho E 8 cho E 5 cho E Entero 7 Entero Parecho N Parecho NT Parecho Parecho Rhino A chi i Influenza A not subt Influenza A not subtyp yped Influenza A H Influenza A Hpdm0 dm Influenza A H Influenza A H Influenza B N Influenza B NT Influenza B/Victori Influenza B/Victoria Influenza B/Yama Influenza B/Yamagat ata Parainfluenza Parainfluenza Res Respirator iratory sync ncytial tial Human meta Human metapneum neumo Other coron Other corona Mum Mump s 4 Measles Measles genot ype N e NT 3 Measles Measles genot ype A Measles Measles genot ype B e B3 Measles Measles genot ype D e D8 Measles Measles genot ype D e D9 Measles Measles genot ype H e H Rubella Rubella genot ype N e NT Rubella Rubella genot ype e a Rubella Rubella genot ype e E 5 5 Rubella Rubella genot ype e B Den Deng e u Chikungunya Chikungunya Rota Rota grou roup unknow unknown Rota Rota grou roup A A tro s 5 Noro Noro geno enogrou roup unknow unknown Noro Noro geno enogrou roup I Noro Noro geno enogrou roup II Sa Sapo geno enogrou roup unknow unknown Sa Sapo geno enogrou roup I Sa Sapo geno enogrou roup II Sa Sapo geno enogrou roup II III Sapo genogroup IV Sapo genogroup IV Adeno N deno NT 34 5 A eno d 3 A deno A eno d A 4 4 eno d A eno d A 6 eno d A 8 eno d A eno d A 3 eno d A 37 eno d Adeno 40/4 deno 40/4 A 4 eno d A 54 eno d A 56 eno d Her Herpes sim es simplex N lex NT 7 Her Herpes sim es simplex lex 4 Her Herpes sim es simplex lex Varicellazoster aricellazoster Cytome tomegal alo Human her Human herpes es Human her Human herpes es EpsteinBarr steinbarr He Hepatitis A N atitis A NT He Hepatitis A I atitis A IA He Hepatitis E atitis E Human Human papilloma illoma 30 9 B Human boc Human boca 7 3 Orientia tsutsu Orientia tsutsugamush amushi Rickettsia japonica Rickettsia japonica NT : Vol. 34 No

29 Picorna NT Picorna NT Entero NT Entero NT 7 Coxsackie A Coxsackie A 4 Coxsackie A4 Coxsackie A4 5 Coxsackie A5 Coxsackie A Coxsackie A6 Coxsackie A6 3 6 Coxsackie A8 Coxsackie A8 7 Coxsackie A9 Coxsackie A9 Coxsackie A Coxsackie A Coxsackie A4 Coxsackie A4 0 0 Coxsackie A6 Coxsackie A6 Coxsackie B Coxsackie B 6 Coxsackie B Coxsackie B 5 Coxsackie B3 Coxsackie B3 3 3 Coxsackie B4 Coxsackie B Coxsackie B5 Coxsackie B5 Echo 3 Echo Echo 6 Echo 6 6 Echo 7 Echo 7 3 Echo 9 Echo 9 Echo Echo Echo 8 Echo 8 Echo 5 Echo Entero 7 Entero 7 Parecho NT Parecho NT 5 Parecho Parecho Rhino Rhino Aichi ichi 7 Influenza A not subt Influenza A not subtyp yped ed Influenza A H Influenza A Hpdm09 dm Influenza A H3 Influenza A H Influenza B NT Influenza B NT Influenza B/Victoria Influenza B/Victoria Influenza B/Yama Influenza B/Yamagata ata Parainfluenza Parainfluenza Res Respirator iratory sync ncytial tial Human meta Human metapneumo neumo Other corona Other corona 0 46 Mum Mumps 3 Measles Measles genot ype NT e NT Measles Measles genot ype A e A Measles Measles genot ype B3 e B3 Measles Measles genot ype D8 e D8 4 Measles Measles genot ype D9 e D9 Measles Measles genot ype H e H Rubella Rubella genot ype NT e NT Rubella Rubella genot ype a e a 0 0 Rubella Rubella genot ype E e E Rubella Rubella genot ype B e B 4 6 Den Dengue ue Chikungunya Chikungunya Rota Rota grou roup unknown unknown Rota Rota grou roup A Astro stro Noro Noro geno enogrou roup unknown unknown Noro Noro geno enogrou roup I Noro Noro geno enogrou roup II II Sa Sapo geno enogrou roup unknown unknown Sa Sapo geno enogrou roup I Sa Sapo geno enogrou roup II II Sa Sapo geno enogrou roup III III 3 6 Sapo genogroup IV Sapo genogroup IV Adeno NT deno NT Adeno deno Adeno deno Adeno 3 deno Adeno 4 deno Adeno 5 deno 5 9 Adeno 6 deno 6 5 Adeno 8 deno 8 Adeno deno 6 Adeno 3 deno Adeno 37 deno Adeno 40/4 deno 40/ Adeno 4 deno Adeno 54 deno 54 3 Adeno 56 deno 56 9 Her Herpes sim es simplex NT lex NT Her Herpes sim es simplex lex Her Herpes sim es simplex lex 5 5 Varicellazoster aricellazoster 3 66 Cytome tomegalo alo Human her Human herpes 6 es Human her Human herpes 7 es 7 47 EpsteinBarr steinbarr 4 He Hepatitis A NT atitis A NT 5 He Hepatitis A IA atitis A IA He Hepatitis E atitis E Human Human papilloma illoma 4 B9 B Human boca Human boca 4 Orientia tsutsu Orientia tsutsugamush amushi 3 5 Rickettsia japonica Rickettsia japonica NT : Vol. 34 No

30 Picornavirus NT Picornavirus NT Enterovirus NT Enterovirus NT Coxsackievirus A Coxsackievirus A 6 7 Coxsackievirus A4 Coxsackievirus A4 3 4 Coxsackievirus A5 Coxsackievirus A5 4 5 Coxsackievirus A6 Coxsackievirus A Coxsackievirus A8 Coxsackievirus A8 4 6 Coxsackievirus A9 Coxsackievirus A9 3 7 Coxsackievirus A Coxsackievirus A Coxsackievirus A4 Coxsackievirus A4 Coxsackievirus A6 Coxsackievirus A Coxsackievirus B Coxsackievirus B Coxsackievirus B Coxsackievirus B 5 6 Coxsackievirus B3 Coxsackievirus B3 3 5 Coxsackievirus B4 Coxsackievirus B4 6 Coxsackievirus B5 Coxsackievirus B5 5 5 Echovirus 3 Echovirus 3 Echovirus 6 Echovirus Echovirus 7 Echovirus 7 6 Echovirus 9 Echovirus 9 3 Echovirus Echovirus Echovirus 8 Echovirus Echovirus 5 Echovirus 5 Enterovirus 7 Enterovirus Parechovirus NT Parechovirus NT Parechovirus Parechovirus 3 5 Rhinovirus Rhinovirus Aichivirus Aichivirus Influenza virus A not subtyped Influenza virus A not subtyped Influenza virus A Hpdm09 Influenza virus A Hpdm Influenza virus A H3 Influenza virus A H Influenza virus B NT Influenza virus B NT Influenza virus B/Victoria Influenza virus B/Victoria Influenza virus B/Yamagata Influenza virus B/Yamagata Parainfluenza virus Parainfluenza virus Respiratory syncytial virus Respiratory syncytial virus Human metapneumovirus Human metapneumovirus Other coronavirus Other coronavirus Mumps virus Mumps virus Measles virus ge NT Measles virus ge NT 3 Measles virus ge A Measles virus ge A 8 Measles virus ge B3 Measles virus ge B3 Measles virus ge D8 Measles virus ge D8 Measles virus ge D9 Measles virus ge D9 4 4 Measles virus ge H Measles virus ge H Rubella virus ge NT Rubella virus ge NT Rubella virus ge a Rubella virus ge a Rubella virus ge E Rubella virus ge E Rubella virus ge B Rubella virus ge B Dengue virus Dengue virus Chikungunya virus Chikungunya virus Rotavirus group unknown Rotavirus group unknown Rotavirus group A Rotavirus group A Astrovirus Astrovirus Norovirus genogroup unknown Norovirus genogroup 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 III Sapovirus genogroup III Sapovirus genogroup IV Sapovirus genogroup IV 6 6 Adenovirus NT Adenovirus NT Adenovirus Adenovirus Adenovirus Adenovirus Adenovirus 3 Adenovirus Adenovirus 4 Adenovirus Adenovirus 5 Adenovirus Adenovirus 6 Adenovirus Adenovirus 8 Adenovirus Adenovirus Adenovirus Adenovirus 3 Adenovirus Adenovirus 37 Adenovirus Adenovirus 40/4 Adenovirus 40/ Adenovirus 4 Adenovirus Adenovirus 54 Adenovirus Adenovirus 56 Adenovirus Herpes simplex virus NT Herpes simplex virus NT Herpes simplex virus Herpes simplex virus Herpes simplex virus Herpes simplex virus 0 Varicellazoster virus Varicellazoster virus Cytomegalovirus Cytomegalovirus Human herpes virus 6 Human herpes virus Human herpes virus 7 Human herpes 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 4 Human bocavirus Human bocavirus Orientia tsutsugamushi Orientia tsutsugamushi 4 4 Rickettsia japonica Rickettsia japonica NT : Vol. 34 No

31 Vol. 34 No IASR An outbreak of legionellosis attributable to a onedaytrip hot spring Saitama Prefecture An outbreak of legionellosis attributable to a bathing facility in a hotelyamagata Prefecture Legionellosis cases associated with the Great East Japan Earthquake, which were reported to NESID Typing of clinical isolates of Legionellareport from Legionella Reference Center... 6 Detection of Legionella species from puddlestoyama Prefecture Epidemiological studies on clinical isolates of L. pneumophila serogroup 3, sequence type 93Okayama Prefecture Rapid detection of viable Legionella bacilli Assessing Legionella contamination by measuring ATP levels for monitoring hygienic conditions of bathing facilities Disinfection of bathing water by monochloramineshizuoka Prefecture Legionellosisvarious sources identified in the recent infections Human coronavirus isolates from infants with respiratory symptoms (JanuaryApril, 03)Mie Prefecture HIV/AIDS in Japan, JanuaryMarch, Legionellosis is an infectious disease caused by Gramnegative bacteria belonging to the genus Legionella. It is a respiratory tract infection and the bacteria multiply within alveolar macrophages. There are two clinical types, severe form of pneumonia called Legionnaires disease and flulike Pontiac fever. As the symptoms of Legionella pneumonia are not unique, differentiation from other pneumonias by symptoms alone is difficult. The first choices for chemotherapy are quinolones and macrolides. Sudden worsening of the general condition may occur among patients, who were not treated with appropriate antibiotics. Pontiac fever is a less severe form of infection and the symptom is like common cold. Elderlies, newborns and immunocompromised persons constitute highrisk groups of legionellosis. Legionella bacilli live within protozoa (amoeba) that inhabit water, moist soil, etc. Optimum growth temperature is 36 C with permissive range of 045 C. Incidence of legionellosis: Legionellosis is a category IV notifiable infectious disease in the National Epidemiological Surveillance of Infectious Diseases (NESID) under the Infectious Diseases Control Law ( de400.pdf). Physicians who have made diagnosis of legionellosis are obliged to notify all the cases. From January 008 to December 0, 4,08 legionellosis patients (including 3 asymptomatic carriers) were reported (as of May 5, 03) (Table ). The peak season of legionellosis was mostly July (Fig. ). More patients were reported from more populated prefectures as expected ( f400a.gif). Number of patients per 00,000 was high in Toyama, Ishikawa, Okayama and Tottori Prefectures (Fig. ). The average patients age was 67.0 years, 65.7 years in males and 7.5 years in females. While the patients ages were distributed widely from 0 year to 03 years, patients younger than 30 years were few (.0%) (Fig. 3). Males occupied 8% of the patients. According to MMWR 60: , 0, males were 64% of the patients in USA. Occupations at high risk were reported to be mining and construction, manufacturing of metal materials, assembly and/or repair of transportation machines, and car driving, etc. Symptoms are fever (9%), pneumonia (90%), cough (48%), dyspnea (44%), disturbance of consciousness (7%), diarrhea Table. Notified cases of legionellosis, 9990 Year of diagnosis Total Male Female 999* *AprilDecember (National Epidemiological Surveillance of Infectious Diseases: Data based on the reports as of May 5, 03) Vol. 34 No. 6 June 03 Infectious Agents Surveillance Report <THE TOPIC OF THIS MONTH> Legionellosis, January 008December 0 Figure. Monthly incidence of legionellosis cases, January 008December Month* Cases * The day of the first consultation (National Epidemiological Surveillance of Infectious Diseases: Data based on the reports received before May 5, 03) Year Figure. Incidence of legionellosis by prefecture, January 008December 0 Symptomatic and asymptomatic cases per 00,000 population (National Epidemiological Surveillance of Infectious Diseases: Data based on the reports received before May 5, 03) 55 ISSN National Institute of Infectious Diseases and Tuberculosis and Infectious Diseases Control Division, Ministry of Health, Labour and Welfare Continued on page 56

32 86 Vol. 34 No THE TOPIC OF THIS MONTHContinued (9.8%), multiple organ failure (8.5%), and abdominal pain (.5%) (percentage in parenthesis indicates percentage among the notified patients having the symptom indicated). As for the location of infection, 3,96 cases (97%) were infected in Japan, 95 cases (.3%) abroad and 4 cases (0.6%) unknown. Methods of diagnosis: Of 4,08 cases, 3,98 (96%) were diagnosed by antigen detection in urine, 3 cases (.8%) by bacterial culture, 69 (.7%) by titration of serum antibody, 6 (.5%) by PCR (including LAMP method), and 8 (0.%) by the indirect fluorescent antibody method or by the enzymelinked antibody method (Table on p.57 of this issue). While antigen detection in urine was used in a great majority, it can detect only Legionella pneumophila serogroup (SG). The LAMP assay that can detect a wide range of genus Legionella started to be covered by the medical insurance since October 0. In 0, 5 cases were diagnosed by this method. The number of deaths among the total cases was 34 (3.3%) for Among 4,03 patients having the record of the first medical consultation, there were 9 deaths. It was noted Figure 3. Age distribution of legionellosis cases, by gender, January 008December 0 00 Females that the longer was the delay from the first consultation to the definitive diagnosis, the higher was the fatality rate, i.e.,.8% for 03 day delay, 4.% for 46 day delay and 5.3% for 7 day delay. Early diagnosis is important for saving lives of the patients. Species of Legionella isolated by culture: In addition to the above 3 culturepositive cases, reported were additional 48 cases that included isolates provided to the Legionella Reference Center after the notification (see p. 6 of this issue). Thus Legionella was isolated from total 6 cases. Among them, there were 6 cases attributable to infection of L. pneumophila SG. Some such cases of infection with L. pneumophila SG were infected additionally with other Legionella species or serogroups, such as, L. feeleii (one case), L. rubrilucens (one case), L. pneumophila SG6 (two cases), and L. pneumophila SG6 and SG9 and untypable (one case). There were 4 cases due to L. pneumophila other than L. pneumophila SG; six cases each due to infection with SG and SG3, four cases due to infection with SG6, two cases each due to infection with SG5, SG0 and SG, and one case each due to infection with SG9 and SG5. Furthermore, there were one case of L. londiniensis, one case of L. longbeachae, and 9 cases of Legionella whose species were not identified. Outbreaks: Outbreaks that occurred in Japan during 0080 involved cases at a public bathing facility in Kobe City in January 008 (IASR 9: 39330, 008); cases at a welfare facility for the elderly in Okayama Prefecture in July 008 (IASR 9: 33033, 008); 8 cases attributable to a bathing facility in a hotel in Gifu Prefecture in October 009 (IASR 3: 0709, 00); 9 cases attributable to a bathing facility of a sports club in Yokohama City in September 0; 3 cases attributable to a bathing facility in a hotel in Yamagata Prefecture in November 0 (see p. 59 of this issue); and 9 cases attributable to a onedaytrip hot spring in Saitama Prefecture in November to December 0 (see p. 57 of this issue). There were 3 suspected clusters, each reporting 5 legionellosis patients that were found among those who used the same facilities or toured together. In addition, after the tsunami associated with the Great East Japan Earthquake, legionellosis was reported among those who were rescued from drowning or engaged in debris processing (see p. 60 of this issue). Control measures: Legionella infection occurs through inhalation of aerosols or dusts contaminated by Legionella. The infection source includes spa pools, cooling towers, showers (IASR 3: 3333, 00 & 3: 33333, 00), hot water supply system, landscaping water, humidifiers (see p.69 of this issue), solar waterheaters (IASR 3: 35, 0) and leaf molds (IASR 6:, 005). Biofilm growing on porous natural stones in a bath sometimes becomes a hotbed of Legionella (IASR 9: 9394, 008). Principles of prevention of legionellosis include ) prevention of microbial growth and biofilm formation, ) removal of biofilm formed on equipments and facilities, 3) minimizing aerosol splash, and 4) minimizing of bacterial contamination from external sources. For this, following measures should be taken. Firstly, water should be disinfected (see p.68 of this issue), which should be checked by culture of microbes or by rapid tests (see p.65 of this issue). The current hygienic standard of bath water that may pose risk of aerosol inhalation is Legionella counts less than 0 cfu per 00 ml (below the detection limit). Secondly, the wall of bath rooms and inner surface of water tanks should be cleaned. Removal of the biofilm can be checked by measuring adenosinetriphosphate (ATP) (see p.67 of this issue). Thirdly, equipments and facilities should be designed so as not to splash aerosols. Fourthly, those who clean the wall of bathrooms or hand leaf molds should wear a dust mask. Hygienic control for prevention of legionellosis should follow guidelines, such as Legionella Control Measures (Ministry of Health, Labour and Welfare: MHLW), Building Hygiene (MHLW), Guidelines for prevention of legionellosis (3 rd Ed., Building Management Education Center), Introduction to hygienic maintenance of storagetype hotwater supply equipment ( st Ed., Japan Water Facilities Environmental Hygiene Association). For prevention of legionellosis, infection sources should be identified by analyzing the data obtained from the pulsedfield gel electrophoresis and sequencebased typing using Legionella obtained from both patients and environment (see p.6 of this issue). With such information, disinfection and/or removal of Legionella can be effectively conducted. Cases Males IASR Vol. 34 No. 6 Jun Deaths Age group National Epidemiological Surveillance of Infectious Diseases: Data based on the reports received before May 5, 03 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 ) 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 3, Shinjukuku, Tokyo 68640, JAPAN Tel (+83)585