Publications by authors named "Kazunori Oishi"

236 Publications

Global Landscape Review of Serotype-Specific Invasive Pneumococcal Disease Surveillance among Countries Using PCV10/13: The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) Project.

Microorganisms 2021 Apr 2;9(4). Epub 2021 Apr 2.

National Public Health Organisation, 15123 Athens, Greece.

Serotype-specific surveillance for invasive pneumococcal disease (IPD) is essential for assessing the impact of 10- and 13-valent pneumococcal conjugate vaccines (PCV10/13). The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project aimed to evaluate the global evidence to estimate the impact of PCV10/13 by age, product, schedule, and syndrome. Here we systematically characterize and summarize the global landscape of routine serotype-specific IPD surveillance in PCV10/13-using countries and describe the subset that are included in PSERENADE. Of 138 countries using PCV10/13 as of 2018, we identified 109 with IPD surveillance systems, 76 of which met PSERENADE data collection eligibility criteria. PSERENADE received data from most (n = 63, 82.9%), yielding 240,639 post-PCV10/13 introduction IPD cases. Pediatric and adult surveillance was represented from all geographic regions but was limited from lower income and high-burden countries. In PSERENADE, 18 sites evaluated PCV10, 42 PCV13, and 17 both; 17 sites used a 3 + 0 schedule, 38 used 2 + 1, 13 used 3 + 1, and 9 used mixed schedules. With such a sizeable and generally representative dataset, PSERENADE will be able to conduct robust analyses to estimate PCV impact and inform policy at national and global levels regarding adult immunization, schedule, and product choice, including for higher valency PCVs on the horizon.
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http://dx.doi.org/10.3390/microorganisms9040742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066045PMC
April 2021

Serotype Distribution of Remaining Pneumococcal Meningitis in the Mature PCV10/13 Period: Findings from the PSERENADE Project.

Microorganisms 2021 Apr 1;9(4). Epub 2021 Apr 1.

Department of Clinical Microbiology, Landspitali-The National University Hospital, Hringbraut, 101 Reykjavik, Iceland.

Pneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5-7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites ( = 8; cases = 1141), PCV10 types caused 5% of cases <5 years of age and 15% among ≥5 years; the top serotypes were 19A, 6C, and 3, together causing 42% of cases <5 years and 37% ≥5 years. In PCV13-using sites ( = 32; cases = 4503), PCV13 types caused 14% in <5 and 26% in ≥5 years; 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed.
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http://dx.doi.org/10.3390/microorganisms9040738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066874PMC
April 2021

Increase in congenital syphilis cases and challenges in prevention in Japan, 2016-2017.

Sex Health 2021 May;18(2):197-199

Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.

In Japan, the increase in congenital syphilis (CS) notifications has become a public health concern. We conducted a case series study to describe the characteristics of CS patients and their mothers. Of the 13 mothers who consented to participate, seven had regular prenatal care visits, including four who had tested negative at their first trimester syphilis screening. Only three mothers noted that their partners were tested, with all three partners being diagnosed with syphilis. Raising awareness for syphilis prevention during pregnancy, partner testing, and considering additional syphilis testing at the third trimester of pregnancy during times of increased syphilis prevalence is imperative.
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http://dx.doi.org/10.1071/SH21004DOI Listing
May 2021

Distribution and Variation of Serotypes and Pneumococcal Surface Protein A Clades of Strains Isolated From Adult Patients With Invasive Pneumococcal Disease in Japan.

Front Cell Infect Microbiol 2021 19;11:617573. Epub 2021 Mar 19.

Toyama Institute of Health, Toyama, Japan.

Pneumococcal surface protein A (PspA) is a surface protein of that may be a candidate antigen for new pneumococcal vaccines. This study investigates the distribution of PspA clades of the causative strains of adult invasive pneumococcal disease (IPD) in Japan. Of the 1,939 strains isolated from cases of adult IPD during 2014-2019, the PspA clades of 1,932 (99.6%) strains were determined, and no was detected in the remaining 7 strains (0.4%). PspA clades 1-6 were detected in 786 (40.5%), 291 (15.0%), 443 (22.8%), 369 (19.0%), 33 (1.7%), and 6 (0.3%) strains, respectively. New PspA clades (0.2%) were identified in two non-typeable and two serotype 35B pneumococci. The proportions of clade 1 and clade 2 showed significantly decreased and increased trends, respectively. Furthermore, the PspA clade of pneumococcal strains was partially serotype- and sequence type-dependent. The majority of strains belonging to serotypes contained in both the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23) belonged to PspA clades 1 or 3. In contrast, the distribution of clades in non-vaccine serotypes was wider than that of vaccine serotype pneumococci. Our findings demonstrate that almost all pneumococcal strains from adult IPD express PspA clades 1-4, especially for non-vaccine serotypes. These results may be useful for the development of a new pneumococcal vaccine with PspA.
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http://dx.doi.org/10.3389/fcimb.2021.617573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044978PMC
July 2021

Invasive pneumococcal disease affected the fatal outcome in a COVID-19 patient.

J Infect Chemother 2021 Jul 8;27(7):1108-1111. Epub 2021 Apr 8.

Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan.

A 68-year-old man experienced fever and cough and was referred to a hospital for day 4. He had a positive reverse transcription-polymerase chain reaction result for severe acute respiratory syndrome coronavirus-2. On day 12, his PaO/FiO ratio worsened to 120 and he was transferred to Sapporo Medical University Hospital for treatment using extracorporeal membrane oxygenation. Venous blood cultures were positive for Streptococcus pneumoniae, which were serotype 3, mucoid-type, and penicillin susceptible. Coinfections with coronavirus disease-2019 and invasive pneumococcal disease are rare; however, they are associated with a higher case fatality than either of the conditions manifesting alone.
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http://dx.doi.org/10.1016/j.jiac.2021.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026269PMC
July 2021

Subtype screening of bla genes using bipartite primers for DNA sequencing.

Jpn J Infect Dis 2021 Mar 31. Epub 2021 Mar 31.

Department of Microbiology, Ehime Prefectural Institute of Public Health and Environmental Science, Japan.

Genes conferring carbapenem resistance have spread worldwide among gram-negative bacteria. Subtyping of these genes has epidemiological value due to the global cross-border movement of people. Subtyping of bla genes that frequently detected in Japan appears to be important in public health settings; however, there are few useful tools for this purpose. We developed a subtyping screening tool based on PCR direct sequencing, which targets the internal sequences of almost all bla genes. The tool used bipartite multiplex primers with M13 universal sequences at the 5'-end. According to in silico analysis, among the 78 known IMP-type genes, except for bla, 77 detected genes were estimated to be differentiated. In vitro evaluation indicated that sequences of amplicons of IMP-1, IMP-6, IMP-7, and IMP-20 templates were identical to their respective subtypes. Even if the amplicons were small or undetectable through the first PCR, sufficient amplicons for DNA sequencing were obtained through a second PCR using the M13 universal primers. In conclusion, our tool can be possibly used for subtype screening of bla, which is useful for the surveillance of bacteria with bla in clinical and public health settings or environmental fields.
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http://dx.doi.org/10.7883/yoken.JJID.2020.926DOI Listing
March 2021

Prolonged viral clearance of severe acute respiratory syndrome coronavirus 2 in the older aged population.

J Infect Chemother 2021 Jul 11;27(7):1119-1121. Epub 2021 Mar 11.

Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan. Electronic address:

Introduction: The detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) is the standard method for the diagnosis of coronavirus disease 2019 (COVID-19). This PCR test can be positive even in patients who have recovered from the disease, and the duration for achieving viral clearance has not been clarified yet.

Methods: This study was conducted between April 3, 2020, and June 17, 2020, at the Toyama University Hospital and the Toyama Rehabilitation Home. We collected the data of patients with COVID-19, analyzing the duration until twice-consecutive negative qRT-PCR test.

Results: A total of 42 patients were enrolled. The median duration of the twice-consecutive negative qRT-PCR test was 29.0 d (interquartile range: 25.75-35.25). The longest duration of viral shedding was 73 d. The duration of viral clearance was significantly longer in the older (>65 years) group than in the younger group (34.5 d vs. 25.0 d, P < 0.0001).

Conclusion: This study demonstrated that viral clearance tends to be sustained in the older adults.
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http://dx.doi.org/10.1016/j.jiac.2021.03.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951882PMC
July 2021

Descriptive epidemiology of rickettsial infections in Japan: Scrub typhus and Japanese spotted fever, 2007-2016.

Int J Infect Dis 2021 Apr 18;105:560-566. Epub 2021 Feb 18.

National Institute of Infectious Diseases, Tokyo, Japan. Electronic address:

Objective: This study aimed to describe the epidemiological and clinical characteristics of endemics of two rickettsial diseases, scrub typhus (ST) and Japanese spotted fever (JSF), in Japan.

Methods: We conducted a retrospective, descriptive epidemiological assessment of cases notified via national surveillance from 2007-2016.

Results: Over the 10-year period, 4185 ST and 1765 JSF cases were notified; of these, 20 (0.48%) cases of ST and 16 (0.91%) cases of JSF were fatal at the time of reporting. The elderly had higher notification rates and fatalities. While the annual number of ST notifications was stable and cases were reported from a broad geographic range, the number of JSF reports increased three-fold, expanding from the southwest to the east. The seasonality of ST varied by region and was more common during spring/summer in the north and autumn/winter in the south; 78% of cases occurred during autumn/winter, mainly in the southern region. Most of the fatal ST cases occurred in the spring/summer and occurred in the northern region.

Conclusion: Our analysis identified seasonal and regional variations in the distribution of rickettsiosis. These variations were most likely to be related to the ecology of the vectors and etiological agents. Knowing the recent epidemiological and clinical features of ST and JSF can support clinical diagnosis and guide preventative activities against these vector-borne diseases.
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http://dx.doi.org/10.1016/j.ijid.2021.02.069DOI Listing
April 2021

Effects of message order and active participation on vaccine risk communication.

Pediatr Int 2021 Feb 18. Epub 2021 Feb 18.

Faculty of Business and Commerce, Keio University, Tokyo, Japan.

Background: "Message order" and "Active participation" could be effective as risk communication methods. Additionally, "anticipated regret (AR)" has been recognized to affect risk perception and vaccine uptake in risk communication of vaccination. We aimed to evaluate the effects of message order and active participation and the interactions between these two interventions on AR for vaccination.

Methods: We conducted a 2 (message order: positive-negative or negative-positive) × 2 (message calendar: with or without planning) factorial design study among 81 study participants. The effects of message order and active participation of mothers, using a message calendar, were evaluated on mothers' decision-making of vaccination of Haemophilus influenzae type b vaccine and Pneumococcal conjugated vaccine for their children. Participants completed questionnaires to evaluate AR of infection if unvaccinated (anticipated regret of inaction, ARI) and of side effects if vaccinated (anticipated regret of action, ARA) twice: immediately after interventions and one month later.

Results: An interaction between message order and active participation was significant on ARI immediately after interventions (p = .01), but this effect disappeared one month after interventions. The message order showed no main effect on ARA. However, the main effect of active participation was marginally significant on ARA one month after interventions (p = .09); AR over vaccine side effects was lower when vaccination was planned, compared to without planning condition.

Conclusions: The effect of message order was hardly detectable in a clinical setting. However, active participation induced by planning may affect on AR. Further studies are needed to evaluate the effect of active participation in decision-making for vaccination.
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http://dx.doi.org/10.1111/ped.14662DOI Listing
February 2021

Detection of Bartonella quintana infection among the Homeless Population in Tokyo, Japan, from 2013-2015.

Jpn J Infect Dis 2021 Jan 29. Epub 2021 Jan 29.

Department of Medical Entomology, National Institute of Infectious Diseases, Japan.

Several outbreaks of trench fever caused by Bartonella quintana, occurred in soldiers during World Wars I and II. Although the number of trench fever cases has been decreasing worldwide, the disease has been reported among the homeless population in both developing and developed countries. The current prevalence of B. quintana infection in Japan is unclear. We collected blood and body louse (Pediculus humanus humanus) samples from homeless inpatients who had body lice at the time of emergency hospitalization in Tokyo from January 2013 to March 2015. Patients were tested for B. quintana infections using culture method, polymerase chain reaction, and indirect immunofluorescence assay (IFA). Among the 29 patients tested, the presence of Bartonella spp. was confirmed by genomic sequencing of DNA extracted from the samples from 2 patients (blood culture performed for 13 out of 15 patients), and from body louse samples of 20 patients (69%). Immunoglobulin G against B. quintana was detected in 10 patients (34.5%) at a cut-off titer of 1:256 in IFA. B. quintana infection was detected in samples obtained between 2013 and 2015 in Tokyo and needs to be on the list of differential diagnoses performed for febrile homeless individuals.
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http://dx.doi.org/10.7883/yoken.JJID.2020.505DOI Listing
January 2021

Pneumococcal Serotype-specific Opsonophagocytic Activity in Interleukin-1 Receptor-associated Kinase 4-deficient Patients.

Pediatr Infect Dis J 2021 May;40(5):460-463

Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Background: The antibody response after pneumococcal vaccines and their effectiveness against invasive pneumococcal disease (IPD) in patients with interleukin-1 receptor-associated kinase 4 (IRAK4) deficiency have not been fully evaluated. Here, we evaluated pneumococcal serotype-specific opsonophagocytic activity (OPA) in IRAK4-deficient patients along with their clinical course.

Methods: We investigated 6 IRAK4-deficient patients in Japan, whose attending physicians could be contacted. We performed OPA measurements using stored and more recent serum samples obtained from these patients.

Results: All patients had received pneumococcal vaccination. Among the 3 patients who had IPD, 2 had an episode of pneumococcal meningitis and the other developed pneumococcal bacteremia 3 years after the occurrence of pneumococcal meningitis. Only one episode of invasive bacterial infection was caused by a Streptococcus pneumoniae vaccine-type strain. An increased opsonization index was found in the sera after vaccination for all IRAK-deficient patients, including when the 23-valent pneumococcal polysaccharide vaccine was used.

Conclusions: A significant increase in levels of OPA against most of the pneumococcal vaccine antigens was observed for all IRAK4-deficient patients. However, IPD could not be prevented by pneumococcal vaccination alone. Therefore, adequate prophylaxis should be provided with antibiotics at least until 8 years of age, along with regular immunoglobulin therapy, particularly during the infantile period.
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http://dx.doi.org/10.1097/INF.0000000000003060DOI Listing
May 2021

Clinical manifestations of adult patients requiring influenza-associated hospitalization: A prospective multicenter cohort study in Japan via internet surveillance.

J Infect Chemother 2021 Mar 12;27(3):480-485. Epub 2020 Nov 12.

Division for Development of Anti-infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, 6-45-1, Kunimi, Aoba-ku, Sendai, 981-8551, Japan.

Introduction: Influenza remains a clinically heavy burden worldwide. The objective of this study was to clarify clinical manifestations of severely ill patients infected with influenza.

Methods: The clinical data for patients who were severely ill with influenza, and required hospitalization were gathered and analyzed between November 2014 and August 2019 (5 influenza seasons) using an internet-surveillance system.

Results: A total of 924 patients were enrolled and analyzed. The median age was 78 years (IQR, 67-84), and the patients in the 2015-2016 season were significantly younger than those in other seasons. Pneumonia was the most common disease indicated as a cause for hospitalization, followed by a poor general condition and exacerbation of underlying respiratory diseases. Antiviral drugs were administered in 97.0% of the patients with peramivir being the most-frequently use antiviral. In-hospital death was recorded for 44 patients (4.8%). Multivariate analysis indicated that nursing home resident (OR: 6.554) and obesity (OR: 24.343) were independent predictors of in-hospital mortality.

Conclusions: Complications of influenza infection remain a heavy burden especially among the elderly. Continuous nationwide surveillance will be required to grasp the actual situation of influenza epidemics. (UMIN000015989).
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http://dx.doi.org/10.1016/j.jiac.2020.10.021DOI Listing
March 2021

Syphilis in heterosexual women: case characteristics and risk factors for recent syphilis infection in Tokyo, Japan, 2017-2018.

Int J STD AIDS 2020 11 15;31(13):1272-1281. Epub 2020 Oct 15.

Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan.

In response to an increase in heterosexual syphilis notifications in Tokyo, we conducted a questionnaire-based case-control study among women aged ≥20 years and sexually active in the past six months who sought a syphilis test in Tokyo during 2017-2018. Cases were women diagnosed as recent syphilis infection based on serological tests. Controls were serologically non-reactive or those with only a past syphilis infection. We described cases and assessed for risk factors of recent syphilis using logistic regression. A total of 524 women (60 cases, 464 controls) were enrolled. Notably, among cases, 10 (16.7%) were students, 3 (5.0%) had a history of syphilis, and 14 (23.3%) had a single sex partner in the past six months. Female sex worker (FSW) status was strongly associated with syphilis (odds ratio [OR] = 3.40; 95% confidence interval [CI] = 1.96-5.90). In multivariable analysis, recent syphilis was associated with inconsistent condom use for vaginal/anal sex among FSWs (adjusted OR [aOR] = 3.42; 95%CI = 0.92-12.70) and among non-FSWs, with younger age (aOR = 0.36; 95%CI = 0.19-0.70; increase per category from 20-24, 25-29 to ≥30 years) and ≤high school education (aOR = 5.24; 95%CI = 1.95-14.10). A notable proportion of cases were those with first time infection and those with only a single partner. Moreover, risk factors differed between FSWs and non-FSWs, and a multi-pronged approach to prevent syphilis is required.
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http://dx.doi.org/10.1177/0956462420945928DOI Listing
November 2020

Seroepidemiological analysis of anti-pneumococcal surface protein A (PspA) immunoglobulin G by clades in Japanese population.

Vaccine 2020 11 7;38(47):7479-7484. Epub 2020 Oct 7.

Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan; Toyama Institute of Health, Toyama, Japan. Electronic address:

Background: Pneumococcal surface protein A (PspA) is one of the candidates of the novel pneumococcal protein vaccines. The seroepidemiology of naturally acquired anti-PspA immunoglobulin G (IgG) by clades, across a wide range of ages has not been investigated.

Methods: We examined the concentrations of anti-PspA IgG by clades (1, 2, 3, 4, and 5) in 397 sera from persons aged 0-≥70 years by enzyme-linked immunosorbent assay, and determined the geometric mean concentrations (GMCs) by age group. The relationships between concentrations of anti-PspA IgG antibody for each clade for each person were also assessed.

Results: GMC of anti-PspA IgG was lowest, highest, and plateaued in those aged 6-11 months, 5-9-years, and 20-49 years, respectively. It gradually declined in those aged > 70 years. GMCs patterns in different age groups were similar for all clades. Correlations were found especially within the same PspA family (between clades 1 and 2 or clades 4 and 5).

Conclusions: Our data suggested that most people acquired anti-PspA IgG across clades 1, 2, 3, 4, and 5 during childhood. These results would be a fundamental data of clade-specific anti-PspA IgG antibodies.
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http://dx.doi.org/10.1016/j.vaccine.2020.09.068DOI Listing
November 2020

Rubella outbreak among workers in three small- and medium-size business establishments associated with imported genotype 1E rubella virus-Shizuoka, Japan, 2015.

Vaccine 2020 10 2;38(46):7278-7283. Epub 2020 Oct 2.

Division of Global Infectious Diseases, Department of Infection and Epidemiology, Graduate School of Medicine, Tohoku University, Japan; Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Japan; Toyama Institute of Health, Japan.

On 12 February 2015, a local health department (LHD) in Shizuoka prefecture identified two reported rubella cases in its jurisdiction as employees of the same company. As other employees at the company resided both inside and outside of the health department's jurisdiction, it began collaborating with two additional LHDs and the National Institute of Infectious Diseases to investigate and respond to the outbreak, which subsequently identified cases in two additional companies. We obtained epidemiological, clinical, and outbreak response information from the national epidemiological surveillance of infectious disease system's database, the local health departments, and the associated companies. One specimen for genetic sequencing was collected from each of the three companies. The outbreak included a total of twenty-five cases, with seventeen confirmed and eight probable cases from three companies. Among them, 24 (96%) were male, 22 (88%) were employees of one company (Company X), and none had rubella vaccination history. The median age was 45 years (interquartile range: 40-51). Epidemiological information did not reveal the source of infection nor transmission route. All rubella viruses sequenced from the three specimens were classified into genotype 1E. The nucleotide sequences in the 739 bp-window region were completely identical in two specimens, with only one nucleotide difference in the third specimen. According to phylogenetic analysis, these strains were closely related to the Southeast and East Asian lineage. This rubella outbreak at three companies, ranging in size from small- to medium-size, in Japan occurred among unvaccinated employees aged at least 30 years, most of whom were male. Virologic analyses suggest all cases were infected with the same viral strain imported from Southeast Asia. Similar to these companies, most employees at small- and medium-size businesses in Japan are males with no vaccination history for rubella, which poses a serious risk for associated cases of congenital rubella syndrome (CRS).
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http://dx.doi.org/10.1016/j.vaccine.2020.09.045DOI Listing
October 2020

Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine against Invasive Pneumococcal Disease in Adults, Japan, 2013-2017.

Emerg Infect Dis 2020 10;26(10):2378-2386

The decline in the proportion of pneumococcal conjugate vaccine (PCV)-covered serotypes among adult invasive pneumococcal disease (IPD) patients might change the overall effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) because its effectiveness differs according to serotype. Using the indirect cohort method, we calculated the effectiveness of PPSV23 against IPD among adults in Japan to assess the impact of the national pediatric PCV program. Clinical and epidemiologic information and pneumococcal isolates were collected from IPD patients >20 years of age through enhanced IPD surveillance during April 2013-December 2017. Adjusted effectiveness against PPSV23-serotype IPD was 42.2%. Despite a substantial decline in the proportion of 13-valent PCV serotypes during the study period (45% to 31%), the change in effectiveness for PPSV23-serotype IPD was limited (47.1% to 39.3%) and only marginal in the elderly population (39.9% to 39.4%). The pediatric PCV program had limited impact on PPSV23 effectiveness against IPD in adults.
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http://dx.doi.org/10.3201/eid2610.191531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510723PMC
October 2020

A shigellosis outbreak associated with a sports festival at a kindergarten in Kitakyushu City, Japan.

J Infect Chemother 2020 Nov 2;26(11):1146-1151. Epub 2020 Jul 2.

Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan; Toyama Institute of Health, 17-1 Nakataikouyama, Imizu, Toyama, 939-0363, Japan.

Introduction: Shigellosis cases have decreased gradually in Japan in recent years, but indigenous shigellosis outbreaks sometimes occur in childcare facilities. From national surveillance data, we identified a shigellosis outbreak involving a kindergarten.

Methods: After detecting Shigella sonnei in Kitakyushu City, we conducted active case finding and epidemiological investigation in Kindergarten Z, including stool specimen collection and interviews. The stool specimens were cultured, and isolated strains were subjected to pulsed-field gel electrophoresis (PFGE) and multiple-locus variable-number tandem-repeat analysis (MLVA).

Results: Between September 1 and December 31, 2014, we identified 19 cases: 14 confirmed, 2 suspected, and 3 asymptomatic. Of the 19 cases, 16 were epidemiologically associated with Kindergarten Z (10 pupils, 5 family members, and 1 teacher). On October 19, a pupil with gastrointestinal illness participated in the kindergarten's sports festival, in which the pupils were split into "red" and "white" teams; the pupil in question belonged to the red team. Attack rates of the red and white teams were 8% (7/82) and 0% (0/108), respectively (relative risk, 10.5; 95% confidence interval, 1.3-82.1). PFGE patterns were identical or similar for the isolates in all 17 cases; 7 isolates were identical, and the others had one locus difference on MLVA.

Conclusions: We concluded that contact during the sports festival could have been responsible for spread of the shigellosis outbreak at the kindergarten, although the infection source was not determined. It is vital to inform guardians immediately after detection of shigellosis cases that symptomatic pupils should not participate in activities such as sports festivals.
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http://dx.doi.org/10.1016/j.jiac.2020.06.005DOI Listing
November 2020

[Re-emerging Rubella Epidemic and Public Health Measures in Japan].

Yakugaku Zasshi 2020 ;140(7):901-904

Infectious Disease Surveillance Center, National Institute of Infectious Diseases.

Although rubella is usually a mild, febrile illness, and up to 50% of rubella infections are asymptomatic, congenital rubella syndrome (CRS) can occur in the developing fetus of a pregnant woman infected with rubella virus (RV) in early pregnancy. After a rubella outbreak from early 2012 to late 2013 in Japan, another outbreak re-emerged from mid-2018 in the Tokyo metropolitan area and other large cities. In 2018, and up to epidemiological week (EW) 25 in 2019, more than 4000 rubella cases had been reported. Three CRS cases were also reported up to EW 24. Seroepidemiological surveys among Japanese residents indicated that the susceptible pocket to RV in male adults aged 30-50 years, as determined in 2013, remained unchanged in 2018. To reduce the number of male adults sensitive to RV, in early 2019, Japan's Ministry of Health, Labour and Welfare decided to implement routine immunization of male adults aged 40-57 years between 2019 and 2021. These male adults have been determined to have low anti-RV antibodies, and were therefore designated as the target population for this routine immunization (as category A). Although one-third of male patients with rubella reported in 2018 were in their 20 s and 30 s, these younger generations were not included in the target population for routine immunization against rubella, because they had already received a routine vaccination. Rubella vaccination is also required for male adults aged 20-40 years to diminish the susceptible pocket.
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http://dx.doi.org/10.1248/yakushi.19-00255-3DOI Listing
September 2020

Epidemiology of a workplace measles outbreak dominated by modified measles cases at Kansai international airport, Japan, during august-september 2016.

Vaccine 2020 07 10;38(32):4996-5001. Epub 2020 Jun 10.

Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku, Tokyo 162-8640, Japan; Toyama Institute of Health, Imizu, Toyama 939-0363, Japan. Electronic address:

Objectives: In August 2016, a measles outbreak at Kansai International Airport was the first workplace measles outbreak since Japan was verified as having achieved measles-elimination status in March 2015. We investigated this outbreak with a focus on evaluating the ability of vaccinated individuals to transmit measles virus (MV).

Methods: We considered a case of laboratory-confirmed measles with onset between August 9 and September 29, 2016, among workers of Kansai International Airport. History of vaccination status with measles-containing vaccine (MCV) was confirmed by reviewing records. The potential sources of each MV infection were assessed by interviewing each infected worker about the clinical course of their infection and their behavioral history.

Results: Of 30 affected ground crews identified, 16 (53%) were vaccinated with ≥ 1 dose of MCV, 2 (7%) were unvaccinated, and 12 (40%) had an unknown vaccination status. The index case, a patient with classical measles with unknown vaccination status, presumably transmitted MV to all the subsequent 29 cases. The majority of patients (23, 77%; 15 vaccinated, 8 in unknown vaccination status) were diagnosed with modified measles due to mild illness. Modified measles were characterized clinically by signs of catarrh (4/23, 17%) in a few cases, with a median incubation period of 16 (range, 11-21) days. No onward transmission from vaccinated cases was suggested. An overseas traveler who visited the airport with measles symptoms was identified as the possible primary source of this outbreak.

Conclusions: The low MV transmission ability of vaccinated individuals was reaffirmed. Contact tracing of vaccinated modified measles cases can be limited to a person at high risk of infection (e.g., households, person with immunosuppression). To maintain measles-elimination status, completing two doses of MCV should be ensured, especially for international travelers and for those who are frequently exposed to these travelers, such as airport workers.
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http://dx.doi.org/10.1016/j.vaccine.2020.05.067DOI Listing
July 2020

Contrasting Results from Two Commercial Kits Testing for the Presence of Clostridium perfringens Enterotoxin in Feces from Norovirus-Infected Human Patients.

Clin Lab 2020 May;66(5)

Background: Detection of Clostridium perfringens enterotoxin (CPE) is critical for disease surveillance; however, commercial testing kits produce contrasting results.

Methods: We examined the cause of the differing results from a reversed passive latex agglutination (RPLA) assay (PET-RPLA Toxin Detection Kit) and an enzyme-linked immunosorbent assay (C. perfringens Enterotoxin ELISA Kit) using 73 human norovirus-positive fecal samples from gastroenteritis patients across 22 episodes in Japan.

Results: CPE was detected in 39/73 samples using the RPLA method; however, ELISA-based examination of 10 RPLA-positive samples produced negative results. Moreover, cpe was not detected in any of the RPLA-positive (n = 32) or -negative (n = 5) samples, and C. perfringens was only isolated from one RPLA-positive sample.

Conclusions: An ELISA-based testing approach may be more reliable than RPLA assays for CPE detection from human fecal samples. These findings may also be applicable to the detection of other foodborne diseases.
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http://dx.doi.org/10.7754/Clin.Lab.2019.190801DOI Listing
May 2020

Human psittacosis in Japan: notification trends and differences in infection source and age distribution by gender, 2007 to 2016.

Ann Epidemiol 2020 04 25;44:60-63. Epub 2020 Mar 25.

Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan.

Purpose: Psittacosis is a bacterial zoonosis caused by Chlamydia (Chlamydophila) psittaci that infects birds. Although potentially fatal, infections can be reduced by controlling the source of infection. We therefore described the epidemiology of psittacosis, focusing on the infection source.

Methods: We descriptively analyzed psittacosis cases reported through national surveillance in Japan from 2007 to 2016. We also analyzed Chlamydia psittaci prevalence among captive psittaciformes during the same period.

Results: One hundred eleven cases were reported, and the annual number and notification rate of psittacosis declined. While 58% were male and the median age was 61 years, the median age differed by gender (males: 63 years, females: 53 years), with more female cases in those aged <50 years. In addition, the most common infection source differed by gender (men: columbiformes; women: psittaciformes). The decline in notifications was associated with a decline in psittaciformes-associated cases, with a concomitant decline in female cases. The prevalence of C. psittaci among captive psittaciformes also decreased over the period.

Conclusions: We found important differences in the epidemiology of psittacosis by gender, and the recent decrease in notifications correlated with decreasing C. psittaci prevalence in birds. Risk communications for psittacosis should consider the current epidemiology regarding gender, age, and infection source.
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http://dx.doi.org/10.1016/j.annepidem.2020.03.001DOI Listing
April 2020

Severe Fever with Thrombocytopenia Syndrome, Japan, 2013-2017.

Emerg Infect Dis 2020 04;26(4):692-699

We conducted an epidemiologic study of severe fever with thrombocytopenia syndrome (SFTS) in Japan during 2013-2017. Of 303 cases reported during that period, 133 (44%) were included in this study. The median time between onset of illness and diagnosis of SFTS shortened, from 11.5 to 3.0 days, but the case-fatality rate remained high, at 27%. In 64 patients (48%), a close contact with companion animals was reported within 2 weeks of disease onset. Of these 64 patients, 40 were surveyed further, and we confirmed that 3 had direct contact with body fluids of ill companion animals; 2 had direct contact with the saliva of an ill feral cat or pet dog. These patients reported no history of tick bite, suggesting that ill companion animals might be a source of SFTS virus transmission. Direct contact with the body fluids of ill companion animals should be avoided.
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http://dx.doi.org/10.3201/eid2604.191011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101122PMC
April 2020

A prolonged multispecies outbreak of IMP-6 carbapenemase-producing Enterobacterales due to horizontal transmission of the IncN plasmid.

Sci Rep 2020 03 5;10(1):4139. Epub 2020 Mar 5.

Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan.

A multispecies outbreak of IMP-6 carbapenemase-producing Enterobacterales (IMP-6-CPE) occurred at an acute care hospital in Japan. This study was conducted to understand the mechanisms of IMP-6-CPE transmission by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing and whole-genome sequencing (WGS), and identify risk factors for IMP-6-CPE acquisition in patients who underwent abdominal surgery. Between July 2013 and March 2014, 22 hospitalized patients infected or colonized with IMP-6-CPE (Escherichia coli [n = 8], Klebsiella oxytoca [n = 5], Enterobacter cloacae [n = 5], Klebsiella pneumoniae [n = 3] and Klebsiella aerogenes [n = 1]) were identified. There were diverse PFGE profiles and sequence types (STs) in most of the species except for K. oxytoca. All isolates of K. oxytoca belonged to ST29 with similar PFGE profiles, suggesting their clonal transmission. Plasmid analysis by WGS revealed that all 22 isolates but one shared a ca. 50-kb IncN plasmid backbone with bla suggesting interspecies gene transmission, and typing of plasmids explained epidemiological links among cases. A case-control study showed pancreatoduodenectomy, changing drains in fluoroscopy room, continuous peritoneal lavage and enteric fistula were associated with IMP-6-CPE acquisition among the patients. Plasmid analysis of isolates in an outbreak of IMP-6-CPE suggested interspecies gene transmission and helped to clarify hidden epidemiological links between cases.
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http://dx.doi.org/10.1038/s41598-020-60659-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057946PMC
March 2020

Case-control study of risk factors for incident syphilis infection among men who have sex with men in Tokyo, Japan.

Western Pac Surveill Response J 2019 Oct-Dec;10(4):1-8. Epub 2019 Dec 9.

Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan.

Introduction: In Japan, syphilis notifications have increased. Men who have sex with men (MSM) in Tokyo have contributed substantially to the increase in syphilis notifications. We thus aimed to determine the correlates of incident syphilis among them.

Methods: MSM who attended a Tokyo clinic that serves sexual minorities were recruited in a case-control study in 2015. A case was seropositive for primary/secondary/asymptomatic syphilis at enrolment visit and seronegative at prior visit or had oral ulcers positive for DNA at enrolment. For each case, two controls seronegative at enrolment and prior visit were selected. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated to assess for correlates of case status.

Results: Among 35 cases, the median age was 37 (range = 21-63) years and was similar to the 71 controls. Among HIV-positive participants (26 cases and 67 controls), cases were independently associated with higher frequency of anal or oral sex (OR = 3.4; 95% CI = 1.4-8.6; increase per category from < 1/month, ≥ 1/month but < 1/week, to ≥ 1/week) and no or inconsistent condom use during anal or oral sex (OR = 3.0; 95% CI = 1.1-8.3; increase per category from using every time, occasionally, to never), adjusted for residency and time between visits.

Discussion: Modifiable behaviours were associated with incident syphilis, and dissemination of prevention messages are needed.
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http://dx.doi.org/10.5365/wpsar.2019.10.1.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043094PMC
July 2020

Risk of Seasonal Influenza by Occupation in a Railway Company in a Metropolitan Area of Japan during Three Influenza Seasons.

Jpn J Infect Dis 2020 07 28;73(4):268-271. Epub 2020 Feb 28.

College of Healthcare Management, Japan.

Station staff may be at high risk for influenza due to high frequency contact with other people. We examined the risk of influenza by occupational group in a railway company. A retrospective observational study was conducted among employees at a branch office of a railway company in eastern Japan, located in a metropolitan area, for 2012/13, 2013/14, and 2014/15 influenza seasons. The study population included employees who had received influenza vaccination for the season in question and the previous season. Outcome was defined as self-reported influenza illness during the respective season, identified through the vaccine screening questionnaire in the following season. Study participants included employees whose outcome information could be obtained. Standardized morbidity ratios (SMRs) by occupational group (station staff, engineers, train crew) for each season were calculated. For 2012/13, 2013/14, and 2014/15 seasons, attack rates were 4.7% (19/403), 5.2% (21/407), and 7.8% (31/397), respectively. Among the participants, SMRs of station staff were lower in the 2012/13 (SMR = 57; 95% confidence intervals [CI] = 18-133) and 2014/15 (SMR = 75; 95%CI = 36-138) seasons and similar to other groups in the 2013/14 season. Enhanced countermeasures, regardless of occupational group, may be effective in preventing the spread of influenza infection.
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http://dx.doi.org/10.7883/yoken.JJID.2019.245DOI Listing
July 2020

Truncated Class 1 Integron Gene Cassette Arrays Contribute to Antimicrobial Resistance of Diarrheagenic .

Biomed Res Int 2020 31;2020:4908189. Epub 2020 Jan 31.

Kawasaki City Institute for Public Health, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki, Kanagawa 210-0821, Japan.

Class 1 integrons (c1-integrons) are associated with multidrug resistance in diarrheagenic (DEC). However, little is known about gene cassettes located within these c1-integrons, particularly truncated c1-integrons, in DEC strains. Therefore, the aims of the present study were to reveal the relationship between antimicrobial resistance and the presence of truncated c1-integrons in DEC isolates derived from human stool samples in Japan. A total of 162 human stool-derived DEC isolates from Japan were examined by antimicrobial susceptibility testing, PCR-based gene detection, and next-generation sequencing analyses. Results showed that 44.4% (12/27) of c1-integrons identified in the DEC isolates harbored only 1 (an element of c1-integrons) and were truncated by IS, Tn, or IS-group insertion sequences. No difference in the frequency of antimicrobial resistance was recorded between intact and truncated c1-integron-positive DEC isolates. Isolates containing intact/truncated c1-integrons, particularly enteroaggregative isolates, were resistant to a greater number of antimicrobials than isolates without c1-integrons. and were the most prevalent antimicrobial resistance genes in the intact/truncated c1-integrons examined in this study. Therefore, gene cassettes located within these intact/truncated c1-integrons may only play a limited role in conferring antimicrobial resistance among DEC. However, DEC harboring truncated c1-integrons may be resistant to a greater number of antimicrobials than c1-integron-negative DEC, similar to strains harboring intact c1-integrons.
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http://dx.doi.org/10.1155/2020/4908189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013361PMC
November 2020

Immunogenicity and safety after the third vaccination with the 23-valent pneumococcal polysaccharide vaccine in elderly patients with chronic lung disease.

Hum Vaccin Immunother 2020 09 12;16(9):2285-2291. Epub 2020 Feb 12.

Infectious Disease Surveillance Center, National Institute of Infectious Diseases , Tokyo, Japan.

An observational study to assess immunogenicity before and after the first, second, and third vaccinations with the 23-valent pneumococcal polysaccharide vaccine in a cohort of 16 elderly patients with chronic lung diseases was conducted. The safety of this vaccine was also compared between the first, second, and third vaccinations. Serotype-specific immunoglobulin G (IgG) and the opsonization index (OI) for serotypes 6B, 14, 19F, and 23F were analyzed, and adverse local and systemic reactions were compared. The levels of serotype-specific IgG and OI increased significantly 1 month after the first, second, and third vaccinations. Peak IgG levels were higher after the third vaccination than after the second vaccination, but the levels of serotypes 6B, 14, and 19F were not higher than after the first vaccination. Serotype-specific OIs did not differ after the third vaccination compared with the first and second vaccinations. The level of serotype-specific IgG required for killing 50% of bacteria decreased significantly 1 month after the second vaccination. This level was slightly elevated immediately before the third vaccination but decreased after the third vaccination. Although self-limited local and systemic reactions were more frequent after the second and third vaccinations than after the first vaccination, no serious systemic reactions were seen after any vaccination. These data suggest that sustained functional serotype-specific IgG is produced after the first, second, and third vaccinations and they confirm the safety of the second and third vaccinations in elderly people with chronic lung disease.
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http://dx.doi.org/10.1080/21645515.2020.1718975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553684PMC
September 2020

Author Correction: Đakrông virus, a novel mobatvirus (Hantaviridae) harbored by the Stoliczka's Asian trident bat (Aselliscus stoliczkanus) in Vietnam.

Sci Rep 2020 Jan 15;10(1):760. Epub 2020 Jan 15.

Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, 162-8640, Japan.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41598-020-57832-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6960149PMC
January 2020
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