The mean herpes zoster incidence in Japan was 4.15/1,000 person-years and was 5.23-7.84/1,000 person years among those 50 years old and older. One in three persons experiences herpes zoster before age 80, indicating how common it is. The Oka varicella vaccine was developed to prevent varicella in healthy and immunocompromized children and is now used to prevent varicella in 20 million people worldwide. Contact with varicella patients and Oka varicella vaccine are reported to augment varicella-zoster virus immunity in adults and the elderly. Oxman et al. have shown that Oka varicella vaccine prevents herpes zoster and postherpetic neuralgia (PHN) in the elderly. Oka varicella vaccine is approved to prevent herpes zoster and PHN in the elderly in USA and Europe. We review the relationship between varicella/Oka varicella vaccine and herpes zoster, the study by Oxman et al., and the need to introduce this new application of Oka varicella vaccine in Japan.
A norovirus gastroenteritis outbreak at a wedding reception hall in Nagano Prefecture in April 2008 affected that hallʼs reception participants and waiters, but not waiters or food handlers at another hall. To determine the infection route, dust in three vacuum cleaners used to clean the venue were tested for norovirus using real-time reverse transcriptase polymerase chain reaction (RT-PCR), with norovirus RNA detected from all three. Sequencing analysis of a 280-nt portion of the capsid region showed that 9 specimens from infected reception participants and waiters and dust samples had 100％nucleotide identity. This suggests that the infection route was dust transmission, that the reception venue floor had been contaminated with norovirus, and that participants and staff had been exposed to norovirus in dust during the wedding reception. Dust thus requires specific attention as a potential infection source because norovirus cDNA copies were 1.7×104 to 1.6×105 per gram in dust specimens.
US president Barak Obamaʼs November 13-14, 2009 visit to Japan gave us an opportunity to enhanced routine syndrome surveillance upgrade countermeasure against bioterrorism attacks and other emergencies. We conducted analysis using suspected case surveillance based on the Infection Control Law, surveillance for ambulance transfer by the local Tokyo government, and prescription surveillance by the National Institute of Infectious Diseases. Thanks to regularly conducted prior surveillance, we enhanced the routine by closer monitoring and sharing information, conducting postvisit surveillance for two weeks until November 30. Information as of 07 : 00 from the Prescription Survey and a 17 : 00 ambulance transfer survey were submitted to and evaluated National Institute of Infectious Diseases and Tokyo Metropolitan Institute of Public Health. The fact that we conducted enhanced surveillance easily without prior preparation indicates that we may be able to cut the cost and time of syndrome surveillance negotiation and preparation. Such enhanced surveillance is highly feasible and we expect to do so similarly cooporating flexibly with local and central governments.
Epidemiological investigation of a March 2007 detected measles outbreak of 28 cases in a 792-student high school in Tokyo. Students with a vaccination history had significantly milder symptoms than those without, and no cases occurred among students having two of measles vaccine in two doses of measles vaccine in their childhood. Vaccine efficacy（VE）calculated in our investigation was 93.9％（95％CI : 87-97）, and no significant difference was observed in vaccine type or manufacturer product. Students and parents were extremely difficult to persuade to cooperate in control measures such as emergency vaccination and home isolation through notification letters even during outbreaks. Schools should thus develop measles outbreak preparedness and response plans and identify potentially susceptible students in advance through documented proof of case histories and MCV vaccination. Outbreaks should promote early detection of patients and emergency vaccination targetting potentially susceptible students backed through close cooperation with medical facilities, education institutions, and the public health sector,together with school closures as appropriate.
VIM-1 metallo-β-lactamase（MBL）producing Pseudomonas aeruginosa was isolated from 35 Kobe City Medical Center General Hospital patients from September 2007 to July 2008. All but one were highly resistant to all β-lactams, aminoglycoside, and fluoroquinolone, and one susceptible to amikacin. Strains negative to a disk diffusion screening test using sodium mercaptoacetate for detecting MBL numbered 35. PCR for MBL indicated all strains were positive for blaVIM-1. These strains were indistinguishable by pulsed-field gel electrophoresis, indicating an outbreak of infections caused by VIM-1 MBL producing Pseudomonas aeruginosa. After intervention to control contact, the outbreak was controlled.
Once a day of arbekacin（ABK）administrations based on a new object of peak concentration setting on 9-20μg/mL were performed to 14 neonates. The gestational ages were 27.3±4.2 weeks. As to the preparing initial dosage, Therapeutic Drug Monitoring Program soft was used. Mean daily dose of 6.2±0.4mg/kg body weight was administered every 24 to 48h by 30 min intravenous infusion. Mean serum peak concentrations of ABK and those of trough concentrations were 15.2±4.3μg/mL and 2.0±1.4μg/mL respectively. The relationship between the measured values（y）and predicted values（x）showed the regression equation y＝0.969＋0.931x（R2＝0.769, n＝35），which suggested the usefulness of the dosage design. Overall clinical effectiveness was 78.9％（11/14）. There were no obvious adverse effects including abnormal auto auditory brainstem responses and serum creatinine increase. Effectiveness rate and no adverse effects suggested that once a day of ABK therapy in neonate including extremely preterm infant was preferable regimen.
Conventional outbreak detection laboratory-based made one unit from the beginning of the month to the end of the month, totaled and analyzed, cannot correctly detect outbreaks continued during two months. The real-time analysis（RTA）we devised adapts to methicillin-resistant Staphylococcus aureus（MRSA）and avoids the problems of conventional detection. RTA analyzes all data for the last 30 days when MRSA is newly isolated 48 hours or more after hospital admission. In the three years from April 2006 to March 2009, we compared the day and number of MRSA outbreaks newly isolated 48 hours or more after hospital admission in 572 subjects using the conventional method and RTA. We also calculated the RTA infection prevention effect. The number of outbreaks detected conventionally numbered 68 cases and those detected by RTA numbered 106 cases. The number of outbreaks newly detected by RTA numbered 38 cases in three years, averaging 4.3 days earlier than conventional detection using conventional method A an average of 15.7 days earlier than conventionally which totals for every end of the month using conventional method B. The effect of infection prevention in the change of RTA from conventional method A presumably decreases MRSA infection to 14-18 persons and it in the change of RTA from conventional method B decreases MRSA infection to 18-25 persons in one year. These results suggested that outbreak detection by RTA could help prevent MRSA outbreak and decrease MRSA infection freqency.
Disseminated penicilliosis-an AIDS-indicator disease in Southeast Asian countries -but not Japan- is a systemic fungal infection caused by Penicillium marneffei. A 30-year-old HIV-positive Japanese man visiting Southeast Asia three months before admission and reporting fever, general fatigue, and enlarged lymph nodes lasting over one month was admitted for detailed tests. Blood culture and fine-needle aspiration lymph node biopsy a led to a diagnosis of disseminated penicillioisis, later cured by several anti-fungal agents. Caution is thus recommended regarding the possibility of this disease, given the large number of travelers visiting overseas, geographical proximity to Southeast Asia, and increasing numbers of HIV patients in Japan.