Resurgence of human metapneumovirus infection and influenza after three seasons of inactivity in the post-COVID-19 era in Hokkaido, Japan, 2022-2023.

Following the coronavirus disease 2019 (COVID-19) outbreak in February 2020, incidences of various infectious diseases decreased notably in Hokkaido Prefecture, Japan. However, Japan began gradually easing COVID-19 infection control measures in 2022. Here, we conducted a survey of children hospitalized with human metapneumovirus (hMPV), influenza A and B, and respiratory syncytial virus infections in 18 hospitals across Hokkaido Prefecture, Japan, spanning from July 2019 to June 2023. From March 2020 to June 2022 (28 months), only 13 patients were hospitalized with hMPV, and two patients had influenza A. However, in October to November 2022, there was a re-emergence of hMPV infections, with a maximum of 27 hospitalizations per week. From July 2022 to June 2023 (12 months), the number of hMPV-related hospitalizations dramatically increased to 317 patients, with the majority aged 3-6 years (38.2%, [121/317]). Influenza A also showed an increase from December 2022, with a peak of 13 hospitalizations per week in March 2023, considerably fewer than the pre-COVID-19 outbreak in December 2019, when rates reached 45 hospitalizations per week. These findings suggest the possibility of observing more resurgences in infectious diseases in Japan after 2023 if infection control measures continue to be relaxed. Caution is needed in managing potential outbreaks.

Changing Patterns of Infectious Diseases Among Hospitalized Children in Hokkaido, Japan, in the Post-COVID-19 Era, July 2019 to June 2022.

BACKGROUND: Many reports have reported a reduction in respiratory infectious diseases and infectious gastroenteritis immediately after the coronavirus disease 2019 (COVID-19) pandemic, but data continuing into 2022 are very limited. We sought to understand the current situation of various infectious diseases among children in Japan as of July 2022 to improve public health in the post-COVID-19 era. METHODS: We collected data on children hospitalized with infectious diseases in 18 hospitals in Japan from July 2019 to June 2022. RESULTS: In total, 3417 patients were hospitalized during the study period. Respiratory syncytial virus decreased drastically after COVID-19 spread in early 2020, and few patients were hospitalized for it from April 2020 to March 2021. However, an unexpected out-of-season re-emergence of respiratory syncytial virus was observed in August 2021 (50 patients per week), particularly prominent among older children 3-6 years old. A large epidemic of delayed norovirus gastroenteritis was observed in April 2021, suggesting that the nonpharmaceutical interventions for COVID-19 are less effective against norovirus. However, influenza, human metapneumovirus, Mycoplasma pneumoniae , and rotavirus gastroenteritis were rarely seen for more than 2 years. CONCLUSIONS: The incidence patterns of various infectious diseases in Japan have changed markedly since the beginning of the COVID-19 pandemic to the present. The epidemic pattern in the post-COVID-19 era is unpredictable and will require continued careful surveillance.

Surveillance in hospitalized children with infectious diseases in Japan: Pre- and post-coronavirus disease 2019.

INTRODUCTION: The epidemic of coronavirus disease 2019 (COVID-19) rapidly spread worldwide, and the various infection control measures have a significant influence on the spread of many infectious diseases. However, there have been no multicenter studies on how the number of hospitalized children with various infectious diseases changed before and after the outbreak of COVID-19 in Japan. METHODS: We conducted a multicenter, prospective survey for hospitalized pediatric patients in 18 hospitals in Hokkaido Prefecture, Japan, from July 2019 to February 2021. We defined July 2019 to February 2020 as pre-COVID-19, and July 2020 to February 2021 as post-COVID-19. We surveyed various infectious diseases by sex and age. RESULTS: In total, 5300 patients were hospitalized during the study period. The number of patients decreased from 4266 in the pre-COVID-19 period to 701 (16.4%) post-COVID-19. Patients with influenza and RSV decreased from 308 to 795 pre-COVID-19 to zero and three (0.4%) post-COVID-19. However, patients with adenovirus (respiratory infection) only decreased to 60.9% (46-28) of pre-COVID levels. Patients with rotavirus, norovirus, and adenovirus gastroenteritis decreased markedly post-COVID-19 to 2.6% (38-1), 27.8% (97-27) and 13.5% (37-5). The number of patients with UTIs was similar across the two periods (109 and 90). KD patients decreased to 31.7% (161-51) post-COVID-19. CONCLUSIONS: We suggest that current infection control measures for COVID-19 such as wearing masks, washing hands, and disinfecting hands with alcohol are effective against various infectious diseases. However, these effects vary by disease.

Molecular and clinical characterization of the equine-like G3 rotavirus that caused the first outbreak in Japan, 2016.

Since 2013, equine-like G3 rotavirus (eG3) strains have been detected throughout the world, including in Japan, and the strains were found to be dominant in some countries. In 2016, the first eG3 outbreak in Japan occurred in Tomakomai, Hokkaido prefecture, and the strains became dominant in other Hokkaido areas the following year. There were no significant differences in the clinical characteristics of eG3 and non-eG3 rotavirus infections. The eG3 strains detected in Hokkaido across 2 years from 2016 to 2017 had DS-1-like constellations (i.e. G3-P[8]-I2-R2-C2-M2-A2-N2-T2-E2-H2), and the genes were highly conserved (97.5-100 %). One strain, designated as To16-12 was selected as the representative strain for these strains, and all 11 genes of this strain (To16-12) exhibited the closest identity to one foreign eG3 strain (STM050) seen in Indonesia in 2015 and two eG3 strains (IS1090 and MI1125) in another Japanese prefecture in 2016, suggesting that this strain might be introduced into Japan from Indonesia. Sequence analyses of VP7 genes from animal and human G3 strains found worldwide did not identify any with close identity (>92 %) to eG3 strains, including equine RV Erv105. Analysis of another ten genes indicated that the eG3 strain had low similarity to G2P[4] strains, which are considered traditional DS-1-like strains, but high similarity to DS-1-like G1P[8] strains, which first appeared in Asia in 2012. These data suggest that eG3 strains were recently generated in Asia as mono-reassortant strain between DS-1-like G1P[8] strains and unspecified animal G3 strains. Our results indicate that rotavirus surveillance in the postvaccine era requires whole-genome analyses.

Synostosis of the joint between the body and greater cornu of the human hyoid bone.

The structure of the joint between the body and the greater cornu in the human hyoid bone was examined histologically in 259 cadavers (16-98 years). Joints were classified into three grades based on histological observations. Grade I showed fibrocartilage without degenerative change in the marginal region of the joint. Grade II showed prominent calcification or ossification on the outer margin of the joint without fusion. Grade III showed bony fusion. Histological changes with age were revealed by a comparison of the prevalences of these three grades among individuals of three age groups: young adult (16-39 years), middle aged (40-69 years), and elderly (70+ years). The frequency of hyoid bones with diarthrodial structure of this joint was compared between the age groups. The mean age of subjects with each grade of histological changes was calculated. Results show that, with age, the proportion of Grade I decreased significantly (P < 0.05) and that of Grade III increased significantly. Joints with diarthrodial structure decreased significantly with age relative to all subjects (P < 0.05). Clefts with necrotic tissue were observed in cartilage along with progressive calcification. The mean age of subjects with the histological changes was significantly higher than that of individuals without such changes (P < 0.05). Calcification and ossification of joints were induced with age from fibrous tissue and cartilage on the outer margin of a joint. The authors suggest that the age changes in the joint between the body and greater cornu of the hyoid bone may affect the mobility of this joint and may be related to masticatory and swallowing functions.

Quantitative study of ageing epiglottal taste buds in humans.

OBJECTIVES: This investigation aimed to demonstrate age-related changes of taste buds on the human epiglottis using histomorphometrical analysis. METHODS: Histological observation and measurement of taste bud density were performed on oral and laryngeal surfaces of 237 human epiglottises (138 male and 99 females). The cases were divided into two age groups: 67 cases in the younger group, for subjects aged 10-39 years and 170 cases in the older group, for those aged 70-98 years. Each epiglottis was investigated at the upper and middle height levels. RESULTS: The mean density of taste buds significantly decreased on the laryngeal surfaces in the older group. Most taste buds were present in the upper height level on the laryngeal surfaces which were covered with thin and flat stratified squamous epithelium. The covering epithelium revealed developed epithelial ridges on the oral surfaces without taste buds. These results suggest a relationship between the existence of taste buds and the thickness of the covering epithelium. CONCLUSIONS: The presence of taste buds in the epiglottises of elderly people was demonstrated. In addition, the decrease of these taste buds with advancing age was clarified.

Histological evaluation of the effects of initially light and gradually increasing force on orthodontic tooth movement.

OBJECTIVE: To investigate histologically the effect of initially light and gradually increasing force on tooth movement in the rat. MATERIALS AND METHODS: Cuboids made of neodymium-iron-boron magnets (experimental groups) or titanium (control group) were bonded to the lingual surface of the right and left maxillary first molars of 18-week-old male Wistar rats. The initial distances between materials were 1.0 mm generating 4.96 gf (experimental group 1) and 1.5 mm generating 2.26 gf (experimental group 2). In three groups, rats were killed 1, 3, 7, 10, or 14 days after treatment. Histological sections were prepared and stained with hematoxylin and eosin or for tartrate-resistant acid phosphatase (TRAP) activity. The number of TRAP-positive osteoclasts was counted, and the relative hyalinized area was measured on the pressure side of periodontal ligament. RESULTS: There were significant differences in the number of osteoclasts among the three groups (P < .05). On days 1 and 3, the numbers of osteoclasts in experimental group 2 were greater than in experimental group 1. There were significant differences in the relative hyalinized area between the control group and experimental group 1 (P < .01) and between experimental groups 1 and 2 (P < .01). On days 1 and 3, the hyalinized area in experimental group 1 was larger than in experimental group 2. CONCLUSION: Initially light and gradually increasing force induced tooth movement without the lag phase and showed smooth recruitment of osteoclasts and inhibition of hyalinization.

Age-related morphological changes in the human hyoid bone.

OBJECT: Age-related morphological changes in the human hyoid bone were investigated radiographically and histologically. MATERIALS AND METHODS: Thirty-two measurements were performed on radiographs of 238 hyoid bones from autopsy cases of known age and sex. Thirty-one hyoid bones that were studied by radiography were also examined histologically in horizontal sections. RESULTS: Analysis of the length and width of the hyoid bone revealed significant increases in the body and the anterior part of the greater cornu and a significant decrease in the posterior part of the greater cornu with aging. Most measurements of the body and the greater cornu revealed differences between male and female hyoid bones. The outer margins of the body and the greater cornu were situated further outside in older males compared with females. The breadth of the joint space showed a significant age-related decrease, and the degree of fusion showed a significant age-related increase. Histological findings showed ossified or calcified fusion, with osteoclasts in the marginal area of the joint space. CONCLUSIONS: Increasing age induces fusion of the body and the greater cornu. The morphometric changes in the shape of the hyoid bone may represent functional adaptation to articulation fixation.

A morphometric study of age-related changes in adult human epiglottis using quantitative digital analysis of cartilage calcification.

The epiglottis plays an important role in deglutition in humans. The present study investigated age-related changes in the epiglottis using macroscopic and microscopic measurements. Epiglottic specimens from 281 Japanese adult cadavers (177 males, 104 females) were obtained. Specimens were divided into three groups according to age: group I: 20-39 years old (32 males, 26 females), group II: 50-69 years old (82 males, 36 females), and group III: 80-98 years old (63 males, 42 females). Width, height, and thickness were measured macroscopically. To evaluate the degree of calcium deposition, the calcium volume in digitalized von Kossa-stained sections was assessed using a quantitative analysis. An elemental analysis of the area detected with von Kossa staining was done using energy-dispersive X-ray fluorescence spectrometer (EDX). Measurements of the thickness and cell density in the superficial and deep layers of epiglottic cartilage were performed in horizontal histological sections. No significant differences in macroscopic width or height were found across the age groups in either sex. A series of three measurements in males was significantly larger than in females (p<0.05). The volume of the calcium deposit area was greater in males than in females (p<0.05) and was significantly increased in group III in males (p<0.05). The lower level of the epiglottic cartilage showed a greater calcium deposit area than the upper level. In the scanning image by line and surface analysis using EDX, the calcium deposit areas detected with von Kossa staining indicated a close association of calcium and phosphorus ions. The mean Ca/P molar ratio in the calcium deposit area was 1.32+/-0.12. Microscopic cartilage thickness increased significantly with age (p<0.05), and was greater in males than in females (p<0.05). Cartilage cell density in the superficial cartilage layer was higher than in the deep layer and was decreased in group III (p<0.05). Cartilage cell density was lower in males compared to females. Diameter of chondrocytes significantly increased in group III (p<0.05) and was larger in males than in females in group III (p<0.05). Epiglottic cartilage exhibited marked sex-related differences and progression of calcification with age. Calcification of epiglottic cartilage in elderly individuals may affect movement patterns in deglutition.

Asymmetry of the sphenoid bone and its suitability as a reference for analyzing craniofacial asymmetry.

The purposes of this study were to evaluate the asymmetry of the sphenoid bone and to determine its suitability as a reference for analyzing asymmetry of the skull. Thirty-seven dry skulls from India were divided into group A (n = 18), with a right-left length discrepancy of less than 2 mm for both the external acoustic meatus-frontozygomatic suture and external acoustic meatus-subspinale, and group B (n = 19), with a right-left length discrepancy of more than 2 mm for either of these 2 parameters. The skulls were then examined with regard to the percentage of asymmetry of the sphenoid bone, the angles between the cranial base and the facial axis, and the distance between reference surfaces of the sphenoid bone and facial landmarks by 3-dimensional measurement system. The following results were obtained: 1. Asymmetry of the sphenoid bone, while slight, was found in both groups. There were no significant differences between the 2 groups. 2. The cranial base and the facial axis did not form a right angle in group A, and there were no significant differences between the 2 groups. 3. The distances between reference surfaces of the sphenoid bone and the lower landmarks of the facial bone were greater than those of the upper landmarks. 4. The external acoustic meatus was the most suitable reference for analysis of craniofacial asymmetry.