Background： Catch-up vaccination of adults with measles, rubella, mumps, and varicella (MMRV) vaccine is important, but is often not accepted due to the cost and frequency of vaccination, especially when the childhood vaccination records are unknown. We examined whether antibody testing might lead to a better acceptance of vaccination. Methods： This was a single-center prospective observational study of persons in their 20s-40s seen between November 2018 and March 2019, who did not possess their childhood immunization records at the time of their first pre-travel consultation. Data of a control group matched for the MMRV antibody status and vaccination rate, age, travel destination, and purpose of travel seen between April 2018 to March 2019 were included in the analysis. The cost of supplemental MMRV immunization was calculated. Results： A total of 37 subjects were included (median age, 39 years). Of these, 18, 8, 22, and 4 cases required catch-up vaccination based on the results of antibody tests for measles, rubella, mumps, and varicella, respectively, with acceptance rates of 66.7%, 100%, 59.1%, and 75.0%, respectively. As comparing to the rate in the matched controls, the overall MMRV vaccination rate was significantly higher (8%-73% vs. 4%-17%), except for varicella. Compared to the cost of two doses of MMRV vaccine without antibody testing, the cost of vaccination in response to antibody testing was lower (27,000 vs. 19,000 yen/person). Conclusion： Antibody testing is expected to increase the MMRV catch-up vaccination rate and reduce the cost of vaccination in pre-travel consultations.

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Recently, with the improvements in rapid antigen test methods for viruses and widespread use of high-sensitivity genetic diagnostic methods, the diagnosis rate of the causative pathogen in cases of acute gastroenteritis has improved remarkably. Therefore, in the Soma-Futaba area of Fukushima Prefecture, in which the rotavirus (RV) vaccine was introduced recently, we identified the outbreak trend of viral gastroenteritis using pathologic samples of children hospitalized with acute gastroenteritis, and examined the effect of introduction of the RV vaccine. Over a period of 24 months, between January 2015 and December 2016, we examined children who were admitted to the Pediatrics Department of Soma General Hospital for acute gastroenteritis. The severity of each case was evaluated at the time of admission, and stool or anal swabs were collected as pathologic samples. Identification of the causative pathogens was attempted using rapid diagnostic tests, culture tests, virus isolation methods, and polymerase chain reaction assay techniques. The hospitalized children with acute gastroenteritis were divided into RV-positive and non-RV-positive groups, and the effect of the RV vaccine was evaluated using a test-negative design. During the study period, a total of 238 children were hospitalized with acute gastroenteritis. Presence of RV, norovirus (NV), and/or adenovirus (AdV) was detected in 146 samples (61.9%) by rapid diagnostic tests. In addition, using virus isolation and PCR techniques, other pathogenic viruses were detected in 191 samples (80.3%). In addition, of the 66 RV-positive patients, 8 (12%) had received the RV vaccine, and of the 158 RV negative patients, 67 (42%) had received the RV vaccine. Using the test-negative design, the RV vaccine was determined, after adjustment for gender, age, and presence of siblings/going to a nursery school, to be 81% effective (95% confidence interval : 55.9-91.8). The present study revealed that in most cases, acute gastroenteritis in hospitalized children is caused by a viral infection, and also that the RV vaccine is significantly effective in preventing hospitalization of children due to RV gastroenteritis.

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Neisseria gonorrhoeae is one of the causative bacteria of sexually transmitted infections. In rare cases, N. gonorrhoeae can also cause disseminated gonococcal infection (DGI). Herein, we report a case of DGI that was diagnosed by a positive blood culture for N. gonorrhoeae in a 26-year-old female patient who was receiving treatment with eculizumab for paroxysmal nocturnal hemoglobinuria (PNH). Eculizumab, a monoclonal antibody directed against complement C5, inhibits C5 complement activation and suppresses hemolysis. The patient was hospitalized with fever and joint pains. A blood culture returned positive for N. gonorrhoeae. The patient improved gradually in response to ceftriaxone treatment, and was discharged from the hospital. It was considered that the patient developed DGI during eculizumab treatment as a result of sexual transmission of N. gonorrhoeae from her partner, as after she left the hospital, her partner tested positive for N. gonorrhoeae. Eculizumab use is associated with an elevated risk of severe DGI, but the underlying mechanism remains poorly understood. In recent years, with the diversification of sexual activity, cases of extragenital infection, such as infection of the pharynx and rectum have also increased. Our patient also possibly suffered from a pharyngeal infection due to her history of oral sexual activity. Thus, in patients with sexually transmitted infection receiving eculizumab treatment, obtaining a careful sexual history of the patient is important to trace the origin of the infection. It is necessary to communicate the risk of DGI to the patients and to

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A 39-year-old woman was admitted to our hospital with pyelonephritis. While she was hospitalized, she developed septic shock with watery diarrhea, diffuse erythema, and multi-organ failure. She reported having used a vaginal tampon for two days before she was admitted. Staphylococcal toxic shock syndrome toxin-1- producing, methicillin-susceptible Staphylococcus aureus (S. aureus) was identified in a vaginal fluid specimen,and we made the diagnosis menstruation-associated S. aureus toxic shock syndrome (TSS). Transthoracic echocardiography showed diffusely reduced left ventricular wall motion, and a left ventricular ejection fraction of 20%. As the shock state and multi-organ failure persisted despite removal of the tampon, antimicrobial therapy, fluid resuscitation, and vasopressor use, immunoglobulin therapy was attempted. After the administration of immunoglobulin, the shock and multi-organ failure improved, and the patient was discharged after 15 days of hospitalization. Fourteen days after discharge, transthoracic echocardiography no longer showed left ventricular wall motion abnormalities, and the left ventricular ejection fraction had improved to 60%. While S. aureus TSS is rarely associated with cardiomyopathy, the possibility of cardiomyopathy should be considered in cases of refractory shock. In patients diagnosed as having S. aureus TSS, immunoglobulin administration should be considered in cases where the circulatory failure and multi-organ failure persist even after appropriate drainage and antimicrobial therapy.

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Coronavirus disease 2019 (COVID-19) is often mild in children, but many severe cases with Kawasaki disease-like symptoms have been reported in Europe and the United States, and termed as multisystem inflammatory syndrome in children(MIS-C). We experienced a 12-year-old boy met the diagnostic criteria for Kawasaki disease and MIS-C after COVID-19. His clinical feature reviewed neither shock nor respiratory failure. His laboratory findings on admission showed remarkable inflammatory reaction, lymphocytopenia, thrombocytopenia, and coagulation abnormality. The number of pediatric cases of COVID-19 is increasing in Japan, and attention should be paid to the development of Kawasaki disease and MIS-C in the future.

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Tozinameran, a vaccine that is approved for COVID-19, is expected to be effective in preventing COVID-19 infection. The objective of this study was to measure the dead space volumes in 250 tozinameran vials used between April 15 and May 25, 2021. Our results revealed that the weight of liquid that can actually be collected from 1 vial is 2241.19 ± 31.24 mg. The weight of liquid required to provide a 0.3 mL dose is 391.88 ± 10.43 mg (in a vaccination syringe and 25G needle), 389.96 ± 10.81 mg (in a tuberculin syringe and 25G needle), 351.81 ± 7.71 mg (in a loaded syringe [gasket protrusion type] and 25G needle), 343.87 ± 10.78 mg (in a vaccination syringe and 25G loaded needle), and 307.46±3.04 mg (in a loaded injector [needle integrated type]). To use the limited amounts of vaccine available most efficiently, it is important to reduce the proportion of vaccine that is discarded. We hope that our results will contribute to preventing the spread of COVID-19.

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