The Japanese Experience with Vaccinating Schoolchildren against Influenza
New England Journal of Medicine · 2001 · 861 citations · 29 references
Influenza epidemics raise mortality mainly in the elderly, and while most developed countries target high‑risk groups for vaccination, Japan historically focused on vaccinating schoolchildren. From 1962 to 1987, vaccination of Japanese schoolchildren was widespread and mandatory, but the policy was relaxed in 1987 and repealed in 1994, causing rates to fall. The high coverage of school‑child vaccination likely produced herd immunity, reducing influenza incidence and mortality among older adults.
Influenza epidemics lead to increased mortality, principally among elderly persons and others at high risk, and in most developed countries, influenza-control efforts focus on the vaccination of this group. Japan, however, once based its policy for the control of influenza on the vaccination of schoolchildren. From 1962 to 1987, most Japanese schoolchildren were vaccinated against influenza. For more than a decade, vaccination was mandatory, but the laws were relaxed in 1987 and repealed in 1994; subsequently, vaccination rates dropped to low levels. When most schoolchildren were vaccinated, it is possible that herd immunity against influenza was achieved in Japan. If this was the case, both the incidence of influenza and mortality attributed to influenza should have been reduced among older persons.
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