Trends in varicella and mumps vaccination rates in children under 3 years of age in a tertiary children's hospital in Japan.

BACKGROUND: In Japan, the voluntary vaccination rate is not known accurately. Although two doses of the measles and rubella vaccines have been part of the universal vaccine program since 2006, the varicella vaccine was added in October 2014 while the mumps vaccine still remains voluntary. The aim of this study was to evaluate trends in the live measles, rubella, varicella and mumps vaccination rates in Japan. METHODS: This retrospective cohort study was conducted at Tokyo Metropolitan Children's Medical Center between October 2012 and December 2016. Patients aged 1-2 years who were admitted to the Department of General Pediatrics were enrolled. The trend in the vaccination rate against measles, rubella, varicella, and mumps was examined. RESULTS: The measles and rubella vaccination rate was 80-90%. The varicella vaccination rate in the second quarter of 2012, the third quarter of 2014, and the fourth quarter of 2016 was 34.6%, 67.1%, and 80.7%, respectively. The mumps vaccination rate in the second quarter of 2012, the third quarter of 2014, and the fourth quarter of 2016 was 27.6%, 59.5%, and 61.8%, respectively. CONCLUSIONS: The varicella and mumps vaccination rate improved until 2014 despite the fact that they were voluntary vaccinations. After varicella vaccination was added to the universal vaccination program, the varicella vaccination rate continued to improve. The mumps vaccination, which was not included, failed to improve, suggesting that the universal vaccination program contributed to increasing the uptake of the vaccines it includes.

Sibling visits and viral infection in the neonatal intensive care unit.

BACKGROUND: Sibling visits to the neonatal intensive care unit (NICU) are a part of family-centered care, which is now being increasingly endorsed as a positive development in patient care. Sibling visits, however, pose a risk of viral infection, and hence many NICU in Japan impose strict limits on the practice. The aim of this study was therefore to assess whether sibling visits to the NICU are related to an increase in the nosocomial viral infection rate. METHODS: This retrospective study was conducted between April 2012 and March 2017 at Tokyo Metropolitan Children's Medical Center in Japan. Sibling visits were implemented after screening for symptoms of viral illness. Symptomatic patients in the NICU were tested for common viruses on rapid antigen test and polymerase chain reaction. The number of sibling visits and the rate of nosocomial viral infections were examined on Spearman's correlation test. RESULTS: The total number of sibling visits and rate of nosocomial viral infection in the NICU was 102 and 0.068 per 1,000 patient-days during the study period, respectively. The number of enterovirus, respiratory syncytial virus, human metapneumovirus, influenza virus A, and Herpes simplex virus infections was 3, 2, 1, 1, 1, and 1, respectively. No infections were identified after sibling visits. The number of sibling visits and the rate of nosocomial viral infections were not correlated (correlation coefficient, -0.1; P = 0.873). CONCLUSION: Sibling visits to the NICU did not result in an increase in the nosocomial viral infection rate.

[Contact investigation using QuantiFERON-TB Gold test to evaluate TB exposure in 61 subjects in a hospital setting--(2) Change in QuantiFERON response during one year after exposure].

UNLABELLED: OBJECTIVES & SUBJECTS: The change in IGRA (interferon-gamma release assay, with QuantiFERON-TB Gold, QFT) responses was followed up for one year in a group of contacts of healthcare workers who had been exposed to tuberculosis (TB) infection for a relatively short period in a hospital. The observation was made of a total of 59 close contacts of the index case, where 16 showed positive QFT-conversion and 7 showed the intermediate response ranging 0.1 to 0.35 IU/mL. Three of the conversion cases developed active TB. RESULTS: 67% of the QFT conversions occurred within 2 months of exposure and the others between 2 to 9 months. Those having converted later than 2 months after the exposure showed generally weaker QFT responses than the earlier converters. In response to the treatment to converters (either to latent TB infection or to active TB), 80% of the cases reversed to negative or intermediate. The geometric means of the response values for ESAT-6 and CFP-10 also showed significant decline over the treatment time. DISCUSSIONS: The time profile of responses in the intermediate responders revealed an obviously distinct pattern from that of the negative responders with the values remaining uniformly at very low level throughout, which suggests that this group includes somehow exceptional responders either with or without infection.

[Contact investigation using QuantiFERON-TB Gold test to evaluate TB exposure in 61 subjects in a hospital setting--(1) Outline of the outbreak and its clinical picture].

The index case was a patient who was admitted to a general hospital and treated with pulsed corticosteroid therapy; her breathing was assisted by a respirator. Soon she developed tuberculosis (TB) and died. Immediately after her death, QuantiFERON-TB Gold (QFT) test was conducted in healthcare workers who were in close contact with the index case. From the results of the test, all the healthworkers except 1 were TB negative. However, the QFT test repeated in the healthworkers after 8 weeks was positive in 18.6%. Subsequently, 5 healthworkers, including a doctor, nurses, and radiology technicians, developed TB. Bacterial isolates from 3 of them showed restriction fragment length polymorphism (RFLP) patterns similar to that of the index case. These 3 secondary TB cases included one healthworker who was in contact with the index case for less than 5 min, another whose QFT was negative (or "doubtful" according to the Japanese criterion of the QFT), and a third who was TB positive for QFT test but declined treatment for latent TB infection (LTBI). No other healthworkers or hospitalized patients developed TB. These healthcare workers with TB were further assessed using the QFT test at 6, 9, and 12 months after initial exposure, which showed an additional 4 positive reactors and 4 "doubtful" reactors who were indicated for LTBI treatment. Among these subjects, 7 were those who showed TB positive results 6 months after initial contact. Discussions were made on TB prevention in hospital settings including contact investigations the staff with special reference to application of the QFT test.

A metallo-beta-lactamase producing Enterobacteriaceae outbreak from a contaminated tea dispenser at a children's hospital in Japan.

An outbreak of metallo-ß-lactamase (MBL) producing Klebsiella pneumoniae occurred at a children's hospital in Japan. MBL-producing K. pneumoniae was detected in tea dispenser in the hospital, the use of which was associated with the acquisition of the MBL-producing Enterobacteriaceae. The outbreak ceased after use of the tea dispenser was banned.