Japan has remarkably low H1N1 mortality

[JimO]

Japan has reported 193 total H1N1 deaths. With a population of just over 127.4 million, that's a mortality rate of 1.5 deaths per million. I believe that this is the lowest rate in the developed world (where deaths are more likely to be reported). Assuming that Japan has a relatively sophisticated surveillance infrastructure and is openly releasing their data, I am puzzled why their mortality rate has been between 5 and 10 times lower than other nations. It appears that Japan has not been spared H1N1 outbreaks, and Japan was one of the earliest nations to report outbreaks last year. Are they containing it better?

[Anne]

Re: Japan has remarkably low H1N1 mortality

Japan people are not obese ( just a small pourcentage : juste " one or 2 %" , very low % )
it was an early difference noted by a medical study.
they don't eat same thing ( there is many more cancer if a Japanese people go to USA, and eat like US people ).

then they are more often wearing a mask when they are infected.

this may be a partial explanation

[JimO]

Re: Japan has remarkably low H1N1 mortality

Japan people are not obese ( just a small pourcentage : juste " one or 2 %" , very low % )
it was an early difference noted by a medical study.
they don't eat same thing ( there is many more cancer if a Japanese people go to USA, and eat like US people ).

then they are more often wearing a mask when they are infected.

this may be a partial explanation

I know there are health differences between Japanese and Americans; however, there are other countries with higher death rates who probably don't have problems with obesity or poor diets.

The prevalence of wearing masks could be offset by more crowded conditions, as compared with other nations.

I'm sure that there are multiple reasons for the differences, but it might be worth investigating.

[german-docter]

Re: Japan has remarkably low H1N1 mortality

Japan has reported 193 total H1N1 deaths. With a population of just over 127.4 million, that's a mortality rate of 1.5 deaths per million. I believe that this is the lowest rate in the developed world (where deaths are more likely to be reported). Assuming that Japan has a relatively sophisticated surveillance infrastructure and is openly releasing their data, I am puzzled why their mortality rate has been between 5 and 10 times lower than other nations. It appears that Japan has not been spared H1N1 outbreaks, and Japan was one of the earliest nations to report outbreaks last year. Are they containing it better?

Hi JimO

Yes, I think the Japanese just did a good job !
To give some snapshots in a timeline:

Credits to: SuperNova1987A

http://www.flutrackers.com/forum/showthread.php?t=108940

June 8, 2009:
A professional hunch?

Source: TV report

Dr. T who consulted the first domestic case of novel flu in Kobe, a high school student, thought that maybe his patient had been infected with novel flu, judging from his symptoms and a sudden outbreak of ILI in his school. The other students had been diagnosed by other doctors as ordinary seasonal flu.

Dr. T, however, pleaded and persuaded Kobe medical lab to do PCR test on the student's specimen although it was not according to the government's guideline to do PCR test on anybody who did not have record of overseas travel.

Because the lab was very busy testing other specimens of suspected cases, the student's specimen was left behind for two days during which outbreak in the school further spread. But finally, to every government official's astonishment, the first domestic case of novel flu was confirmed with Dr. T?s patient.
The schools of the entire Kobe city were closed immediately and the outbreak was somehow contained. Many people now praise Dr. T?s judgement and thank him for finding the first case before the school outbreak going out of control. But he doesn?t want his name to be known. (?)


Credits to tropical (post #2: June 29 th, 2009)

http://www.flutrackers.com/forum/showthread.php?t=113181

Re: ASU scientist: Study of first wave of swine flu requires revised public health strategies

In addition to this latest research, Chowell-Puente also was a co-author on a recent study of the flu in Japan. "Here we looked at the public health strategies they used that essentially stopped the spread of the disease in its tracks," he says.
The researchers found that in Japan, more than 90 percent of the cases were in school-aged children and teens. Quick action was taken to contain the disease through school closures and other social distancing measures, such as avoiding use of public transportation and the use of face masks. In addition, Japan employed active surveillance at airports, using recently developed sensors to detect passengers with fevers for additional screening. The disease was contained within two-to-three weeks, with only about 500 cases and no fatalities. Findings from this study appeared in the June 4 issue of Eurosurveillance in an article titled "Transmission potential of the new influenza A(H1N1) virus and its age-specificity in Japan." (...)

Reducing the spread of the disease is key to preventing deaths, according to Chowell-Puente. "As transmissibility grows, timely implementation of control measures is key to reduce epidemic impact on the population." "


Credits to pathfinder:

http://www.flutrackers.com/forum/showthread.php?t=128890

School closures in Japan double because of swine flu pandemic

By Anna Kitanaka | Bloomberg News

Sunday, October 18, 2009 8:08 PM EDT

The number of schools in Japan closed because of the swine flu pandemic nearly doubled by Oct. 10 from a week earlier, according to figures from the Ministry of Health, Labor and Welfare.

Almost 6,480 schools, kindergartens and day care centers were fully or partially closed because of the influenza outbreak, the report said. Tokyo had the highest number, with 752 schools affected last week. Japan had 52,956 schools and kindergartens in May this year, according to the Education Ministry.

School closures are at the highest since January 2000 when 4,131 schools were closed, said Takeshi Enami, Deputy Director of the division of infectious diseases at the Ministry of Health, Labor and Welfare.

There were 3,403 educational centers closed between Sept. 27 and Oct. 3, according to another report from the ministry.
(...)
Many schools are closed in Japan during the flu season, the ministry said on its Web site. Schools may be required to close if they are in an infected area, even if no students or staff develop flu symptoms, according to the ministry.

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19385

Eurosurveillance, Volume 14, Issue 44, 05 November 2009
Rapid communications
MEASURES AGAINST TRANSMISSION OF PANDEMIC H1N1 INFLUENZA IN JAPAN IN 2009: SIMULATION MODEL
H Yasuda1, K Suzuki ( )2,3
1. Department of Mathematics, Josai University, Sakado, Saitama, Japan
2. Inflammation Programme, Department of Immunology, Chiba University Graduate School of Medicine, Chiba, Japan
3. National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan
The first outbreak of pandemic H1N1 influenza in Japan was contained in the Kansai region in May 2009 by social distancing measures. Modelling methods are needed to estimate the validity of these measures before their implementation on a large scale. We estimated the transmission coefficient from outbreaks of pandemic H1N1 influenza among school children in Japan in summer 2009; using this transmission coefficient, we simulated the spread of pandemic H1N1 influenza in a virtual community called the virtual Chuo Line which models an area to the west of metropolitan Tokyo. Measures evaluated in our simulation included: isolation at home, school closure, post-exposure prophylaxis and mass vaccinations of school children. We showed that post-exposure prophylaxis combined with isolation at home and school closure significantly decreases the total number of cases in the community and can mitigate the spread of pandemic H1N1 influenza, even when there is a delay in the availability of vaccine.

http://www.who.int/wer/2009/wer8446.pdf

WHO: Weekly epidemiological record
13 NOVEMBER 2009

Page 481:

Transmission dynamics and impact of pandemic influenza A (H1N1) 2009 virus

(?) Attack rates in schools in Japan, which closed schools early in the pandemic, were low, ranging from <1% to 5.3%, (personal communication, H. Nishiura), whereas self-reported ILI attack rates among students and staff in school outbreaks in the USA have been much higher. (?)





Credits to Pathfinder (December 10, 2009):

http://www.flutrackers.com/forum/showthread.php?t=136281

http://www.bloomberg.com/apps/news?pid=20601202&sid=auxGTNXRwuAI

Japan Mask Wearing, Tamiflu Rush Beat Back Swine Flu Threat ________________________________________
By Kanoko Matsuyama and Jason Gale

Dec. 11 (Bloomberg) -- Eight hours after Tokyo office worker Shungo Yamamoto started feeling feverish and faint, he got a diagnosis of swine flu, received antiviral drugs and embarked on three days of self-imposed isolation last month.

?I knew it was influenza immediately? because of the fever and joint pain, Yamamoto, 25, said. His doctor confirmed the diagnosis with a nose swab test and prescribed five days of Roche Holding AG?s antiviral drug Tamiflu. When he left the doctor?s office, Yamamoto put on a mask, bought a three-day supply of food, rented DVDs and headed home, where he stayed for the duration of his illness.

Japan?s aggressiveness against H1N1 influenza, the result of hygiene standards, social etiquette and a willingness to test and medicate immediately, means the country has fared better than the U.S. or the U.K. in battling the first pandemic in 41 years. A World Health Organization report shows Japan?s mortality rate is 2 deaths for every 100,000 people. The rate is higher by 11 times in the U.K., 16 times in the U.S. and 43 times in Australia.

?No doctor in Japan would tell a flu patient just to go home and sleep it off,? said Norio Sugaya, a pediatric specialist at Keiyu Hospital in Yokohama, a port city south of Tokyo. Sugaya sits on a committee that advises WHO, a Geneva- based arm of the United Nations, on managing swine flu patients.

In the U.K., a study this month found patients typically waited three days to start taking Tamiflu, one of two medicines available to fight the new virus as well as seasonal influenza.
Complication Risk

The U.S. Centers for Disease Control and Prevention, based in Atlanta, recommends that antiflu drugs be given to hospitalized patients, pregnant women and others with increased risk of complications. In Japan, doctors are advised to administer the medicines to anyone suspected of having flu, even if a rapid diagnostic test is negative, according to the Japanese Association for Infectious Diseases, a Tokyo-based organization of specialist doctors that provides treatment recommendations.

Japan accounted for three-quarters of the Tamiflu dispensed globally in the drug?s first five years of sale, Roche, based in Basel, Switzerland, said in a November 2005 filing to the U.S. Food and Drug Administration.

Three years later, Japan?s government announced plans to stockpile enough antiflu medicines for 45 percent of its 128 million people. That may be triple the amount required to treat every swine flu patient. The proportion of people sickened by the pandemic virus ranges from 7 percent to 15 percent, depending on the country, according to WHO.

Japanese Practices

Japan?s status as one of the biggest users of antiviral medicines and its approach to treating seasonal and pandemic flu should be compared with practices elsewhere and the data should be published in English, said Lance Jennings, a clinical virologist with Canterbury Health Laboratories in Christchurch, New Zealand, who has studied flu for more than 30 years.

?If you have better capacity to diagnose cases earlier and are treating appropriately and early, you?re more likely to reduce the number of patients who will go on to develop more- severe influenza,? Jennings said in an interview.

While the majority of pandemic flu sufferers got over their illness within days without treatment, 1 percent to 10 percent needed hospitalization and as many as a quarter of those patients required intensive care, WHO said on Dec. 4.

Early Treatment

Tamiflu and Relenza, an inhaled medicine made by London- based GlaxoSmithKline Plc, appear beneficial in fighting the H1N1 virus, especially if treatment begins within 48 hours of the onset of symptoms, researchers said in a study in the New England Journal of Medicine in November. A paper in the same journal in December reported reduced complications, including deaths, among hospitalized patients treated with the medications.

A survey of Japanese patients in 2005 found 85 percent sought medical treatment for flu and 90 percent of consultations took place within 48 hours after the first symptoms appeared, according to David Reddy, who heads Roche?s influenza task force in Basel.

?These people do not wait until it?s too late,? Reddy said in a telephone interview. ?Japan has to be the gold standard of management of influenza.

It?s almost a societal response in terms of the way people modify their behavior.?

Japanese have become accustomed during the past decade to wearing masks in public to ward off allergic reactions to pollen from cedar trees throughout the country, said Masataka Yoshikawa, a researcher who tracks consumer behavior at Hakuhodo Institute of Life and Living, the research arm of a Tokyo-based advertising company. Japanese expect someone with a cold or flu to wear a mask to limit the spread of the virus, he said.

Wash and Gargle

?Hand-washing, gargling and wearing masks are three hygiene measures that are very well accepted in the community in Japan,? said Nikki Shindo, the Japanese doctor who is leading WHO?s investigation of swine flu patients. ?People don?t really hesitate to wear masks in public places. Even the 24/7 convenience stores sell high-particulate respirators at a reasonable price.?

Some researchers say they are skeptical that Tamiflu is effective and concerned that the virus will develop resistance to the drug because of misuse. An analysis of 20 studies published in the British Medical Journal on Dec. 8 showed Tamiflu offered mild benefits for healthy adults and found no proof it prevented lower respiratory tract infections or complications of flu. There is little evidence to show that otherwise healthy people should be given Tamiflu routinely, the researchers said.

?No Doubt?

?Based on our analysis and other subsequent work, there is no doubt that the drug can reduce complications,? said Frederick Hayden, a professor of clinical virology at the University of Virginia School of Medicine in Charlottesville, who was one of the first doctors to study Tamiflu in patients.

Missing doses or failing to complete a course of medicine increases the risk that a drug-evading strain will emerge, said William Aldis, an assistant professor of global health at Thammasat University in Bangkok and a former WHO representative to Thailand. In societies such as Japan, where treatment compliance is high, patients are less likely to contribute to drug resistance, he said.
(?)

[JimO]

Re: Japan has remarkably low H1N1 mortality

Perhaps the success that the Japanese have apparently had with school closings could be used to rebut the theory held by many public health officials in the U.S. that closing schools is not an effective control measure.

Unfortunately, at least in the U.S., we have collectively chosen convenience over transmission control. It was pathetic when schools would close on a Friday, disinfect the building contents, and then re-open the next week, as though the school building itself was the source of viruses.

Those measures, and brief closings of a week or two, did little IMHO to contain the spread of H1N1. However, so many parents complained when the schools closed for even a few days in some areas, that the school officials didn't want to take meaningful control measures.

I wonder how many of the more than 400 children who have died of H1N1 in the U.S. would still be alive if we had been serious about control measures.

[kiwibird]

Re: Japan has remarkably low H1N1 mortality

A survey of Japanese patients in 2005 found 85 percent sought medical treatment for flu and 90 percent of consultations took place within 48 hours after the first symptoms appeared, according to David Reddy, who heads Roche?s influenza task force in Basel.

?These people do not wait until it?s too late,? Reddy said in a telephone interview. ?Japan has to be the gold standard of management of influenza."

Certainly D3 is also widely accepted and taken as well. Even given all of the above, many people certainly became ill.

I am wondering if a low protein diet was helpful. It seems there were fewer cardiac problems in Japan. If that is the case then further discussion could be useful.