[Survey of the past history of measles and rubella and advocacy for vaccination and certificates of vaccination at entry to kindergarten, primary school and junior high school in Kurashiki City--to improve the vaccination rate].

Although there have been measles outbreaks involving more than 100,000 patients every few years in Japan, vaccination is not compulsory under Japanese law and the vaccination rate remains low. In addition, because MMR vaccines have been suspended due to complications, monovalent measles vaccine is still used and administered only once for life. Under these circumstances, a new system was started to develop motivation for vaccination in order to try to eliminate measles and rubella. Although educational campaigns for vaccination are important, their effect is frequently temporary. To maintain a high vaccination rate after such campaigns, we advocated checking children for susceptibility, recommended vaccination and asked for certificates of vaccination at school entry. The participating subjects were 65/68 kindergartens, 55/55 primary schools and 24/24 junior high schools in Kurashiki City, Japan. The total number of subjects was 11,365. The susceptibility rate for measles and the unknown rate were 5.6% and 2.0% at kindergartens, 4.6% and 4.4% at primary schools, and 3.0% and 8.3% at junior high schools, whereas the susceptibility rate for rubella and the unknown rate were 14.0% and 2.3% at kindergartens, 21.8% and 5.4% at primary schools, and 35.2% and 11.7% at junior high schools. Among the children who were susceptible to measles, we confirmed that a certificate of vaccination was presented by 38.0% of pupils in kindergartens, 85.3% of those in primary schools and 43.7% of those in junior high schools. As for rubella, we confirmed 21.8% presented a certificate in kindergartens, 28.6% in primary schools and 11.6% in junior high schools. As a result, we achieved our goal for measles, which was previously determined as more than 90% for students with past history of infection or vaccination. However, we could not attain our goal for rubella. These systems were more effective than educational campaigns alone and were thought to increase the motivation for vaccination through their continuation. The rate of those who could not receive the vaccination due to allergy or seizure among the susceptible was 26% in total but more than 40% in some schools. We should educate not only parents but also doctors regarding vaccination and advocate that it be done.