In this study, we have described the clinical characteristics of vaccine-modified measles to assess the performance of an expanded case definition in a school outbreak that occurred in 2010. The sensitivity, specificity, and the positive and negative predictive values were evaluated. Among 74 cases of vaccine-modified measles, 47 (64%) met the original case definition. Fever and rash were observed in 73% (54/74); fever was the most common (96%, 71/74) presenting symptom, and rash was noted in 77% (57/74) of the cases. The original case definition showed an overall sensitivity of 63.5% and a specificity of 100.0%. The expanded case definition combining fever and rash showed a higher sensitivity (72.9%) but a lower specificity (88.2%) than the original. The presence of fever and one or more of cough, coryza, or conjunctivitis scored the highest sensitivity among the combinations of signs and symptoms (77.0%), but scored the lowest specificity (52.9%). The expanded case definition was sensitive in identifying suspected cases of vaccine-modified measles. We suggest using this expanded definition for outbreak investigation in a closed community, and consider further discussions on expanding the case definition of measles for routine surveillance in South Korea.

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During bacterial infection, activated polymorphonuclear leukocytes (PMNs) often cause inflammation and organ dysfunction in severely ill patients. Gene expression was analyzed in circulating PMNs isolated from these patients to determine the distinct expression profile. We focused on immunomodulatory genes, such as those for pattern recognition receptors, inflammatory cytokines, PMN surface antigens, and myeloid cell receptors in PMNs. Gene expression in 23 patients (12 with pneumonia and 11 with sepsis) were analyzed using quantitative real-time polymerase chain reaction. The mRNA levels of TLR2 (20/23 cases) and CD14 (18/23 cases) were upregulated in the PMNs of patients when compared with healthy subjects. The mRNA expression levels of TLR4 (16/23 cases) and IL6 (16/23 cases) were downregulated in patients' PMNs, and of TNFA (16/23 cases) were upregulated in these cells. Although mRNA levels of IL8RA (15/23 cases) were downregulated in PMNs, MAC-1 mRNA levels (14/23 cases) were upregulated in the same cells. Copies of the TREM1 transcript were 0.7- to 2.1-fold higher in patients with moderate pneumonia than in the healthy subjects; the average fold change was 1.1. The mRNA levels were 0.3-fold lower in the patients with severe pneumonia and sepsis than in the healthy subjects. In conclusion, the downregulation of TREM1 expression in PMNs is associated with the severity of the pathophysiological conditions and may be used as a surrogate marker of acute bacterial infections.

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This study examined pathological changes in the lung tissues of young and aged mice infected with influenza virus. Young mice inoculated with influenza virus showed body weight loss at 4 days post-infection (dpi), meanwhile body weight decrease started from 9 dpi in the aged mice. We histopathologically examined the lungs of these mice. Immunohistochemical examination revealed that viral antigen-positive bronchiolar and alveolar epithelial cell numbers at 3 dpi were significantly higher in young mice than in the aged ones. Further, viral antigen-positive cells were observed at 9 dpi in the aged mice, but not in the young ones. Diffuse and severe bronchointerstitial pneumonia characterized by the accumulation of polymorphonuclear leukocytes (PMNs) was observed in young mice at 6 dpi. Histopathological changes in the aged mice were milder than those in the young mice. Moreover, T cell and macrophage accumulation in the lungs was significantly higher in the young mice than in the aged mice at 9 dpi. These results suggest that there may be a correlation between the relatively low level of infiltration of PMNs, macrophages, and T lymphocytes and the delayed body weight loss and longer lasting infections observed in the lungs of the aged mice. These findings provide detailed insights into the age-specific course of infection in young and aged populations with associated differences in lung pathology.

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Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal infectious disease, and it is endemic in Turkey. Patients are placed in isolation when hospitalized, and some may require blood transfusions. Moreover, some patients may require admission to intensive care units (ICU). CCHF is not a recurrent disease, and relapses are not expected. Therefore, no medical follow-up is conducted on recovery from CCHF. In this study, health-related quality of life (HRQL) and the presence of post-traumatic stress disorder (PTSD) among CCHF survivors were evaluated 12 months after recovery from the disease. PTSD diagnosis was established by DSM-IV-TR criteria and HRQL was investigated by using the Medical Outcomes Study Short Form 36. This study included 54 patients. Our results showed that 48.1% of the patients had PTSD symptoms and 18.5% had PTSD. PTSD incidence was higher among patients who required an ICU stay, who had bleeding, and who required blood transfusion. In addition, 4 out of 8 dimensions of HRQL were impaired. However, none of these patients admitted psychiatric problems to health care professionals. Our findings revealed that periodic psychiatric evaluation should be performed on CCHF patients, and they should be provided medical support, if required.

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Rabies was eliminated in Japan over 50 years ago; however, the recent increase in the movement of humans and animals across the world highlights the potential threat of disease reentry into the country. The immune status against rabies among the dog population in Japan is not well known; thus, the purpose of this study was to estimate the prevalence of dogs with effective immunity from the vaccination history using a web-based survey. We found that 76.9% (95% confidence interval, 75.8–78.1) of dogs in this study population belonged to the population in which 90% were assumed to have the internationally accepted antibody titer. We showed that dogs taken less frequently for walks were less likely to be vaccinated. Additionally, the frequency of encounters with other dogs during walks and the number of individuals in households were associated with vaccination history. To our knowledge, this study is the first report estimating the prevalence of dogs in Japan with effective immunity against rabies. Further, we identified the population with low vaccination coverage as well as the heterogeneous characteristics of vaccination history among the dog population. These findings contribute to the implementation of an efficient strategy for improving the overall vaccination coverage in Japan and the development of a quantitative risk assessment of rabies.

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We conducted focus group interviews to understand how residents of Japan feel about the transport of pathogens. Twelve randomly selected housewives, who had no special knowledge regarding the topic before the interview, expressed their opinions in 2 separate meetings regarding pathogen transport. The results of the interviews were analyzed by the KJ method. The analysis found that although the transport of pathogens is universally recognized to be necessary, there is not clear consensus on the exact methods of transport, the positive and/or negative value of such information, and how clearly and/or uniquely to label containers, packages, compartments, vehicles, and conditions used for such transportation. Further studies to improve the skills of both the providers and receivers of such information (a technique of risk communication) are necessary.

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The purpose of this study was to understand the geographic extent, risk factors, and attack rate of the 2009 pandemic influenza A (H1N1) virus [A(H1N1)pdm09] infection in Shandong Province, China and to identify the influencing factors. A randomized serological survey of A(H1N1)pdm09 infection was carried out in August and September 2010. A total of 4,549 participants involved in the survey had their antibody levels tested by hemagglutination-inhibition assay. The overall seropositive rate for A(H1N1)pdm09 antibodies was 25.85%. The seropositive rate was 25.89% for the unvaccinated group, with statistically significant differences among individuals of different age groups, occupations, and cities. The highest seropositive rate was observed in young children aged 0–5 years and elderly people aged ≥60 years. Multivariate logistic regression revealed that subjects in rural areas had significantly higher odds ratio of A(H1N1)pdm09 seropositivity than those in the capital city. Individuals belonging to all professions, except for teachers, had significantly lower odds ratio of A(H1N1)pdm09 seropositivity compared with children in family care. Our data indicated that almost 26% of the residents in Shandong Province had appropriate antibody titers against A(H1N1)pdm09. This seroepidemiology study provides valuable data for understanding the epidemiology of the 2009 pandemic influenza and for planning future intervention strategies; moreover, it highlights the significance of seroprevelance studies.

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When quantifying periodontopathic bacteria, it is important to use a convenient method that does not produce false negative results. The Invader assay is a convenient method because it does not involve gene amplification. The purpose of this study was to evaluate the validity of the Invader assay to quantify periodontopathic bacteria. The Invader technology was applied in quantifying five periodontopathic bacteria (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, and Treponema denticola). The Invader assay produced a linear quantitative detection range over concentrations spanning seven exponential values, with a detection limit of 10^3.7 copies/tube and intra-day and inter-day variance of 0.1% to 4.7% and 0.1% to 3.4%, respectively, in quantifying five periodontopathic bacteria. We compared the results of the Invader assay with those of real-time polymerase chain reaction (PCR) performed for quantifying five periodontopathic bacteria in 22 patients with periodontitis. Among the Invader-detectable bacterial strains of each species, significant correlations were observed in the counts of concerned bacterial species between these two methods, with correlation coefficients ranging from 0.757 to 0.996. This study validated repeatability and reproducibility of the Invader assay in quantifying periodontopathic bacteria and demonstrated consistent agreement between the Invader assay and real-time PCR in quantifying periodontopathic bacteria.

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Sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV) infection have become a major public health problem globally as well as in India. Prevalence of STIs varies across different high risk groups including the population with sexually transmitted diseases (STDs). Individuals with STDs are at a higher risk of acquisition of HIV through the sexual route than the other routes. The tendency of HIV infection was studied in attendees aged 15–49 years in an STD clinic in West Bengal from 2004 to 2008. Blood samples were collected consecutively from 250 attendees per year (a total of 1,250 samples over 5 years) from an STD clinic during 12 weeks (October-December) every year. HIV sero-status was screened using ELISA, and positive samples were subjected to rapid assay and confirmed by Western blot. Overall HIV seropositivity in STD patients was 1.28% (women, 1.04%; men, 1.48%). Data from 5 consecutive years showed a prominent decline from 2.40% (2004) to 0.0% (2007) and a minor increase (1.6%) in 2008, which was not statistically significant (χ² = 4.6, df = 4, P > 0.05). The highest seroprevalence (1.66%) was observed in the 25–29 age group, and the lowest (0.87%) was observed in the 40–44 age group. The overall decreasing tendency of HIV infections signifies the efficiency of current interventions. Focused intervention for the 25–29 age group may help in decreasing HIV infections further.

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This study concerns the quantitative analysis of brucellosis outbreaks and the related risk factors and control programs for both domestic cattle and human brucellosis infections in Korea between 2002 and 2009. There were a total of 77,082 infections of bovine brucellosis (BB) in domestic cattle with a prevalence rate (PR) of 13.3 per 1,000 cattle; during the same period there were 620 cases of human brucellosis (HB) with a PR of 0.16 per 100,000 persons. Moreover, the correlation coefficient of brucellosis outbreaks between cattle and humans was highly significant (r = +0.985). The attack ratio of HB cases was 8.04 per 1,000 BB cases. The distribution of brucellosis outbreaks was concentrated in the southeast region of Korea (P < 0.01). Significantly more males were infected than females (86.9% versus 13.1%), and a high incidence of HB was observed in those aged more than 40 years (86.1%). The majority of HB cases occurred primarily among rural inhabitants (92.3%) and among farmers and related workers (47.9%). Finally, all of the measures that were applied in the extensive eradication program for brucellosis outbreaks and control were based principally on an intensive test-and-slaughter policy and contributed significantly to the reduction in the outbreaks of brucellosis in Korea.

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Many viruses have been reported to be associated with rash development. Multiplex real-time PCR was used to investigate the presence of 5 viruses associated with rashes: measles virus (MV), rubella virus (RV), human parvovirus B19 (PVB19), human herpes virus 6 (HHV-6), and HHV-7. A total of 187 clinical specimens from 169 patients with erythema were collected between January 2006 and December 2011. Virus-positive specimens were as follows: MV (n = 23), PVB19 (n = 8), RV (n = 2), HHV-6 (n = 5), HHV-7 (n = 1), MV and PVB19 (n = 1), and HHV-6 and HHV-7 (n = 1). All of the MV-positive specimens were collected in 2007 and the strains whose sequence were available (21/24, 87.5%) were of genotype D5. The results indicate that multiplex real-time PCR might be a useful screening method for detecting and differentiating rash-associated viruses in clinical specimens.

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The prevalence of ceftriaxone resistance and the associated genes encoding extended-spectrum β-lactamase (ESBL) was determined in 149 non-duplicate non-typhoidal Salmonella isolated in 2008–2009 from patients in a tertiary care hospital in Kuala Lumpur, Malaysia. The resistance rate to ceftriaxone was 2.7% (2/74) in 2008, 4.0% (3/75) in 2009, and 3.4% (5/149) overall. CTX-M ESBL genes were detected in 2 of the 5 ceftriaxone-resistant isolates. The prevalence of ceftriaxone resistance, although low, is a concern because it limits therapeutic options. Continued surveillance of ceftriaxone resistance is important to monitor its trends.

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Kudoa septempunctata, a myxosporean parasite, was recently identified as the causative agent of food poisoning resulting from the consumption of raw olive flounder (Paralichthys olivaceus). A single blind inter-laboratory study, involving 5 laboratories, was conducted to validate a quantitative real-time PCR assay for the detection of the parasite. We obtained relatively constant values for log rDNA copies/g from these laboratory analyses (SD = 0.35–0.86), suggesting the validity of the real-time PCR method for the detection of K. septempunctata in P. olivaceus. Detection of K. septempunctata in muscle tissue samples collected from both sides of the fish indicated that K. septempunctata infection spreads throughout the body of P. olivaceus. K. septempunctata infection in P. olivaceus is thought to occur during the early stage of fish growth because a K. septempunctata gene was detected in 1 of 300 P. olivaceus fry tested. Feeds seem not to be sources of infection. To prevent food poisoning due to K. septempunctata, the mechanism of infection and proliferation of K. septempunctata in P. olivaceus should be elucidated, and other hosts of the prasite should be identified. The sensitive real-time PCR method described here will be a useful tool for resolving these issues.

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Staphylococcus aureus produces various virulence factors. The catalase enzyme, in particular, is considered to be involved in oxidative stress resistance, and catalase activity is an important criterion for differentiating staphylococci from streptococci. In this report, we describe the catalase-negative S. aureus strain SH3064, which was isolated from the sputum of a patient with aspiration pneumonia. To evaluate the causes of the lack of catalase activity in S. aureus SH3064, we analyzed the sequence of katA gene encoding the catalase enzyme in this strain. We amplified the complete sequence of katA gene of S. aureus SH3064 by polymerase chain reaction using 2 sets of primers. The katA sequence showed 99.6% sequence identity (1512/1518 bp) with that of S. aureus ATCC 12600. We detected 2 mutations in the katA gene from S. aureus SH3064, an A217T substitution leading to a threonine 73-to-serine substitution and a single-base pair deletion (c.637delG) resulting in a frameshift mutation. The lack of catalase activity in this strain was attributed to the shift of the nucleotide reading frame.

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Fifteen Japanese colitis patients, aged above 16 years old, infected with verotoxin-producing Escherichia coli O157 (VTEC O157) were divided into 2 treatment groups. Of the 15 patients, 6 (mean ± SD, 41.3 ± 19.0 years old) were treated with levofloxacin (LVFX), while the remaining 9 patients (32.0 ± 10.0 years old) were not treated with any antimicrobial agents. All patients complained of abdominal pain and bloody stool and were not administered antidiarrheals. Hemolytic uremic syndrome (HUS) did not develop in any of the 6 patients treated with LVFX, but developed in 1 of the 9 patients not treated with antimicrobial agents. No statistical difference was found in the occurrence rate of HUS between LVFX-treated patients and patients not treated with antimicrobial agents. Our results suggest that oral administration of LVFX is not associated with risk of HUS in hemorrhagic colitis patients aged above 16 years infected with VTEC O157.

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