Dynamic changes in clinical characteristics and serotype distribution of invasive pneumococcal disease among adults in Japan after introduction of the pediatric 13-valent pneumococcal conjugate vaccine in 2013–2019

Nationwide population-based surveillance for invasive pneumococcal disease (IPD) is being conducted in few Asian countries. We aimed to evaluate the clinical characteristics and serotype distribution among Japanese adult patients with IPD after introduction of the pediatric 13-valent pneumococcal conjugate vaccine (PCV13) in 2013. IPD surveillance was conducted among adults between 2013 and 2019, and 1,995 patients were analyzed by time period (early, 2013–2015; middle, 2016–2017; late, 2018–2019). We found that the period of 2018–2019 was independently associated with a lower risk of fatal outcome, compared with the period of 2013–2015. The proportion of those with serotype PCV13-nonPCV7 decreased significantly in patients aged 15–64 years and in those aged ≥ 65 years within 3 years after the introduction of pediatric PCV13. By contrast, the proportion of those with nonvaccine serotype increased significantly in those aged ≥ 65 years, but not in those aged 15–64 years. No significant change was found in the proportion of 23-valent polysaccharide pneumococcal vaccine (PPSV23)-nonPCV13 in both of adults aged 15–64 years and ≥ 65 years. The proportions of PCV15-, PCV20- and PCV24-covered serotypes were 38%, 56% and 58% in adult patients with IPD aged ≥ 65 years during the late period. Our data on the serotype distribution support an indirect effect from pediatric PCV13 use among adults, and afford a basis for estimates of protection against IPD by vaccination with newly developed PCVs in older adults in Japan.     

Cost-effectiveness analyses of monovalent mumps vaccination programs for Japanese children

BackgroundThe most common preventative measure against mumps is vaccination with mumps vaccine. Over 122 countries have implemented mumps vaccine routine immunization programs, mostly via Measles-Mumps-Rubella (MMR) vaccine. In Japan, the unexpectedly high incidence of aseptic meningitis caused by mumps vaccine led to the discontinuation of the MMR national vaccination program in 1993, inadvertently resulting in the re-emergence of mumps. Plans of introducing monovalent mumps vaccine into routine vaccination schedule have become one of the emerging topics in health policy that has warranted the need in evaluating its value for money.MethodsWe conducted cost-effectiveness analyses with Markov model and calculated incremental cost-effectiveness ratios (ICERs) of two different vaccination programs (a single-dose program at one-year-old, a two-dose program with second dose uptakes at five) compared to status quo from both payers’ and societal perspectives. Transition probabilities and utility weights in estimating quality-adjusted life-year (QALY), and disease treatment costs were either estimated or obtained from literature. Costs per vaccination were assumed at ¥6140 (US$58;1US$ = ¥106).ResultsBoth programs reduce disease treatment costs compared to status quo, while the reduction cannot offset vaccination cost. ICER of either program is found to be under ¥5,000,000 (US$47,170)/QALY willingness-to-pay (WTP) threshold from either perspective. Results of probabilistic sensitivity analyses expressed by net monetary benefit indicated that at the WTP threshold, the acceptability is at 92.6% for two-dose vaccination program, 0% for single-dose vaccination program, and 7.4% for current no vaccination program. Two-dose program was optimal among the alternatives. One-way sensitivity analyses revealed that proportion of mumps-related hearing loss among mumps cases and vaccine effectiveness (VE) were key variables in changing the ICERs.ConclusionRoutine vaccination program of single- and two-dose programs were cost-effective from both payers’ and societal perspectives. Between the two, the two-dose vaccination program was observed to be more favorable.     

Issues in adherence with pediatric regimens

Adherence to recommendations for health care is an area of serious concern for pediatric psychologists. The present article highlights several key issues affecting research and clinical work in this area. They include: difficulties defining and measuring adherence; developmental aspects of adherence; special concerns with low income populations; and limitations of intervention research. In addition, several directions for future investigation in the area of pediatric adherence are addressed.     

Predictive equation for acquisition of hepatitis B in hospital workers in a general hospital

A cross-sectional study was performed to obtain risk factors for hepatitis B disease, HBsAg carriers and immunised personnel, among 2470 workers in a general hospital in Madrid, Spain. The data obtained were analyzed with multiple logistic regression to obtain coefficients for variables. The results of the analysis show that being a nurse or being regularly exposed to blood are the most important risk factors for hepatitis B acquisition. The length of time working at the same job activity was also a risk factor. The resulting coefficients allow the construction of a predictive equation for non-immunised, HBsAg carrier and immunised HBV status, which can select subjects for a hepatitis B vaccination program.     

酵母重组乙型肝炎疫苗在中小学生中接种效果评价

目的 评价中小学生大规模乙型肝炎疫苗接种效果。方法 随机选取来实行乙型肝炎疫苗计划免疫管理的6－18岁中小学生1829名,采用血清流行病学方法观测大规模酵母重组乙型肝炎疫苗接种效果。结果 对HBsAg、抗－HBs和抗－HBc全阴性者,接种疫苗1年后,抗－HBs阳性率为70．55％,HBsAg和抗-HBc阳性率分别为0．56％和1．96％;该人群接种前HBVM阳性率为63．31％,接种后为85．51％,抗－HBs阳性率显著增高,且以6－12岁低年龄组人群更明显,而HBsAg和抗－HBc阳性率在接种后1年无明显变化。结论 酵母重组乙型肝炎疫苗大规模接种后,在中小学生中形成了乙型肝炎高保护性、低感染状态。     

Modified sternal elevation for children with pectus excavatum

Objective To investigate the relationship between intestinal mucus IgA content and mucus barrier function after surface burns. Methods Detection of IgA content in mucus was performed by enzyme linked immunosorbent assay (ELISA) at different time points after burns.Bacterial adherence to cultured epithelial cells (IEC-6) in vitro using E.coli was assessed for each group. Results The intestinal mucus barrier function declined, parallel to a decrease in IgA content after surface burn in mice.In the normal control group, mucus IgA content was 2.32 Dλ, and 2.51, 1.76, 1.49, 1.06 Dλ at 0.5 h, 1 h, 6 h and 24 h after burn, respectively.Bacterial adherence rate was 0.53 in control group, and 0.46, 0.69, 0.58, 0.81 at 0.5 h, 1 h, 6 h, 24 h after burn, respectively. Conclusion The decrease of intestinal mucus IgA contents is one of the reasons why intestinal mucus barrier function declines after burns.     

Epidemiology of childhood hepatitis B in India: Vaccination related issues

It has been estimated that presently hepatitis B kills more people every day than AIDS kills in a year world-wide. Infection with hepatitis B produces a wide range of manifestations ranging from asymptomatic carriers to persistent infections leading to chronic liver diseases and hepatocellular carcinoma. Availability of effective and safe vaccine has made all this preventable. To formulate on appropriate vaccination strategy for India the epidemiology of hepatitis B needs to be defined. This report critically reviews the available data. The burden of long term sequelae of HBV infection is probably under-diagnosed and under-reported in India. Prevalence studies of HBV markers indicate that India falls under the area of intermediate endemicity. Limited data on agespecific prevalence of HBV markers suggests that the majority of the infection seems to take place below 15 years of age, and most of it under one year. Perinatal transmission appears to contribute significantly to the carrier pool. Childhood vaccination for HB among the general population is the obvious strategy of choice. But more information is required to decide on the timing of the first dose.     

COVID-19 vaccine and pregnancy: A safety weapon against pandemic

The ongoing COVID-19 pandemic is raising great concern all over the world. The recent introduction of vaccines has offered reason for optimism, however, new issues have arisen, such as vaccine reluctance. The safety of vaccines for pregnant women is one of the most serious of these concerns. The purpose of this review article is to provide updated international vaccine recommendations, results of ongoing studies and clinical trials, and the role of gynecologists in counseling the women to understand the risks versus benefits as well as form an informed decision towards vaccine acceptance for COVID-19.Although COVID-19 infection increases the risk of severe morbidity and mortality in pregnant women, pregnant women were not included in the initial vaccine trials. As a result, safety information is scarce. Nations have differing recommendations, though many have recently approved the COVID-19 immunization in pregnancy following a risk-benefit analysis. The Joint Committee on Vaccination and Immunization (JCVI) of the United Kingdom recently approved an mRNA vaccination for pregnant women. Vaccination is recommended by the CDC, ACOG, ARFM, and WHO. India recently took a stand, with the ICMR and the Ministry of Health and Family Welfare recommending vaccination during pregnancy and lactation.     

Diphtheria, pertussis, and measles in Portugal before and after mass vaccination: A time series analysis

Techniques of time series analysis were used to examine historical records of the incidence of diphtheria, pertussis, and measles, and of deaths by measles in Portugal during the twentieth century. There are statistically significant seasonal and long-term oscillations in the incidence of these diseases. Seasonal oscillations appear to be in close association with the resumption of school classes in the fall in the case of diphtheria, but not in pertussis and measles. Long-term oscillations in pertussis (3.5–4 year period) and measles (3-year period), before vaccination, corroborate theoretical predictions about the dynamics of these diseases, whereas absence of long-term oscillations in diphtheria is probably due to the influential presence of carriers upon the dynamics of the disease. Mass vaccination strongly suppressed disease incidence, did not eliminate seasonal oscillations, and appeared to have acted to lengthen long-term periodicity in pertussis and measles.