Details of a Researcher - Shinjo, Masayoshi

Papers - Shinjo, Masayoshi

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Inactivated influenza vaccine effectiveness and an analysis of repeated vaccination for children during the 2016/17 season

Shinjo(h) Masayoshi

VACCINE 36 ( 37 ) 5510 - 5518 2018.09

Research paper (scientific journal), ISSN 0264-410X

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Effectiveness of inactivated quadrivalent influenza vaccine in the 2015/2016 season as assessed in both a test-negative case-control study design and a traditional case-control study design

Kimiya, Takahisa, Shinjoh, Masayoshi, Anzo, Makoto, Takahashi, Hiroki, Sekiguchi, Shinichiro, Sugaya, Norio, Takahashi, Takao

EUROPEAN JOURNAL OF PEDIATRICS 177 ( 7 ) 1009 - 1017 2018.07

Research paper (scientific journal), ISSN 0340-6199

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Effectiveness of inactivated quadrivalent influenza vaccine in the 2015/2016 season as assessed in both a test-negative case-control study design and a traditional case-control study design

Kimiya Takahisa, Shinjoh Masayoshi, Anzo Makoto, Takahashi Hiroki, Sekiguchi Shinichiro, Sugaya Norio, Takahashi Takao

European Journal of Pediatrics 1 - 9 2018.04

ISSN 0340-6199

Both traditional case-control studies (TCCSs) and test-negative case-control studies (TNCCSs) are commonly used to assess influenza vaccine effectiveness (VE). To compensate for the fact that observational studies are susceptible to bias, we combined both methods to assess VE in one geographical area during the 2015/2016 season, when influenza A (H1N1)pdm was dominant. Our TNCCS covered 331 children aged 6 months to 15 years who visited our hospital with fever, including 182 with influenza, and our TCCS covered 812 pediatric outpatients aged 6 months to 15 years, including 214 with influenza. Influenza infection and vaccination history were reviewed, and VE was calculated as (1 − odds ratio) × 100. In the TNCCS, VE against influenza A was 68% (95% CI 47–81) overall, and 70% (48–83) for those given two doses; against influenza B, VE was 37% (− 12–64) overall and 49% (2–74) for two doses. In the TCCS, VE against influenza A was 44% (15–63) overall and 44% (13–64) for two doses, and VE against influenza B was 24% (− 19–52) overall and 41% (3–64) for two doses. Conclusion: Both studies confirmed significant VE against influenza A, significant two-dose VE against influenza B, and better two-dose VE than one-dose VE.(Table presented.)

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Three-season effectiveness of inactivated influenza vaccine in preventing influenza illness and hospitalization in children in Japan, 2013-2016

Shinjo(h) Masayoshi

VACCINE 36 ( 8 ) 1063 - 1071 2018.02

Research paper (scientific journal), ISSN 0264-410X

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Purulent lymphadenitis caused by Staphylococcus argenteus, representing the first Japanese case of Staphylococcus argenteus (multilocus sequence type 2250) infection in a 12-year-old boy

Ohnishi Takuma, Shinjoh Masayoshi, Ohara Hirotoshi, Kawai Toshinao, Kamimaki Isamu, Mizushima Ryo, Kamada Keisuke, Itakura Yasutomo, Iguchi Shigekazu, Uzawa Yutaka, Yoshida Atsushi, Kikuchi Ken

Journal of Infection and Chemotherapy 2018.01

ISSN 1341-321X

Staphylococcus argenteus is a novel species separated from a strain of coagulase-positive, non-pigmented S. aureus. Although S. argenteus has been reported to occur globally, multilocus sequence type (ST) 2250 is mainly found in Northeastern Thailand. Because conventional biochemical testing misidentifies this pathogen as S. aureus, multilocus sequence typing (MLST) or nucA sequencing is recommended to distinguish between S. argenteus and S. auereus. The patient was a previously healthy 12-year-old boy who was admitted because of right inguinal lymphadenitis and cellulitis. Although intravenous cefazolin was administered, his lymphadenitis worsened and formed an abscess on day 6 of hospitalization. Incision and drainage were performed on day 7 of hospitalization. Cefazolin was changed to oral cefaclor, and the patient was successfully treated over a period of 5 weeks. No recurrence was observed throughout 12-months of follow-up. He had a history of right axillary lymph node abscess 2 months before this admission, which was successfully treated with incision, drainage, and antibiotic therapy. He has lived in Japan since birth and never traveled abroad. He had no opportunity to interact with foreigners. His immune function, especially neutrophil function, was tested and we did not find any dysfunction. First, methicillin-sensitive S. aureus was misidentified from the abscess culture. Subsequently, the causative agent was re-identified as S. argenteus ST2250 based on MLST. To our knowledge, this is the first case of S. argenteus ST2250 infection in Japan. This pathogen should be taken into consideration in the diagnosis if the patient has atypical non-pigmented S. aureus.

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Pediatric bacterial meningitis in Japan, 2013-2015 - 3-5 years after the wide use of Haemophilus influenzae type b and Streptococcus pneumoniae conjugated vaccines

Shinjoh Masayoshi, Yamaguchi Yoshio, Iwata Satoshi

Journal of Infection and Chemotherapy 2017.01

ISSN 1341-321X

Background: Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugated vaccine (PCV) have been widely used since 2010 in Japan when both vaccines were supported by the regional governments, and they were covered as routine recommended vaccines in 2013. The incidence of bacterial meningitis due to these organisms decreased in 2011 and 2012, but meningitis due to Streptococcus agalactiae and Escherichia coli remained unchanged. Objectives: We planned to confirm whether the incidence also decreased in subsequent years. Methods: We analyzed the epidemiological and clinical data for 2013-2015, and compared the information obtained in the previous nationwide survey database and our previous reports. We also investigated the risk factors for disease outcome. Results: In the 2013-2015 surveys, 407 patients from 366 hospitals from all prefectures were evaluated. S. agalactiae (33%), Streptococcus pneumoniae (25%), and E. coli (10%) were the main organisms. The total number of patients hospitalized with bacterial meningitis per 1000 admissions decreased from 1.19 in 2009-2010 to 0.37 in 2013-2015 (p < 0.001). The incidence of H. influenzae and S. pneumoniae meningitis significantly decreased from 0.66 in 2009-2010 to 0.01 in 2013-2015, and from 0.30 to 0.09, respectively (p < 0.001). Only 0-2 cases with Neisseria meningitidis were reported each year throughout 2001-2015. The fatality rates for H. influenzae, S. pneumoniae, S. agalactiae, and E. coli in 2013-2015 were 0.0, 4.1, 3.1, and 2.6%, respectively. Risk factors for death and sequelae were consciousness disturbance, convulsion, low CSF glucose, and Staphylococcus sp. as a causative organism (p < 0.01). Conclusions: Hib vaccine and PCV have decreased the rate of bacterial meningitis. S. agalactiae has subsequently become the most common cause of bacterial meningitis in Japan.

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The first case of recurrent ultra late onset group B streptococcal sepsis in a 3-year-old child

Hosoda Ai, Gatayama Ryohei, Moriyama Shiori, Ishii Noriyuki, Yamada Kenichiro, Matsuzaki Youhei, Shinjoh Masayoshi

IDCases 7 16 - 18 2017

ISSN 2214-2509

Group B streptococcus (GBS) is a commonly recognized cause of sepsis and meningitis in neonatal and young infants. Invasive GBS infection is classified into early onset GBS disease (EOD, day 0–6), late onset GBS disease (LOD, day 7–89) and ultra late onset GBS disease (ULOD, after 3 months of age). ULOD is uncommon and recurrence is especially rare. We present the first recurrent case of ULOD GBS sepsis in 3-year-old girl with a past medical history of hydrops fetalis and thoracic congenital lymphatic dysplasia. The first episode presented as sepsis at 2 years 8 months of age. The second episode occurred as sepsis with encephalopathy at 3 years 1 months of age. During each episode, the patient was treated using intravenous antimicrobials and her condition improved. Serotype examination was not performed in the first episode, but GBS type V was serotyped in the second episode. ULOD over 1 year of age is quite rare and may recur.

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Trivalent inactivated influenza vaccine effective against influenza A(H3N2) variant viruses in children during the 2014/15 season, Japan

Sugaya Norio, Shinjoh Masayoshi, Kawakami Chiharu, Yamaguchi Yoshio, Yoshida Makoto, Baba Hiroaki, Ishikawa Mayumi, Kono Mio, Sekiguchi Shinichiro, Kimiya Takahisa, Mitamura Keiko, Fujino Motoko, Komiyama Osamu, Yoshida Naoko, Tsunematsu Kenichiro, Narabayashi Atsushi, Nakata Yuji, Sato Akihiro, Taguchi Nobuhiko, Fujita Hisayo, Toki Machiko, Myokai Michiko, Ookawara Ichiro, Takahashi Takao

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 21 ( 42 ) 2016.10

ISSN 1560-7917

The 2014/15 influenza season in Japan was characterised by predominant influenza A(H3N2) activity; 99% of influenza A viruses detected were A(H3N2). Subclade 3C.2a viruses were the major epidemic A(H3N2) viruses, and were genetically distinct from A/New York/39/2012(H3N2) of 2014/15 vaccine strain in Japan, which was classified as clade 3C.1. We assessed vaccine effectiveness (VE) of inactivated influenza vaccine (IIV) in children aged 6 months to 15 years by test-negative case-control design based on influenza rapid diagnostic test. Between November 2014 and March 2015, a total of 3,752 children were enrolled: 1,633 tested positive for influenza A and 42 for influenza B, and 2,077 tested negative. Adjusted VE was 38% (95% confidence intervals (CI): 28 to 46) against influenza virus infection overall, 37% (95% CI: 27 to 45) against influenza A, and 47% (95% CI: -2 to 73) against influenza B. However, IIV was not statistically significantly effective against influenza A in infants aged 6 to 11 months or adolescents aged 13 to 15 years. VE in preventing hospitalisation for influenza A infection was 55% (95% CI: 42 to 64). Trivalent IIV that included A/New York/39/2012(H3N2) was effective against drifted influenza A(H3N2) virus, although vaccine mismatch resulted in low VE.

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Utility of fractional excretion of urea in the differential diagnosis of acute kidney injury in children

Fujita Hisayo, Shinjoh Masayoshi, Ishii Tomohiro, Awazu Midori

Pediatric Nephrology 1 - 5 2016.03

ISSN 0931-041X

Introduction: The fractional excretion of sodium (FE_Na) has been used as an index for the differential diagnosis of acute tubular necrosis (ATN) and prerenal acute kidney injury (AKI). The reliability of this index, however, decreases with the use of the diuretic agent furosemide. The fractional excretion of urea nitrogen (FE_UN) has been shown to be useful in such settings in adults. The objective of this study was to examine whether FE_UN is also useful in these settings in children. Methods: We assessed 102 episodes of AKI in 74 children, classifying these into three groups based on history, physical examination, urine examination and subsequent clinical course: (1) prerenal AKI without furosemide (N = 37), (2) prerenal AKI with furosemide (N = 32) and (3) ATN (N = 33). Results: Of the 37 prerenal AKI episodes without furosemide, 35 showed low FE_Na of Na. FE_UN in the clinical setting of prerenal AKI was lower than that in ATN (27.9 ± 2.1 vs. 51.6 ± 3.8 %, respectively) and, in contrast to FE_Na, not significantly different between the categories of prerenal AKI with and without furosemide (29.2 ± 3.1 vs. 25.1 ± 2.9, respectively). The sensitivity of FE_UN Na was 53 %. Conclusions: FE_UN is useful in detecting prerenal AKI in children administered furosemide.

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Effectiveness of Trivalent Inactivated Influenza Vaccine in Children Estimated by a Test-Negative Case-Control Design Study Based on Influenza Rapid Diagnostic Test Results

Shinjo(h) Masayoshi, Sugaya N, Yamaguchi Y, Tomidokoro Y, Sekiguchi S, Mitamura K, Fujino M, Shiro H, Komiyama O, Taguchi N, Nakata Y, Yoshida N, Narabayashi A, Myokai M, Sato M, Furuichi M, Baba H, Fujita H, Sato A, Ookawara I, Tsunematsu K, Yoshida M, Kono M, Tanaka F, Kawakami C, Kimiya T, Takahashi T, Iwata S; Keio Pediatric Influenza Research Group.

PLoS One 10 ( 8 ) e0136539 2015.08

Joint Work, Accepted

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Catheter-related blood stream infection caused by Dermacoccus barathri, representing the first case of Dermacoccus infection in humans

Takahashi Nobuhiro, Shinjoh Masayoshi, Tomita Hirofumi, Fujino Akihiro, Sugita Kayoko, Katohno Yasuhiro, Kuroda Tatsuo, Kikuchi Ken

Journal of Infection and Chemotherapy 21 ( 8 ) 613 - 616 2015.08

ISSN 1341-321X

A 7-year-old boy undergoing home parenteral nutrition with totally implantable central venous access device for chronic intestinal pseudo-obstruction experienced repeated episodes of fever with a temperature above 39.0°C despite the antibiotic treatment. The fever was considered to be catheter-related blood stream infections, as no other etiology could be justified. Repeated blood culture tests revealed negative after 1-week incubation, whereas some samples of blood collected from the central venous catheter yielded positive and gram-positive rods were detected. These bacteria were detected repeatedly, then the central venous access device was removed with consideration for the possibility of this bacteria being a pathogen. Thereafter, the fever did not recur and the blood culture tests were negative. The causative agent was identified as Dermacoccus barathri based on the 16S rRNA gene sequence and phylogenetic analysis of 6118-bp concatenated sequences of 4 housekeeping genes. Genus Dermacoccus are one form of Actinomycetes isolated from human skin and water, but human infection with Dermacoccus spp. has not been previously reported and the pathogenicity of the bacteria remains unclear. To our knowledge, this is the first reported case of Dermacoccus infection in humans.

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High rate of inducible clindamycin resistance in Staphylococcus aureus isolates - A multicenter study in Tokyo, Japan

Shoji Kensuke, Shinjoh Masayoshi, Horikoshi Yuho, Tang Julian, Watanabe Yasushi, Sugita Kayoko, Tame Tomoyuki, Iwata Satoshi, Miyairi Isao, Saitoh Akihiko

Journal of Infection and Chemotherapy 21 ( 2 ) 81 - 83 2015.02

ISSN 1341-321X

The resistance of Staphylococcus aureus (. S.aureus) to antibiotics is an increasing problem. Clindamycin has been used as empiric therapy for the rising incidence of community-acquired methicillin-resistant S.aureus (MRSA). As such, the local rate of inducible resistance against clindamycin is an important consideration. This multicenter study was conducted to identify the incidence of inducible clindamycin resistance of S.aureus isolates in Tokyo, the most populous city in Japan. A total of 2408 adult and pediatric samples were collected from a university hospital and two pediatric hospitals between January 2011 and December 2011. Among the 2341 samples analyzed, the incidence of inducible clindamycin resistance in erythromycin-resistant and clindamycin-susceptible/intermediate isolates was found to be 91% (. n=585), a figure much higher compared to most reports from other countries. In conclusion, we found a very high rate of inducible clindamycin resistance in macrolide-resistant S.aureus isolates in our geographic area.

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Updated data on effective and safe immunizations with live-attenuated vaccines for children after living donor liver transplantation

Shinjoh Masayoshi, Hoshino Ken, Takahashi Takao, Nakayama Tetsuo

Vaccine 33 ( 5 ) 701 - 707 2015.01

ISSN 0264-410X

Background: Although immunizations using live-attenuated vaccines are not recommended for children post-liver transplant due to their theoretical risks, they will inevitably encounter vaccine-preventable viral diseases upon returning to real-life situations. The window of opportunity for vaccination is usually limited prior to transplantation because these children often have unstable disease courses. Also, vaccine immunity does not always persist after transplantation. Methods: Beginning in 2002, subcutaneous immunizations with four individual live-attenuated vaccines (measles, rubella, varicella, and mumps) to pediatric patients following living donor liver transplantation (LDLT) were performed for those who fulfilled the clinical criteria, including humoral and cell-mediated immunity. Written informed consent was collected. We included the study on 70 immunizations for 18 cases that we reported in 2008 (Shinjoh et al., 2008). Results: A total of 196 immunizations were administered to 48 pediatric post-LDLT recipients. Of these, 144 were first immunizations and 52 were repeated immunizations following LDLT. The seroconversion rates at the first dose for measles (AIK-C), rubella (TO-336), varicella (Oka), and mumps (Hoshino) were 100% (36/36), 100% (35/35), 70% (23/33), and 75% (24/32), respectively. Antibody levels did not fall over time in patients immunized with rubella vaccine. Three mild cases of breakthrough varicella were observed. Two cases with transient parotid gland swelling were observed after mumps immunization. Two admissions because of fever at 2-3 weeks after the measles vaccine were reported but the patients had no symptoms of measles. Conclusions: Immunizations using selected live-attenuated vaccines were safe and effective for post-LDLT children who were not severely immunosuppressed. However, with the exception of rubella, repeated immunization may be necessary.

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A Pediatric Case of Antibiotic-Associated Hemorrhagic Colitis Caused by Klebsiella Oxytoca.

Yamada M, Yamazawa K, Sekiguchi S, Shinjoh M, Tomita K, Takenouchi T, Takahashi T.

Glob Pediatr Health 2014.09

Accepted

Clinical features of bacteremia due to Campylobacter jejuni

Mori Takehiko, Hasegawa Naoki, Sugita Kayoko, Shinjoh Masayoshi, Nakamoto Nobuhiro, Shimizu Takayuki, Hori Shingo, Iketani Osamu, Fujiwara Hiroshi, Takano Yaoko, Iwata Satoshi

Internal Medicine 53 ( 17 ) 1941 - 1944 2014

ISSN 0918-2918

Objective The clinical features of bacteremia due to Campylobacter jejuni (C. jejuni) have yet to be fully elucidated.Methods and Results The cases of C. jejuni bacteremia were retrospectively reviewed during a twelve-year period in a single institute. C. jejuni was identified in 7 patients through blood cultures, and disease onset occurred between June and October. Except for 2 previously healthy individuals, 5 patients had underlying diseases (chronic liver diseases, n=3; hematological malignancies, n=2). All patients were febrile, but 2 patients did not present with gastrointestinal symptoms. C. jejuni isolates were susceptible to gentamicin and macrolides, but about half of them were resistant to fluoroquinolones. Disease outcomes were favorable, and no deaths related to C. jejuni bacteremia were observed.Conclusion These results suggest that C. jejuni bacteremia could occur primarily or secondarily to gastroenteritis with a seasonal peak and that prognosis would be favorable regardless of the underlying diseases.

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Recent trends in pediatric bacterial meningitis in Japan - A country where Haemophilus influenzae type b and Streptococcus pneumoniae conjugated vaccines have just been introduced

Shinjoh Masayoshi, Iwata Satoshi, Yagihashi Tatsuhiko, Sato Yoshitake, Akita Hironobu, Takahashi Takao, Sunakawa Keisuke

Journal of Infection and Chemotherapy 2014

ISSN 1341-321X

To investigate the trends in incidence and the characteristics of bacterial meningitis in Japan where Haemophilus influenzae type b (Hib) vaccine and 7-valent pneumococcal conjugated vaccine (PCV7) were introduced in 2008 and 2010, respectively, which was 5-20 years after their introduction in western countries. The nationwide Japanese survey of pediatric and neonatal bacterial meningitis was performed in 2011 and 2012. We analyzed the epidemiological and clinical data, and compared the information obtained in the previous nationwide survey database. We also investigated the risk factors for disease outcome. In the 2011-2012 surveys, 357 patients were evaluated. H. influenzae, Streptococcus pneumoniae, Streptococcus agalactiae and Escherichia coli were the main organisms. The number of patients hospitalized with bacterial meningitis per 1000 admissions decreased from 1.31 in 2009 to 0.43 in 2012 (p < 0.001). The incidence of H. influenzae and S. pneumoniae meningitis also decreased from 0.66 to 0.08 (p < 0.001), and 0.30 to 0.06 (p < 0.001), respectively. Only 0-2 cases with Neisseria meningitidis were reported each year throughout 2001-2012. The median patient age was 10-12 months in 2001-2011, and became lower in 2012 (2 month old) (p < 0.001). The fatality rate for S. agalactiae is the highest (5.9% (11/187)) throughout 2001-2012 among the four organisms. Risk factors for death and sequelae were convulsions at onset, low CSF glucose, S. agalactiae etiology, and persistent positive CSF culture. Hib vaccine and PCV7 decreased the rate of bacterial meningitis. Earlier introduction of these vaccines may have prevented bacterial meningitis among Japanese children. © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases.

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Presence of Epstein-Barr virus in cerebrospinal fluid from patients with aseptic meningitis appears to be common

Kimiya T., Yagihashi T., Shinjoh M., Kai A., Sato Y.

Infection 41 ( 5 ) 1045 - 1046 2013.10

ISSN 0300-8126

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[Infectious diseases

Shinjoh Masayoshi

Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 101 ( 11 ) 3114 - 3122 2012.11

ISSN 0021-5384

Postexposure prophylaxis for influenza in pediatric wards oseltamivir or zanamivir after rapid antigen detection

Shinjoh Masayoshi, Takano Yaoko, Takahashi Takao, Hasegawa Naoki, Iwata Satoshi, Sugaya Norio

Pediatric Infectious Disease Journal 31 ( 11 ) 1119 - 1123 2012.11

ISSN 0891-3668

BACKGROUND: Postexposure prophylaxis (PEP) using neuraminidase inhibitors against exposure to influenza virus has been well studied in household settings but not in nosocomial settings in pediatric wards. METHODS: We used oseltamivir or zanamivir as PEP in our pediatric wards. All influenza cases were diagnosed by the influenza rapid diagnostic test. RESULTS: Between 2003 and 2011, there were 20 nosocomial introductions of influenza (10 were A, 9 were B and 1 was undetermined). The index cases consisted of 17 inpatients, 2 parents and 1 medical staff member. The 17 inpatients had been admitted to the hospital for reasons other than infectious disease and they developed influenza after hospitalization. Among the 81 contacts, 28 (35%) were exposed to influenza A, and 52 (64%) were exposed to influenza B. The rate of secondary infection among contacts not given PEP was 29% (5/17), and the rate among contacts given PEP was significantly lower, 3% (2/63; P = 0.004). The 2 infected contacts who had been given PEP were both influenza B cases, and both had received oseltamivir. The contacts who received PEP within 24 hours (59), for influenza A (23) and those who received zanamivir (15) did not develop influenza. No adverse events were reported. CONCLUSIONS: PEP using oseltamivir or zanamivir for unexpected occurrences of nosocomial influenza in pediatric wards is safe and effective. The influenza rapid diagnostic test that we used was helpful for detecting nosocomial influenza in children. Copyright © 2012 by Lippincott Williams & Wilkins.

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[Childhood bacterial meningitis trends in Japan from 2009 to 2010].

Shinjoh Masayoshi, Iwata Satoshi, Sato Yoshitake, Akita Hironobu, Sunakawa Keisuke

Kansenshōgaku zasshi. The Journal of the Japanese Association for Infectious Diseases 86 ( 5 ) 582 - 591 2012.09

ISSN 0387-5911

We conducted a pediatric survey of bacterial meningitis epidemiology from January 2009 to December 2010 in Japan, and obtained the following results for 314 cases (186 boys, 124 girls, and 4 with gender not reported). Children younger than one year old accounted for the majority of cases (51.2%, 161/314), and the incidence decreased with increasing age. Haemophilus influenzae (in children aged 1 month to 5 years old) was the most common cause of infection (53.2%), followed by Streptococcus pneumoniae (1 month to 12 years, 24.2%), Streptococcus agalactiae (0-4 months, 7.6%), and Escherichia coli (0-3 months, 3.2%). Susceptibility tests showed that 50.1% (78/153) of the H. influenzae isolates and 63.0% (46/73) of the S. pneumoniae isolates were drug-resistant. Combinations of ampicillin and cephem or carbapenem and other beta-lactams were mainly used as the initial antibiotics for patients under 4 months of age (77.8%, 42/54), and a carbapenem and other beta-lactam combination was used for patients aged 4 months and older (76.4%, 198/259). The final antibiotics for H. influenzae and S. pneumoniae were mainly cefotaxime (CTX) or ceftriaxone (CTRX) and carbapenem, respectively. The overall fatality rate was 2.0% (6/305). Since the Haemophilus influenzae type b vaccine (Hib vaccine) and the 7 valent pneumococcal conjugate vaccine (PCV7) are not widely used in Japan, only 5 patients in our cohort (all with meningitis not caused by H. influenzae) had been immunized with the Hib vaccine, and none had been immunized with the PCV7 vaccine. No remarkable changes in the characteristics of pediatric meningitis have been observed for several years in Japan.

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