1. The burden of serious fungal diseases in Japan Koichi Izumikawa 1, Masato Tashiro 1, Takahiro Takazono 1, Shintaro Kurihara 1, Tomomi Saijo 2, Kazuko Yamamoto 2, Yoshifumi Imamura 2, Taiga Miyazaki 1, Misuzu Tsukamoto 1, Katsunori Yanagihara 3, Hiroshi Mukae 2, Shigeru Kohno 2 and David W. Denning 4 1 Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences 2 Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences 3 Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences 4 The University of Manchester and The National Aspergillosis Centre in association with the LIFE program at www.LIFE-Worldwide.org,. www.LIFE-Worldwide.org Abstract Recent syudies revealed the fungal infections have acquired high relevance rate all over the world. A fungal burden in Japan was preliminary estimated by deterministic scenario modelling and published incidence and prevalence data. Vaginal candidiasis was the most frequent fungal infection revealed in this study, followed by esophageal candidiasis and severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA). The incidence or prevalence of the above referred fungal infections and ~ 2,370,300 (1.9%) people in Japan suffer from those fungal infections each year. Further epidemiological studies are needed to validate and extend these estimations. Introduction Fungal infections have been increasing over the past decades due to the increased number of immunocompromised hosts with immunosuppressant, solid organ transplant, hematopoietic stem cell transplant and others. The few data is currently available for their prevalence in the world, and it is important to estimate the actual fungal burden all over the world to understand the current scenario of these emergent infections. Cutaneous and fatal fungal infections have been studied extensively in Japan, and latterly chronic pulmonary aspergillosis. However, no estimate of the nationwide incidence and prevalence of fungal infections has been attempted. Here we estimate the burden of serious fungal infections in Japan. Objectives We attempt the first estimate of the burden of serious fungal disease in Japan using deterministic scenario modelling and published incidence and prevalence data. Results and Discussion  The population of Japan is ~127 million in 2015; 13% are children, and 30% are women >65 years.  An estimated 1,525/100,000 females suffer from recurrent vulvovaginal candidiasis (>4 episodes/year) each year.  Oesophageal candidiasis affects 280/100,000 per year.  Candidaemia affects 6,350 patients, 40% of the total of invasive candidiasis (15,875), including an estimated 476 with intra-abdominal candidiasis.  ABPA and SAFS were estimated in 20.8/100,000 and 27.5/100,000 respectively, in ~1 million adult asthmatics  Invasive aspergillosis is estimated to affect 1,308, mostly in acute leukemia and after allogeneic stem cell transplantation.  An estimated 3,957 have CPA after pulmonary tuberculosis (19,615 survivors in 2012) 50% of the total burden.  Mucormycosis may affect 254 patients annually.  There are no incidence data on tinea capitis or fungal keratitis, but probably both uncommon or rare. Infection Number of infections per underlying disorder per year Rate/100,000Total burden NoneHIV/AIDSRespiratoryCancer/TxICU Oesophageal candidiasis 354,762696---280355,458 Candidemia ---4,4451,90556,350 Recurrent vaginal candidiasis (4x/year +) 1,937,000----1,525*1,937,000 Allergic bronchopulmonary aspergillosis (ABPA) --26,452--20.826,452 Severe asthma with fungal sensitization (SAFS) --34,914 27.534,914 Chronic pulmonary aspergillosis --7,914--6.27,914 Invasive aspergillosis --??1,25510311,308 Mucormycosis ???254?0.2254 Cryptococcal meningitis -20---0.0220 Pneumocystis pneumonia -9---0.019 Total burden estimated 2,370,314 * rate for females only Contacts: Prof. Koichi IZUMIKAWA, M.D. koizumik@nagasaki-u.ac.jp Phone: +81 (95) 819-7730 FAX: +81 (95) 819-7766 1-7-1 Sakamoto Nagasaki 852-8501, JAPAN Conclusion The present study indicates that around to 1.9% (2,370,300) of the population is affected by a serious fungal infection, predominantly recurrent VVC in women in Japan. This is a preliminary study but constitutes the first report of the global burden of fungal infections in Japan. Further epidemiological studies are needed to validate and extend these estimates. Table 1. Total burden of fungal infections estimated in Japan Methods We searched for existing data and estimated the incidence and prevalence of fungal diseases based on the populations at risk and available epidemiological data. Data were derived from the World Health Organization (WHO), The Joint United Nations Program on HIV/AIDS (UNAIDS) and national and regional published reports. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology by LIFE [1,2]. [1] Denning DW, et al. Bull World Health Organ 2011; 89:864-72. [2] Denning DW, et al. Med Mycol 2013; 51:361-70 Poster #19