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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.117, No.11, November 2013
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Review
Title
Experience in Japan from 2008 to 2011 to Make Countermeasures against Measles More Effective
Author
Takako Misaki1) Hiroshi Satoh2) Kazunori Oishi2) and Keiko Tanaka-Taya2)
1)Field Epidemiology Training Program, National Institute of Infectious Diseases
2)Infectious Disease Surveillance Center, National Institute of Infectious Diseases
Abstract
Measles is a very highly contagious disease, and the achievement of high vaccine coverage is very important for effective prevention. A questionnaire returned by 1,742 Japanese municipalities shows changes in countermeasures against measles between 2008 and 2011: computerization of vaccination records increased from 84.7% to 88.0%, immediate tallying of vaccination situation increased from 96.6% to 97.2%, individual notification to persons at risk increased from 95.1% to 95.5%, recommendation for vaccination of infants at their periodic check-ups increased from 93.7% to 93.9%. In the case of schoolchildren, however, immediate tallying of vaccination statistics remained at 45.3 to 45.7%, group vaccination remained low at 23.9 to 25.3% (3rd stage), and 9.5 to 10.6% (4th stage). In addition, about 2% of municipalities had areas where the vaccination rate was extremely low, and some municipalities even entrusted vaccination responsibilities to other areas.
In the 1st stage, differences in vaccination rates among municipalities were large, but at the second stage, the rates were generally high both in 2008 and 2011. At the 3rd and 4th stages, those municipalities that had either high or low rates in 2008 tended to continue without change.
What influenced the rates in the 3rd and 4th stages was computerization of vaccination records, individual notification of persons at risk, understanding of the measles situation in schools, group immunization, and the immediate understanding of the measles situation in neighboring municipalities.
In raising the 1st stage vaccination rate by ten points or more, computerization of vaccination records, individual notification of persons at risk, and understanding of the measles situation in schools were important.
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Original Article
Title
Epidemiology of Pneumococcal Strains Obtained from the Nasopharynx of Infants and Young Children with Lower Respiratory Tract Infection before the Distribution of 7-valent Conjugate Vaccine in 2010
Author
Akiyoshi Nariai Toru Uchimura Taichi Kanetaka Michisato Hirata Manari Kawamoto and Sakiho Abe
Department of Pediatrics, Yokohama Minami Kyousai Hospital
Abstract
We investigated the serotypes, sequence types (STs), penicillin G (PCG) resistance rates, and high macrolide resistance rates (resistance to both macrolide and clindamycin) of 132 pneumococcal strains obtained from the nasopharynx of 131 infants and young children with lower respiratory tract infection during the year 2010 when the heptavalent pneumococcal conjugate vaccine (PCV7) was introduced. We analyzed the epidemiology of pneumococci in infants and young children before the distribution of PCV7. All infants and young children showing pneumococci were unvaccinated with PCV7.
Twenty serotypes were confirmed, with 6B and 19F being the most frequent (24.2% and 16.7%, respectively). Serotype 4 was not found. However, 81 strains were found to have the PCV7 serotype (61.4%).
Thirty-nine STs were found. Differences in ST polymorphism were seen among the serotypes. Seven STs were found in serotype 6B and 3 STs were found in 19F.
In addition, in terms of PCG resistance rate, the PCV7 serotype strains showed a high level of resistance (81.5%) and the non-PCV7 serotype strains showed a low resistance rate (52.9%). In contrast, in terms of the high macrolide resistance rate, the PCV7 serotype strains demonstrated lower resistance (60.8%) than the non-PCV7 serotype strains (73.5%).
In the future, the distribution of PCV7 to infants and young children is anticipated; therefore, it is important to observe changes in the serotypes, STs, and drug resistance rates of pneumococcal strains.
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Original Article
Title
Epidemiology of Bacterial Meningitis in Childhood before and after the Introduction of Conjugate Vaccines in Hokkaido, the Northernmost Main Island of Japan
Author
Takehiro Togashi1) Hiroshi Sakata2) Hiroyuki Tsutsumi3) and Kimiko Ubukata4)
1)School of Nursing, Sapporo City University
2)Department of Pediatrics, Asahikawa Kosei Hospital
3)Department of Pediatrics, Sapporo Medical University School of Medicine
4)Kitasato Institute for Life Sciences, Kitasato University
Abstract
We started in 2007 the surveillance of bacterial meningitis among children in Hokkaido which is geographically isolated from Mainland Honshu. During 5 years from 2007 through 2011, designated as the pre-vaccination period during which the vaccination rate was estimated to be under 30% among children under 7 months of age, 60 cases (12 a year) of H. Influenzae meningitis and 20 cases (4 a year) of Streptococcus Pneumoniae meningitis were reported by pediatric doctors in 35 hospitals, whereas in 2012 designated as the post-vaccine period, during which the vaccination rate was estimated over 90% among children under 7 months of age, none of H. Influenzae meningitis and 1 case of Streptococcus Pneumoniae meningitis was reported from 1 hospital. The reason for the dramatic decrease of meningitis cases due to the main two pathogens will be by the introduction of an official vaccination program "the Provisional Special Fund for the Urgent Promotion of Vaccination" from November 2010 which encourages the vaccination of Hib and PCV7 for children under 5 years throughout Japan.
Recently meningitis patients due to the serotype 19A and 6C of Streptococcus Pneumoniae were reported in Hokkaido, further serotype surveillance should be continued and the introduction of PCV10 and/or PCV13 should be expected in Japan.
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Original Article
Title
Risk Factors of Central Nervous System Infections for Patients Who Present with Complex Febrile Seizures
Author
Jun Sawai Tetsuo Kubota Tatsuya Fukasawa Erina Kitamura Yoko Sakaguchi Chihiro Hatano Fumiko Miyazaki Sachie Ito Yuichi Kato Yuji Miyajima Akimasa Ogawa and Kuniyoshi Kuno
AnjoKosei Hospital
Abstract
Objective Although it is necessary to differentiate complex febrile seizures from central nervous system infections, such as acute bacterial meningitis and acute encephalitis/encephalopathy, there have so far been no reports discussing this problem in the Japanese literature. We retrospectively examined the risk factors for central nervous system infections in patients presenting at our hospital with complex febrile seizures.
Design and methods We studied 214 children who presented with either clusters of febrile seizures or prolonged febrile seizures between March 2005 and April 2010. The patient characteristics, clinical manifestations, and laboratory findings were then compared between the patients given diagnoses of complex febrile seizures and those with central nervous system infections.
Results Of the 191 confirmed cases of clusters of febrile seizures, 178 patients had complex febrile seizures and 13 had central nervous system infection. The risk factors for central nervous system infection were thus identified to be: more than 3 seizures, coexistence of prolonged febrile seizures, and a prolonged consciousness disturbance. Of the 32 confirmed cases of prolonged febrile seizures, 24 patients were given diagnoses of complex febrile seizures and 8 central nervous system infections. The patients who experienced only 2 seizures with no signs of meningeal irritation, and demonstrated a good consciousness recovery did not have central nervous system infection. The risk factors for central nervous system infection were therefore identified to be: the occurence of more than three seizures and the continuation of a disturbed consciousness
Conclusion Additional testing, such as cerebrospinal fluid examination, should be considered in patients presenting with any of the above-mentioned risk factors of central nervous system infection.
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Original Article
Title
Diagnosis of Balanced Translocation Carriers and Genetic Counseling
Author
Mikiko Kaneko1) Hirofumi Ohashi2) Tomoko Takamura3) and Hiroshi Kawame1)
1)Department of Genetic Counseling, Ochanomizu University
2)Division of Medical Genetics, Saitama Children's Medical Center
3)Department of Developmental and Clinical Psychology, Ochanomizu University
Abstract
In order to describe the status of the diagnosis and psychosocial impacts of balanced chromosomal carriers ascertained through abnormal offspring, we conducted a semi-structured interview in 11 parents followed at Saitama Children's Medical Center. Over 80% of parents remembered what acarrier is, and the purpose of carrier testing. All parents shared information about carrier status with their parents and/or siblings and utilized the information for subsequent pregnancies. For proband siblings, the parents realized and understood that the information about carrier status is very important, and continued to discuss about the disclosure of possible carrier status. They reported healthcare professionals' support when they share the information with siblings. It is necessary to provide long-term genetic counseling to the parents if one is a carrier of a balanced reciprocal translocation when the offspring reach the appropriate age.
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Original Article
Title
A Case of Acute Appendicitis as the Onset Symptom of Kawasaki Disease
Author
Eri Kawatani Rihito Hanamiya Junichi Hashimoto Fusako Sasaki Hitomi Hayashi Reimi Turusawa Yukako Yoshikane and Atushi Ogawa
Fukuoka University Chikushi Hospital
Abstract
A girl presented major symptoms of Kawasaki disease after appendectomy. Pathological findings of the resected appendix revealed infiltration of neutrophils into the perivascular spaces, mainly confined to the subserous layer. On the other hand, the mucosa was normal. Although digestive symptoms of Kawasaki disease include diarrhea, vomiting, abdominal pain, enlarged bladder, and paralytic ileus, usually, acute appendix is not included among them. Although there have been some case reports of Kawasaki disease after acute appendix, few of those reported pathological findings. In this case report, we discuss the pathophysiology of Kawasaki disease based on the pathological findings of the resected appendix.
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Original Article
Title
Case Report -A Rare Combination of Hypertrophic Obstructive Cardiomyopathy and Coronary Artery Dilatation in LEOPARD Syndrome
Author
Kenzo Sakurai Shun Soneda Yachiyo Kurihara Kenjiro Goto Masaki Arima Yoshimitsu Tsuzuki Shiori Kakuage Hirotaka Osada and Kentaro Aso
Department of Pediatrics, St. Marianna University School of Medicine
Abstract
LEOPARD syndrome (LS) is a rare hereditary disease involving a RASopathy that manifests with a heart disease such as hypertrophic cardiomyopathy (HCM) and pulmonary stenosis. We report the case of a 13-year-old boy who had LS with HCM and coronary dilatation. Two days after birth, the patient was transferred to our hospital for evaluation of heart murmur. Noonan syndrome was diagnosed because of typical clinical manifestations, including HCM. During the follow-up, multiple lentigines and dilatation of bilateral coronary arteries were remarkable on echocardiography. Genetic analysis at age 12 indicated a point mutation in PTPN11 exon 13, indicating LS. Cardiac catheterization was performed when the patient was 13 years of age. Aortography results indicated multiple bilateral coronary dilatation and severe left ventricular outflow tract obstruction. The pathological examination of the biopsy specimen, obtained from the left ventricular wall, indicated slight fibrous change and bizarre disarray, characteristics that differ from typical HCM findings. On cardiac magnetic resonance imaging, tiny spotty delayed gadolinium enhancement was observed; this was also an atypical HCM finding. We administered cibenzoline; however, no improvement was observed. From our experience, the findings for HCM, which is known to coexist with LS, differed from that of idiopathic HCM. Therefore, a specific therapeutic plan is required for such cases of HCM with LS.
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Original Article
Title
A case of Limy Bile Syndrome in a 11-year-old Girl
Author
Yoh Kawauchi1) Yuki Chou1) Miki Yamamoto2) Yoshiki Morotomi2) Chikaharu Sakata3) Takao Hoshina4) Akira Nishimura4) Haruo Shintaku1) and Daisuke Tokuhara1)
1)Department of Pediatrics, Osaka City University Graduate School of Medicine
2)Department of Pediatric Surgery, Osaka City University Hospital
3)Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine
4)Department of Pediatrics, PL General Hospital
Abstract
Limy bile syndrome, which presents white milky bile in a gallbladder as a result of calcium carbonate precipitation, is a rare condition in children. Here we report a new case of limy bile syndrome in a 11-year-old girl. The patient presented limy bile and white sludge in a gallbladder with an impaction of a black pigment stone in the gallbladder neck. A black pigment stone was also detected in a common bile duct and a cholecystectomy was underwent. White sludge in the gallbladder was composed of calcium carbonate (97%), and the black pigment stones in a common bile duct even composed chiefly of calcium carbonate (76%) and calcium bilirubinate (15%). Bile acid analysis showed normal bile acid concentration in a bile (pH; 8.3) derived from a common bile duct, but disclosed an absence of bile acid in a gallbladder bile (pH; 7.4). Calcium analysis revealed a gallbladder bile containing a high concentration of ionized calcium (3.3 mmol/L). Our findings suggested an absorption of bile acid and a secretion of calcium following the obstruction of the gallbladder neck caused a reduced bufferization of bile acid against calcium precipitation resulting limy bile and white sludge.
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