Seasonality of child and adolescent injury mortality in Japan, 2000–2010

Objective

Injury is the leading cause of death among children and adolescents in Japan. Despite this, until now there has been comparatively little research on this phenomenon. The purpose of this study was to examine if there was seasonal variation in child and adolescent injury mortality in Japan in 2000–2010.

Methods

Vital statistics injury mortality data were obtained from the Ministry of Health, Labour and Welfare of Japan. The seasonality of the major causes of unintentional injury (transport accidents, drowning and suffocation) and intentional injury (suicide and homicide) mortality was examined for children and adolescents aged 0–19. Incidence ratios (IR) with 95 % confidence intervals (CI) were calculated to determine the difference between the numbers of observed and expected seasonal deaths.

Results

The annual average injury mortality rate among children and adolescents was 9.0 per 100,000. Deaths from transport accidents, drowning, suffocation and suicide had a significant seasonality. There was a summer peak for transport accidents (IR 1.15, 95 % CI 1.10–1.19) and drowning (IR 2.00, 95 % CI 1.88–2.11), a spring peak for suicide (IR 1.09, 95 % CI 1.04–1.14), while the incidence of suffocation was higher in winter (IR 1.12, 95 % CI 1.03–1.21).

Conclusion

Child and adolescent injury mortality from transport accidents, drowning, suffocation and suicide has a pronounced seasonality in Japan. More research is now needed to find the circumstances underpinning different forms of injury mortality in different periods of the year so that effective interventions can be designed and implemented to reduce the burden of injury mortality among Japanese children.     

Changes in Capsule and Drug Resistance of Pneumococci after Introduction of PCV7, Japan, 2010–2013

We aimed to clarify changes in serotypes and genotypes mediating β-lactam and macrolide resistance in Streptococcus pneumoniae isolates from Japanese children who had invasive pneumococcal disease (IPD) after the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into Japan; 341 participating general hospitals conducted IPD surveillance during April 2010–March 2013. A total of 300 pneumococcal isolates were collected in 2010, 146 in 2011, and 156 in 2012. The proportion of vaccine serotypes in infectious isolates decreased from 73.3% to 54.8% to 14.7% during the 3 years. Among vaccine serotype strains, genotypic penicillin-resistant S. pneumoniae strains also declined each year. Among nonvaccine serotype strains, 19A, 15A, 15B, 15C, and 24 increased in 2012. Increases were noted especially in genotypic penicillin-resistant S. pneumoniae isolates of serotypes 15A and 35B, as well as macrolide resistance mediated by the erm(B) gene in 15A, 15B, 15C, and 24.     

Descriptive Epidemiology of Prion Disease in Japan: 1999–2012

Background

Epidemiologic features of prion diseases in Japan, in particular morbidity and mortality, have not been clarified.

Methods

Since 1999, the Research Committee has been conducting surveillance of prion diseases, and the surveillance data were used to assess incident cases of prion diseases. For the observation of fatal cases, vital statistics were used.

Results

Both incidence and mortality rates of prion diseases increased during the 2000s in Japan. However, this increase was observed only in relatively old age groups.

Conclusions

The increased number of patients among old age groups might be due to increased recognition of the diseases. If so, the number of cases should plateau in the near future.Key words: prion diseases, Creutzfeldt-Jakob syndrome, incidence, mortality, secular trends     

National surveillance for meningococcal disease in Japan, 1999–2014

We summarize the epidemiology of Japanese meningococcal disease with serogroup distribution. One hundred seventy-eight meningococcal meningitis cases were reported from April 1999 to March 2013 to the national surveillance system. From April 2013, bacteremia was added to the condition of reporting invasive meningococcal disease (IMD). Since then, 59 IMD cases were reported by the end of 2014. Approximately two thirds of the cases were male and the median age was 56 years (range: 0–93 years). Only 3% of the cases were <5 years old. One third of reported cases were meningitis and the others were bacteremia. The annual incidence (2014) for IMD was 0.028 per 100,000 and case fatality rate (CFR) was 19%. Serogroup Y (42%) was the most dominant serogroup, followed by C (12%), B (7%) and W (3%). Even though the number of reported cases has increased after the amendment of reporting requirements, the incidence of IMD is still low in Japan. Underreporting may play a role in this low incidence. Improving on the limitations of the surveillance system is necessary to capture the true epidemiology and accurate serogroup distribution of IMD cases in Japan, which is essential for making effective recommendations on newly licensed vaccine.     

Trends in serotypes and sequence types among cases of invasive pneumococcal disease in Scotland, 1999–2010

Introduction

The 7-valent pneumococcal conjugate vaccine (Prevenar^®, Wyeth; PCV7) was introduced to the UK paediatric immunisation schedule in 2006. This study investigates trends in serotypes and multi locus sequence types (STs) among cases of invasive pneumococcal disease (IPD) in Scotland prior to, and following, the introduction of PCV7.

Methods

Scottish Invasive Pneumococcal Disease Enhanced Surveillance has records of all cases of IPD in Scotland since 1999. Cases diagnosed from blood or cerebrospinal fluid isolates until 2010 were analysed. Logistic and poisson regression modelling was used to assess trends prior to and following the introduction of PCV7.

Results

Prior to PCV7 use, on average 650 cases of IPD were reported each year; 12% occurred in those aged <5 years and 35% affected those aged over 65 years. Serotypes in PCV7 represented 47% of cases (68% in <5 year olds). The serotype and ST distribution was relatively stable with only serotype 1 and associated ST 306 showing an increasing trend. PCV7 introduction was associated with a 69% (95% CI: 50%, 80%) reduction in the incidence of IPD among those aged <5 years, a 57% (95% CI: 47%, 66%) reduction among those aged 5–64 years but no significant change among those aged 65 years and over where increases in non-PCV7 serotypes were observed. Serotypes which became more prevalent post-PCV7 are those which were associated with STs related to the PCV7 serotypes.

Conclusions

Routine serotyping and sequence typing in Scotland allowed the assessment of the relationship between the capsule and the clones in the post vaccination era. Changes in the distribution of serotypes post PCV7 introduction appear to be driven by associations between serotypes and STs prior to PCV7 introduction. This has implications for the possible effects of the introduction of higher valency vaccines and could aid in predicting replacement serotypes in IPD.     

The effect of pharmaceutical innovation on longevity,hospitalization and medical expenditure in Turkey, 1999–2010

We investigate the impact of pharmaceutical innovation on longevity, hospitalization and medical expenditure in Turkey during the period 1999–2010 using longitudinal, disease-level data.     

Comparison of the Epidemiological Aspects of Imported Dengue Cases between Korea and Japan, 2006–2010

To compare the epidemiological characteristics of dengue cases imported by travelers or immigration in both Korea and Japan, we determined dengue incidence and related risk factors. During 2006–2010, 367 and 589 imported dengue cases were reported in Korea and Japan, respectively. In Korea, the presumptive origins for the dengue infections were Southeast Asia (82.6%), Southern Asia (13.9%), Eastern Asia (1.1%), South America (0.3%), Central America (0.3%), Africa (0.3%), and other countries (1.6%). In Japan, the origins of the infections were Southeast Asia (69.8%), Southern Asia (20.0%), Eastern Asia (1.7%), South America (2.5%), Central America (1.2%), Africa (1.2%), Oceania (2.4%), and other countries (1.2%). In both countries, more dengue cases were reported for men than for women (p < 0.01), and those aged 20–30 years accounted for > 60% of the total cases. The frequency of imported cases in summer and autumn (∼70% of total cases) was similar in both countries. This study demonstrates that there is a similar pattern of imported dengue cases in Korea and Japan. Therefore, there is a risk of an autochthonous dengue outbreak in Korea, as indicated by the recent outbreak in Japan in 2014.     

Association of Perfluoroalkyl Substances,Bone Mineral Density,and Osteoporosis in the U.S. Population in NHANES 2009–2010

Background

Perfluoroalkyl substances (PFASs), including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), are detectable in the serum of 95% of the U.S. population.

Objective

Considering the role of PFASs as endocrine disruptors, we examined their relationships with bone health.

Methods

The association between serum PFAS concentration and bone mineral density at total femur (TFBMD), femoral neck (FNBMD), lumbar spine (LSBMD), and physician-diagnosed osteoporosis was assessed in 1,914 participants using data from the National Health and Nutritional Examination Survey 2009–2010.

Results

The mean age of the participants was 43 years. Men had higher serum PFAS concentrations than women (p < 0.001) except for PFNA. In both sexes, serum PFOS concentrations were inversely associated with FNBMD (p < 0.05). In women, significant negative associations were observed for natural log (ln)–transformed PFOS exposure with TFBMD and FNBMD, and for ln-transformed PFOA exposure with TFBMD (p < 0.05). In postmenopausal women, serum PFOS was negatively associated with TFBMD and FNBMD, and PFNA was negatively associated with TFBMD, FNBMD, and LSBMD (all p < 0.05). With one log unit increase in serum PFOA, PFHxS, and PFNA, osteoporosis prevalence in women increased as follows: [adjusted odds ratios (aORs)] 1.84 (95% CI: 1.17, 2.905), 1.64 (95% CI: 1.14, 2.38), and 1.45 (95% CI: 1.02, 2.05), respectively. In women, the prevalence of osteoporosis was significantly higher in the highest versus the lowest quartiles of PFOA, PFHxS, and PFNA, with aORs of 2.59 (95% CI: 1.01, 6.67), 13.20 (95% CI: 2.72, 64.15), and 3.23 (95% CI: 1.44, 7.21), respectively, based on 77 cases in the study sample.

Conclusion

In a representative sample of the U.S. adult population, serum PFAS concentrations were associated with lower bone mineral density, which varied according to the specific PFAS and bone site assessed. Most associations were limited to women. Osteoporosis in women was also associated with PFAS exposure, based on a small number of cases.

Citation

Khalil N, Chen A, Lee M, Czerwinski SA, Ebert JR, DeWitt JC, Kannan K. 2016. Association of perfluoroalkyl substances, bone mineral density, and osteoporosis in the U.S. population in NHANES 2009–2010. Environ Health Perspect 124:81–87; http://dx.doi.org/10.1289/ehp.1307909     

Serotype Changes and Drug Resistance in Invasive Pneumococcal Diseases in Adults after Vaccinations in Children,Japan, 2010–2013

After 7-valent pneumococcal conjugate vaccine (PCV) for children was introduced in Japan in November 2010, we examined changes in Streptococcus pneumoniae serotypes and in genetic antimicrobial drug resistance of isolates from adults with invasive pneumococcal diseases. During April 2010–March 2013, a total of 715 isolates were collected from adults with invasive pneumococcal diseases. Seven-valent PCV serotypes in adults decreased from 43.3% to 23.8%, most noticeably for serotype 6B. Concomitantly, 23-valent pneumococcal polysaccharide vaccine (PPSV23) serotypes decreased from 82.2% to 72.2%; non-PPSV23 serotypes increased from 13.8% to 25.1%. Parallel with serotype changes, genotypic penicillin-resistant S. pneumoniae decreased from 32.4% to 21.1%, and 6 non-PPSV23 serotypes emerged (6D, 15A, 15C, 16F, 23A, and 35B). Respective vaccine coverage rates for 13-valent PCV and PPSV23 differed by disease: 73.9% and 84.3% for patients with pneumonia, 56.4% and 69.2% for patients with bacteremia and sepsis, and 45.7% and 69.3% for patients with meningitis.     

Effort–reward imbalance, sleep disturbances and fatigue

Objectives: The objective of this study was to investigate the validity of the effort–reward imbalance (ERI) model in relation to disturbed sleep and fatigue. Methods: The study population derived from a subset of the WOLF (WOrk, Lipids, Fibrinogen) cohort study of cardiovascular risk in a working population who replied to the ERI-questionnaire comprising 789 men and 214 women. Cox regression analysis was used to calculate the prevalence ratio (PR) for sleep disorders and fatigue in relation to the components of ERI. Results: As sleep disturbances and fatigue, based on literature, were defined to be represented by the uppermost quintile, 14% of the men and 23% of the women were affected by sleep disturbances while 14 and 26%, respectively, were affected by fatigue. Higher levels of exposure for the ERI components were associated with increased prevalence of sleep disturbances and fatigue. For men, the strongest association was seen between high overcommitment and fatigue (PR 5.77, 95% confidence interval 2.89–11.5). For women, high effort and sleep disturbances (PR 4.04, CI 1.53–10.7), high effort/reward ratio and sleep disturbances (PR 4.13, CI 1.62–10.5), and between low reward and fatigue (PR 4.36, CI 1.79–10.6) yielded the most obvious associations. Conclusions: The present study adds sleep disturbances and fatigue to the list of adverse consequences of effort–reward imbalance.     

Changes in Pesticide Occurrence in Suburban Surface Waters in Massachusetts,USA, 1999–2010

Pesticide occurrence was determined in two suburban surface waters in eastern Massachusetts, USA during 2009 and 2010. Out of 118 collected samples, 45 samples showed detections of one or more target pesticides. Among the herbicides, 2,4-D was the most frequently detected and imidacloprid was the most frequently detected insecticide. Comparison with data from 1999 to 2000 indicated fewer pesticide detections and lower pesticide toxicity index values in the current study. Regulatory phaseout of chlorpyrifos and diazinon from residential use by 2004 was reflected in the results by the absence of chlorpyrifos detections and lower detection frequencies of diazinon. Detected pesticide levels were below aquatic life benchmarks.     

The Association Between Race/Ethnicity and Major Birth Defects in the United States, 1999–2007

Objectives. We investigated the relationship between race/ethnicity and 27 major birth defects.Methods. We pooled data from 12 population-based birth defects surveillance systems in the United States that included 13.5 million live births (1 of 3 of US births) from 1999 to 2007. Using Poisson regression, we calculated prevalence estimates for each birth defect and 13 racial/ethnic groupings, along with crude and adjusted prevalence ratios (aPRs). Non-Hispanic Whites served as the referent group.Results. American Indians/Alaska Natives had a significantly higher and 50% or greater prevalence for 7 conditions (aPR = 3.97; 95% confidence interval [CI] = 2.89, 5.44 for anotia or microtia); aPRs of 1.5 to 2.1 for cleft lip, trisomy 18, and encephalocele, and lower, upper, and any limb deficiency). Cubans and Asians, especially Chinese and Asian Indians, had either significantly lower or similar prevalences of these defects compared with non-Hispanic Whites, with the exception of anotia or microtia among Chinese (aPR = 2.08; 95% CI = 1.30, 3.33) and Filipinos (aPR = 1.90; 95% CI = 1.10, 3.30) and tetralogy of Fallot among Vietnamese (aPR = 1.60; 95% CI = 1.11, 2.32).Conclusions. This is the largest population-based study to our knowledge to systematically examine the prevalence of a range of major birth defects across many racial/ethnic groups, including Asian and Hispanic subgroups. The relatively high prevalence of birth defects in American Indians/Alaska Natives warrants further attention.Birth defects are a leading cause of infant mortality, accounting for 1 in 5 infant deaths in the United States, and these defects contribute substantially to childhood and adult disability, as well as to health care costs.1–3 The examination of racial/ethnic variations in birth defects provides clues regarding their etiology from genetic, cultural, environmental, and other factors. The United States has a relatively large, diverse population, providing an opportunity to examine variations among racial/ethnic groups and specific subgroups.Several population-based studies have examined the racial/ethnic variation of selected birth defects in the United States.4–9 In addition, a number of publications from individual states have included racial/ethnic data for either specific birth defects or a range of conditions.10–31 These studies have generally focused on a limited number of racial/ethnic groups or birth defects.Two previous population-based analyses, conducted through the National Birth Defects Prevention Network (NBDPN), provided clues concerning racial/ethnic variation for a range of birth defects using a large US birth sample.6,32 However, these analyses did not adjust for important covariates and only examined differences among Blacks and Hispanics relative to Whites. For the present study, we used more recent pooled population-based prevalence data over a longer period of time and for a wider range of racial/ethnic groups to examine differences in the prevalence of birth defects. Our objective was to examine the racial/ethnic differences in the occurrence of 27 major birth defects in the United States.     

Association between Mycobacterium tuberculosis lineage and site of disease in Florida, 2009–2015

BackgroundMycobacterium tuberculosis is characterized into four global lineages with strong geographical restriction. To date one study in the United States has investigated M. tuberculosis lineage association with tuberculosis (TB) disease presentation (extra-pulmonary versus pulmonary). We update this analysis using recent (2009–2015) data from the State of Florida to measure lineage association with pulmonary TB, the infectious form of the disease.MethodsM. tuberculosis lineage was assigned based on the spacer oligonucleotide typing (spoligotyping) patterns. TB disease site was defined as exclusively pulmonary or extra-pulmonary. We used ORs to measure the association between M. tuberculosis lineages and pulmonary compared to extra-pulmonary TB. The final multivariable model was adjusted for patient socio-demographics, HIV and diabetes status.ResultsWe analyzed 3061 cases, 83.4% were infected with a Euro-American lineage, 8.4% Indo-Oceanic and 8.2% East-Asian lineage. The majority of the cases (86.0%) were exclusively pulmonary. Compared to the Indo-Oceanic lineage, infection with a Euro-American (AOR = 1.87, 95% CI: 1.21, 2.91) or an East-Asian (AOR = 2.11, 95% CI: 1.27, 3.50) lineage favored pulmonary disease compared to extra-pulmonary. In a sub-analysis among pulmonary cases, strain lineage was not associated with sputum smear positive status, indicating that the observed association with pulmonary disease is independent of host contagiousness.ConclusionAs an obligate pathogen, M. tuberculosis' fitness is directly correlated to its transmission potential. In this analysis, we show that M. tuberculosis lineage is associated with pulmonary disease presentation. This association may explain the predominance in a region of certain lineages compared to others.     

Association between Bone Turnover,Micronutrient Intake,and Blood Lead Levels in Pre-and Postmenopausal Women,NHANES 1999–2002

Background

Blood lead levels (BLLs) have been shown to increase during periods of high bone turnover such as pregnancy and menopause.

Objectives

We examined the associations between bone turnover and micronutrient intake with BLLs in women 20–85 years of age (n = 2,671) participating in the National Health and Nutrition Examination Survey, 1999–2002.

Methods

Serum bone-specific alkaline phosphatase (BAP) and urinary cross-linked N-telopeptides (NTx) were measured as markers of bone formation and resorption, respectively. Lead was quantified in whole blood. The association between tertiles of BAP and NTx, and BLLs was examined using linear regression with natural log_-transformed BLLs as the dependent variable and interpreted as the percent difference in geometric mean BLLs.

Results

In adjusted analyses, mean BLLs among postmenopausal women in the upper tertiles of NTx and BAP were 34% [95% confidence interval (CI), 23%–45%] and 30% (95% CI, 17%–43%) higher than BLLs among women in the lowest tertiles of NTx and BAP, respectively. These associations were weaker, but remained statistically significant, among premenopausal women (NTx: 10%; 95% CI, 0.60%–19%; BAP: 14%; 95% CI, 6%–22%). Within tertiles of NTx and BAP, calcium intake above the Dietary Reference Intake (DRI), compared with below the DRI, was associated with lower mean BLLs among postmenopausal women but not premenopausal women, although most of the associations were not statistically significant. We observed similar associations for vitamin D supplement use.

Conclusions

Bone resorption and bone formation were associated with a significant increase in BLLs among pre-and postmenopausal women.     

The impact of demographic and risk factor changes on coronary heart disease deaths in Beijing, 1999–2010

Background  

Recent, dramatic increases in coronary heart disease (CHD) mortality in China can be mostly explained by adverse changes in major cardiovascular risk factors. Our study aimed to assess the potential impact of subsequent changes in risk factors and population ageing on CHD deaths in Beijing between 1999 and 2010.