背景：成人への麻疹，風疹，ムンプス，水痘（MMRV）ワクチンのキャッチアップ接種は重要であるが，小児期の接種記録が不明な場合には接種費用や回数の問題により受け入れられないことも多い．抗体検査の有無により接種受け入れに繋がるかを検討した． 方法：2018年11月～2019年3月に初診となった渡航前相談時に小児期のワクチン接種歴を持たない20～40代を対象とした単施設前向き観察試験でMMRV 抗体を測定した抗体検査群として抗体保有状況およびワクチン接種率を算出した．年齢，渡航地，渡航目的をマッチした2018年4月～2019年3月の対照群とのMMRV ワクチン接種率を比較し，漏れのないMMRV の免疫補填に要する費用を算出した． 結果：37名が抗体検査群となり（年齢中央値39 歳），抗体検査よりキャッチアップ接種を要すると考えられた人数は，麻疹，風疹，ムンプス，水痘それぞれ18，8，22，4例で，接種率はそれぞれ66.7％，100％，59.1％，75.0％であった．対照群と比べ，全体のMMRV 接種率は8～73% vs 4～17% と水痘を除いて有意に高かった．抗体検査なしにMMRV ワクチンを2 回接種する費用と比べて，抗体検査に応じて接種する方が総じて要する費用が少なかった（27,000 円vs 19,000 円/人）． 結語：渡航前相談における抗体検査は，MMRV キャッチアップ接種率の向上ならびに接種費用削減に寄与し得る．

近年，ウイルスの抗原迅速診断法の改良に加え，高感度の遺伝子診断法が普及し，急性胃腸炎における病原診断率が格段に向上している．そこで，ロタウイルス（RV）ワクチン導入後の福島県相馬双葉地域において，これら診断法を用いて小児急性胃腸炎入院患児の病原体を検索し，ウイルス性胃腸炎の発生動向を明らかにするとともに，RV ワクチン導入の効果について検討することを目的とした． 2015年1月～2016年12月，胃腸炎症状を呈し公立相馬総合病院小児科に入院した患児を対象とした．入院時の重症度評価を行い，便または肛門ぬぐい液を用いて迅速診断法，細菌培養，ウイルス分離，PCR 法により病原体検索を行った．胃腸炎症状を呈して入院した患者をRV 陽性とそれ以外に分け，ワクチン効果をtest-negative design を用いて評価した． 期間中，当科に入院し最終的に急性胃腸炎と診断したのは238名だった．迅速診断法により病原ウイルスが61.9% から検出され，これにウイルス分離法とPCR 法を加えることにより，病原ウイルス検出率は80.3% と高率になった．また，RV 陽性者66名のうちRV ワクチン接種者は8名（12%），RV 陰性者158名のうちRV ワクチン接種者は67名（42%）であった．test-negative design を用いて，性別，月齢，集団生活の有無で調整したRV ワクチン効果は81%（95% 信頼区間：55.9-91.8）であった．本研究により，入院を要する急性胃腸炎の多くがウイルス性胃腸炎であること，RV ワクチンにはRV 胃腸炎による入院を強く予防する効果があることが示された．

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

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.

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.