Cumulative incidence of Kawasaki disease in Japan.

BACKGROUND: Although the incidence rates of Kawasaki disease (KD) in Japan have been determined in nationwide surveys, the cumulative incidence, that is, the proportion of those with a history of KD in the general population of 10-year-olds, is currently unknown. The aim of this study was therefore to assess the cumulative incidence of KD in Japan. METHODS: Using the age- and sex-specific incidence rate of KD in Japan from the results of the nationwide surveys, incidence probabilities, that is, the age-specific number of KD patients divided by the population used in the vital statistics, and cumulative proportions of those not affected by KD up to the end of 9 years of age, were calculated. The cumulative incidence was then defined as 1 minus the cumulative proportion. The observed age classes were 0, 1, 2, 3, 4, and 5-9 years. All data were calculated by sex. RESULTS: The cumulative incidence was 0.004833 for boys and 0.003474 for girls in 1991, but was 0.015284 and 0.012145 in 2014, respectively. According to these figures, 15.284 per 1,000 boys and 12.145 per 1,000 girls have been affected by KD by the age of 10 years. The birth-cohort cumulative incidences had similar trends. CONCLUSIONS: More than 10 persons in 1,000 have a history of KD at age 10 years in Japan.

Epidemiologic features of Kawasaki disease: Winter versus summer.

BACKGROUND: The epidemiology of Kawasaki disease (KD) shows seasonal variations, although the etiology of KD is unknown. In this study, we compared the clinical epidemiology of KD onset in winter versus that in summer to identify its etiology, that is, infectious agents. METHODS: Epidemiologic features of KD were compared between two seasons with high incidence (January [winter] and July [summer]) using a dataset of the 22nd nationwide survey in Japan. Data on patients who visited hospital during 2011-2012 in Japan were analyzed after adjusting for age differences. Subgroup analysis was carried out for day of illness at the day of first hospital visit. RESULTS: The total number of KD patients reported in the survey was 26 691. The number of patients who visited hospital with KD for the first time in January and July was 2,812 and 2,302, respectively. The proportion of patients in the age group 15 months-3 years was 38.8% in January and 33.5% in July. Mean serum albumin was significantly lower in January than in July (at days 2-5 of illness, P < 0.05). There were no between-group differences with respect to treatment, incidence of cardiac lesions, recurrence, or history of KD among the patients' siblings and parents. CONCLUSION: No significant differences were observed between KD with onset in January and July, although minor differences with respect to age distribution and serum albumin were observed.

[Training programs for staff at local Infectious Disease Surveillance Centers: the needs and usefulness].

OBJECTIVES: The objective of this study was to assess the need for and usefulness of training programs for Local Infectious Disease Surveillance Center (LIDSC) staff. METHODS: A structured questionnaire survey was conducted to assess the needs and usefulness of training programs. The subjects of the survey were participants of a workshop held after an annual conference for the LIDSC staff. Data on demographic information, the necessity of training programs for LIDSC staff, the themes and contents of the training program, self-assessment of knowledge on epidemiology and statistics were covered by the questionnaire. RESULTS: A total of 55 local government officials responded to the questionnaire (response rate: 100%). Among these, 95% of participants believed that the training program for the LIDSC staff was necessary. Basic statistical analysis (85%), descriptive epidemiology (65%), outline of epidemiology (60%), interpretation of surveillance data (65%), background and objectives of national infectious disease surveillance in Japan (60%), methods of field epidemiology (60%), and methods of analysis data (51%) were selected by over half of the respondents as suitable themes for training programs. A total of 34 LIDSC staff answered the self-assessment question on knowledge of epidemiology. A majority of respondents selected "a little" or "none" for all questions about knowledge. Only a few respondents had received education in epidemiology. CONCLUSION: The results of this study indicate that LIDSC staff have basic demands for fundamental and specialized education to improve their work. Considering the current situation regarding the capacity of LIDSC staff, these training programs should be started immediately.

Volumetric Analysis of Glioblastoma for Determining Which CpG Sites Should Be Tested by Pyrosequencing to Predict Temozolomide Efficacy.

The aim of the present study was to determine which individual or combined CpG sites among O6-methylguanine DNA methyltransferase CpG 74-89 in glioblastoma mainly affects the response to temozolomide resulting from CpG methylation using statistical analyses focused on the tumor volume ratio (TVR). We retrospectively examined 44 patients who had postoperative volumetrically measurable residual tumor tissue and received adjuvant temozolomide therapy for at least 6 months after initial chemoradiotherapy. TVR was defined as the tumor volume 6 months after the initial chemoradiotherapy divided by that before the start of chemoradiotherapy. Predictive values for TVR as a response to adjuvant therapy were compared among the averaged methylation percentages of individual or combined CpGs using the receiver operating characteristic curve. Our data revealed that combined CpG 78 and 79 showed a high area under the curve (AUC) and a positive likelihood ratio and that combined CpG 76-79 showed the highest AUC among all combinations. AUCs of consecutive CpG combinations tended to be higher for CpG 74-82 in exon 1 than for CpG 83-89 in intron 1. In conclusion, the methylation status at CpG sites in exon 1 was strongly associated with TVR reduction in glioblastoma.

Epidemiologic features of Kawasaki disease distinguished by seasonal variation: an age-specific analysis.

PURPOSE: The purpose of this study was to review the seasonal variation of Kawasaki disease (KD) by an age-specific analysis to clarify the distribution of infectious agents. METHODS: Data obtained from nationwide surveys of KD in Japan, which targeted patients for 12 years (2003-2014), were analyzed. The monthly numbers of patients were classified into the following age groups: 0-11 months, 1 year, 2-3 years 5 months, and 3 years 6 months-4 years. Factors associated with disease onset were analyzed using a 12-month moving average method. RESULTS: In winter, a sharp peak was observed in all age groups, but this was notably sharper in the 1-year age group. Plateaus in disease occurrence were observed in two periods: from March to May in the 2- to 4-year age group and from June to August in the 0- to 11-month age group. Seasonal index was analyzed into two factors that differed depending on the age group. CONCLUSIONS: The age-specific analysis of KD clearly identified age-related differences in the seasonal occurrence of this disease.

[Identification of fungi using DNA sequences: an approach to identify Fusarium species isolated from domestic unpolished rice].

Molecular approaches are being developed to provide for the rapid and objective identification of fungi. We attempted the identification of Fusarium species by a genetic analysis to validate practically the utility of a molecular approach for fungal identification and to reveal its limitations, and sequenced three regions, the 5' end of the 28S rRNA gene (D2 region) and the internal transcribed spacer 1 and 2 (ITS1 and ITS2) regions, in the rRNA genes. The DNA sequences of 38 Fusarium strains isolated from domestic unpolished rice were compared for similarity with entries in the GenBank. Based on this comparison, it was estimated that all these three regions, as a minimum, must be compared with the database to identify Fusaria at the species level. According to the combinations of sequences in the three regions, the 38 isolates were classified into 13 groups. Out of the 13 groups, 6 groups (20 isolates in total) could be identified as definite species based only on the sequence data. For the other 6 groups (17 isolates in total), candidate species were limited on the basis of the sequence similarity, and then the isolates were identified at the species level with the aid of morphology. Only one isolate could not be identified. These results verified that DNA sequence comparison with the GenBank database is useful for the identification of Fusarium species.

[A diffuse outbreak of enterohemorrhagic Escherichia coli O157:H7 related to the Japanese-style pickles in Saitama, Japan].

We have experienced an outbreak of enterohemorrhagic E. coli O157:H7 (Shiga-like toxin 1 & 2 producing) in child independence support facilities in the all dormitory system, in Saitama August 2001. There were 13 patient and EHEC O157s were detected in a total of 29 specimens. As a result of epidemic inspection and microbiological investigation. We recognized that the causative food was Japanese-style pickles named "Wafu-Kimuchi" which had been sold in Saitama and Tokyo area. As the same period, several infections caused by EHEC O157 were considered the same origin in Saitama (8 patients in 5 families). Furthermore some infections happened also in Tokyo. It was made clear this outbreak was a part of a diffuse outbreak caused by Wafu-Kimuchi. In diffuse outbreaks, it is important to grasp a common feature of the individual cases in a wide area. The exchange of epidemic information between two or more municipalities and the guess of the identity in the DNA levels of strains were the key role to the elucidation of this case.

Seasonal patterns of legionellosis in Saitama, 2005-2009.

Sporadic cases of legionellosis have increased in Saitama Prefecture. This study aimed to understand the characteristics and incidence of legionellosis in Saitama Prefecture by studying the corresponding data from Tokyo and all over Japan. We analyzed cases of legionellosis registered from 2005 through 2009 in the annual reports of the Infectious Disease Surveillance Center. There were two peaks in the incidence of legionellosis in Japan between June and November, and a trough between February and May every year. Similar seasonal characteristics were observed in both Tokyo and Saitama. Proper management of risk factors-such as cooling towers and other aerosol-generating devices, before and during the seasonal increase in these incidences-is essential as a prophylactic measure against legionellosis.