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.

Safety and efficacy of linezolid in 16 infants and children in Japan

Shinjoh Masayoshi, Iketani Osamu, Watanabe Kota, Shimojima Naoki, Kudo Mikihiko, Yamagishi Hiroyuki, Shimada Hiroyuki, Sugita Kayoko, Takahashi Takao, Mori Takehiko, Hasegawa Naoki, Iwata Satoshi

Journal of Infection and Chemotherapy 18 ( 4 ) 591 - 596 2012.08

ISSN 1341-321X

Linezolid, an oxazolidinone antibiotic, exhibits a broad spectrum of activity against Gram-positive bacteria. It hasbeen licensed for adult use in Japan since 2006 for MRSA infections, and has also been used off-label for pediatric patients.At our university hospital, a total of 16 infants and children (including one non-Japanese Asian) were administered linezolidowing to infection with multidrug-resistant Gram-positive bacteria, after consent had been provided. All patients had severeunderlying diseases or indications for surgery. Eighty-eight percent of the causal microorganisms were methicillin-resistantStaphylococcus aureus (MRSA) or methicillin-resistant coagulase-negative Staphylococcus and all were sensitive to linezolid.Linezolid was administered because the antecedent anti-MRSA medications were ineffective or contraindicated, orintravenous-to-oral switch therapy was requested owing to cardiac or orthopedic surgical-site infections. The median durationof administration was 13 days (range 3-31 days). The overall efficacy was 91 % (10/11) in those for whom efficacy could beevaluated. Only two patients (both teen-aged) encountered linezolid-related adverse effects (13 %, 2/16). One patient showedelevation of liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]), requiring thatadministration be withdrawn, but enzyme levels returned to normal after the patient had been switched to vancomycin. Theother patient showed transiently decreased platelet counts. Linezolid is considered generally safe and effective for childrenin Japan, especially for those who cannot use other anti-MRSA medications or those who require oral antibiotics forinfections with multidrug-resistant Gram-positive bacteria. © 2012 Japanese Society of Chemotherapy and The JapaneseAssociation for Infectious Diseases.

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Influenza-related mortality trends in japanese and american seniors

Charu Vivek, Viboud Cécile, Simonsen Lone, Sturm-Ramirez Katharine, Shinjoh Masayoshi, Chowell Gerardo, Miller Mark, Sugaya Norio

PLoS ONE 6 ( 11 ) 2011.11

Background: The historical Japanese influenza vaccination program targeted at schoolchildren provides a unique opportunity to evaluate the indirect benefits of vaccinating high-transmitter groups to mitigate disease burden among seniors. Here we characterize the indirect mortality benefits of vaccinating schoolchildren based on data from Japan and the US. Methods: We compared age-specific influenza-related excess mortality rates in Japanese seniors aged ≥65 years during the schoolchildren vaccination program (1978-1994) and after the program was discontinued (1995-2006). Indirect vaccine benefits were adjusted for demographic changes, socioeconomics and dominant influenza subtype; US mortality data were used as a control. Results: We estimate that the schoolchildren vaccination program conferred a 36% adjusted mortality reduction among Japanese seniors (95%CI: 17-51%), corresponding to ~1,000 senior deaths averted by vaccination annually (95%CI: 400-1,800). In contrast, influenza-related mortality did not change among US seniors, despite increasing vaccine coverage in this population. Conclusions: The Japanese schoolchildren vaccination program was associated with substantial indirect mortality benefits in seniors.

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Very low pandemic influenza A (H1N1) 2009 mortality associated with early neuraminidase inhibitor treatment in Japan

Sugaya Norio, Shinjoh Masayoshi, Mitamura Keiko, Takahashi Takao

Journal of Infection 63 ( 4 ) 288 - 294 2011.10

ISSN 0163-4453

Objective: There were many cases of pandemic influenza A (H1N1) 2009 (H1N1/09) in Japan during the 2009-2010 epidemic. They accounted for 16% of the total population (20.7 million/128 million), and 59% of the patients were children 15 years of age and under (12.2 million/20.7million). However, there were only 38 paediatric deaths. We analyzed the clinical manifestations and treatment of children hospitalized because of H1N1/09 infection in order to clarify the association between treatment with neuraminidase inhibitors and the low mortality rate. Methods: A retrospective chart review was performed on a total of 1000 paediatric inpatients. Results: The causes of the hospitalizations were respiratory complications in 651 cases (65.1%), neurological complications in 255 cases (25.5%) and other complications in 94 cases. Neuraminidase inhibitors, primarily oseltamivir, had been used to treat 984 (98.4%) of the 1000 patients, and in 88.9% of the patients, treatment with neuraminidase inhibitors was initiated within 48 h after the onset of illness. Only 12 (1.2%) of the 1000 patients underwent mechanical ventilation, and one patient died of H1N1/09 infection. Conclusions: Although a high proportion of the patients in this study had severe respiratory complications, the case fatality rate was only 0.1%. The low mortality rate of children due to the H1N1/09 epidemic in Japan was probably attributable to the universal implementation of early treatment with neuraminidase inhibitors. © 2011 The British Infection Association.

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Klebsiella oxytoca-positive, penicillin-associated hemorrhagic enterocolitis in children

Shinjoh Masayoshi, Iwata Satoshi, Takahashi Takao

Pediatrics International 52 ( 1 ) 132 - 153 2010.02

ISSN 1328-8067

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Varicella zoster exposure on paediatric wards between 2000 and 2007

Shinjoh M., Takahashi T.

Journal of Hospital Infection 72 ( 2 ) 163 - 168 2009.06

ISSN 0195-6701

Varicella zoster virus is highly contagious and can cause serious complications in immunocompromised patients. To prevent people exposed to the virus from developing secondary varicella we have used oral aciclovir as post-exposure prophylaxis (PEP) since 2000. Between 2000 and 2007, there were 11 unexpected occurrences of varicella and 11 unexpected occurrences of zoster in our paediatric wards. There were 174 contacts, 131 exposed to varicella and 43 exposed to zoster. A total of 163 (94%) received PEP and 11 (6%) did not. The rates of secondary infection among contacts given prophylaxis with aciclovir only were 2.1% (3/141) for all contacts and 1.3% (1/76) for immunocompetent contacts. The rate of secondary infection among contacts not given PEP was significantly higher (18%, 2/11) (P < 0.05). No adverse events due to PEP were reported. We conclude that oral aciclovir PEP following exposure to VZV on paediatric wards is both safe and effective. © 2009 The Hospital Infection Society.

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Effective and safe immunizations with live-attenuated vaccines for children after living donor liver transplantation

Shinjoh Masayoshi, Miyairi Isao, Hoshino Ken, Takahashi Takao, Nakayama Tetsuo

Vaccine 26 ( 52 ) 6859 - 6863 2008.12

ISSN 0264-410X

Immunizations using live-attenuated vaccines are not recommended for post-liver transplant children due to its theoretical risks. However, they will encounter vaccine-preventable viral diseases upon returning to real-life situations. We performed a total of 70 immunizations with four individual live-attenuated vaccines to 18 pediatric post-living donor liver transplant (LDLT) recipients who fulfilled a clinical criteria including humoral and cell-mediated immunity. The seroconversion rates at the first dose for measles (strain AIK-C), rubella (strain TO-336), varicella (strain Oka), and mumps (strains Hoshino) were 100% (15/15), 100% (15/15), 82% (9/11), and 82% (9/11), respectively. During observed period (-5 years 11 months), a few cases with waning immunity (antibodies were once produced but the levels fell over time) were seen except after rubella immunization. Clinical diseases after seroconversion or definite serious adverse effects due to immunization were not observed. Immunizations using selected live-attenuated vaccines were safe and effective for post-LDLT children who were not severely immunosuppressed. © 2008 Elsevier Ltd. All rights reserved.

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Cryptococcal meningitis in an immunocompetent child

Shinjoh Masayoshi, Miyairi Isao, Sakurai Michiko, Takahashi Miki, Ariyasu Daisuke, Nakayama Tetsuo, Tokumura Mitsuaki, Yamashita Ryoko, Sunakawa Keisuke, Takahashi Takao

European Journal of Pediatrics 164 ( 9 ) 596 - 597 2005.08

ISSN 0340-6199

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Effect of post-exposure prophylaxis with oseltamivir for those in contacts with influenza patients in pediatric wards

Shinjoh Masayoshi, Sato Seiji, Sugaya Norio, Mitamura Keiko, Takeuchi Yoshinao, Kosaki Kenjiro, Takahashi Takao

Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 78 ( 3 ) 262 - 269 2004

ISSN 0387-5911

During the influenza season, outbreaks of influenza may occur in the pediatric wards due to spread from the patients hospitalized with influenza, or from those hospitalized during the latency period and develop influenza afterwards. Post-exposure prophylaxis with neuraminidase inhibitors has been reported to be effective in preventing outbreaks among household members and nursing home residents. However, for nosocomial spread, its effectiveness and possible adverse effects are to be determined. During the 2002/2003 influenza season, we experienced a total of 3 nosocomial outbreaks of influenza in the pediatric wards in two hospitals in the Kanto district, Japan. Since the number of contacts who developed influenza had been increasing despite the isolation precaution implemented, post-exposure prophylaxis with oseltamivir (2 mg/kg/dose, maximum 75 mg/dose, once a day for 7-10 days) was implemented with a permission from the parents to terminate the outbreaks. In the outbreaks (one with influenza A, two with influenza B), a total of 29 inpatients had contact with influenza patients: among those 29, 13 were given post-exposure prophylaxis, 16 were not. Out of 16 patients who did not receive post-exposure prophylaxis, 11 (69%) developed influenza: out of 13 with post-exposure prophylaxis, none developed influenza. Those patients who developed influenza were given oseltamivir (2 mg/kg/dose, maximum 75 mg/dose, twice a day for 5 days) and accommodated in a private room or a room with other patients with influenza of the same type. No significant adverse effects due to oseltamivir were observed among those who were enrolled in this study.

Evaluation of an immunochromatography test using enzyme immunoassay for rapid detection of influenza A and B viruses

Mitamura Keiko, Yamazaki Masahiko, Ichikawa Masataka, Kimura Kazuhiro, Kawakami Chiharu, Shimizu Hideaki, Watanabe Sumi, Imai Mitsunobu, Shinjo Masayoshi, Takeuchi Yoshinao, Sugaya Norio

Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 78 ( 7 ) 597 - 603 2004

ISSN 0387-5911

We evaluated the performance of an improved version of Espline Influenza A & B-N (Fujirebio Inc., Japan), an immunochromatography test using enzyme immunoassay for rapid diagnosis of influenza A and B. The test produced positive results for four strains of influenza viruses and thirty-one influenza viral antigens and negative results for all of thirty strains of other respiratory viruses that were tested. The detection limit of this test was 5.8 x 10(2) to 5.8 x 10(3) pfu/assay, which is more sensitive than the old version of Espline. Furthermore, 715 respiratory specimens collected from the patients (children, 79.4%; adults, 18.5%; unknown, 2.1%) with influenza-like illnesses during the 2002/2003 influenza season in Japan were tested as part of a clinical evaluation of this test. The relative performance of this test compared to cell culture and nested RT-PCR results were examined. In the cell cultures, influenza viruses were detected in 488 of the 715 specimens (overall, 68.3%; AH3, 41.7%; B, 26.4%; AH3 and B, 0.1%). For influenza A, the sensitivity of this test was 95.4% (125/131) for nasal aspirates, 96.8% (92/95) for nasal swabs, and 85.1% (63/74) for throat swabs. For influenza B, the sensitivity of this test was 91.2% (52/57) for nasal aspirates, 88.1% (59/67) for nasal swabs, and 71.6% (48/67) for throat swabs. The new test exhibited a remarkably higher sensitivity to influenza A in throat swabs than the old version of Espline. Only two false positive results were obtained out of a total of 223 virus negative specimens; the specificity of the test was 100% (88/88) for nasal aspirates, 97.6% (81/83) for nasal swabs, and 100% (52/52) for throat swabs. We conclude that the new Espline Influenza A&B-N rapid diagnostic test is easy to use and has a high sensitivity and specificity, especially for influenza A.

Perspectives on the characteristics and achievements of recent surveillance of influenza activity in Japan

Nerome R., Nerome K., Tanabe N., Lindstrom S. E., Shinjo M., Taniguchi S., Kasai K.

Vaccine 20 ( SUPPL. 2 ) 2002.05

ISSN 0264-410X

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Effectiveness of oseltamivir treatment against influenza type A and type B infection in children

Mitamura Keiko, Sugaya Norio, Nirasawa Mari, Shinjoh Masayoshi, Takeuchi Yoshinao

Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 76 ( 11 ) 946 - 952 2002

ISSN 0387-5911

We investigated the effectiveness of oseltamivir treatment against influenza virus infection in children. We treated 131 patients (mean age, 5.8 +/- 3.6 years) with oseltamivir (4 mg/kg/day for 5 days) during the 2001-2002 epidemic. All of the patients had been diagnosed with influenza using a rapid diagnosis kit. When treatment was initiated within 48 hours of the onset of fever, 44% of the patients became afebrile (< 37.5 degrees C) within one day, and 86% of them recovered within two days. The average duration of fever after the initiation of oseltamivir treatment was 1.7 days. Oseltamivir was equally effective against both influenza type A and type B. No differences in the effectiveness of oseltamivir treatment were observed between young children (< 4 years of age) and school-aged children (> 6 years of age). No obvious side effects were observed.

Cytomegalovirus retinitis during immunotherapy for common variable immunodeficiency [4]

Ishikawa K., Ando Y., Narita M., Shinjoh M., Iwasaki T.

Journal of Infection 44 ( 1 ) 55 - 56 2002

ISSN 0163-4453

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Prophylaxis and treatment of influenza encephalitis in an experimental mouse model

Shinjoh Masayoshi, Yoshikawa Takashi, Li Yixing, Shiraishi Kyoko, Ueki Hideaki, Nerome Kuniaki

Journal of Medical Virology 67 ( 3 ) 406 - 417 2002

ISSN 0146-6615

A mouse model study using mouse brain-adapted influenza A virus was performed to establish the prophylaxis and treatment of influenza encephalitis and encephalopathy. All mice died after intranasal inoculation of the brain-adapted influenza A virus (H7N3), and the pathological findings indicated the presence of significant encephalitis. Viral antigen was also detected in the brain, both pathologically and virologically. By contrast, infected mice immunized with inactivated vaccine of the same strain did not lose weight, which is an indicator of the overall condition of the mice, and all of them survived. Similarly, antiserum treatment in the early period (0-1 day post-infection) resulted in 100% survival, and no pathological findings were observed in the brain. However, mice treated with antiserum 3 days post-infection showed encephalitis with viral antigens in both glial cells and neurocytes. Although amantadine treatment for 4 days delayed weight loss, it did not prevent death from encephalitis. These results show vaccination and early antiserum treatment to be highly effective, whereas 4-day treatment of amantadine was not very effective in treating or preventing influenza encephalitis. The life-prolonging effect of amantadine, however, suggests that use of amantadine together with other treatments may inhibit the progression of encephalitis. © 2002 Wiley-Liss, Inc.

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Diagnosis and Treatment of Influenza Associated Encephalopathy in Children

Shinjoh Masayoshi

Japanese Journal of Chest Diseases 60 ( 11 ) 1023 - 1024 2001.11

ISSN 0385-3667

Genetic analysis of an influenza B virus isolated from a patient with encephalopathy in Japan

Shiraishi Kyoko, Lindstrom Stephen E., Saito Takehiko, Shinjoh Masayoshi, Nerome Reiko, Funatsumaru Sadayuki, Nerome Kuniaki

Journal of Medical Virology 65 ( 3 ) 590 - 597 2001

ISSN 0146-6615

An influenza B virus, B/Saga/S172/99 (SAG99), was isolated from the nasopharynx of a patient with encephalopathy/encephalitis in Japan in 1999. To clarify the molecular characteristics of this virus, detailed analysis of the gene segments coding for the hemagglutinin (HA), neuraminidase (NA), nucleoprotein (NP), matrix protein (M) and non-structural protein (NS) was undertaken. All five genes of SAG99 showed high nucleotide and predicted amino acid similarities with those of recent non-encephalopathic strains isolated in the same epidemic season. Subsequent phylogenetic analysis revealed that all five gene segments of SAG99 analyzed in the present study were most similar to those of the recent Yamagata/16/88-like viruses. The hemagglutinin and neuraminidase proteins of SAG99 were each distinguished from those of recent epidemic strains by one characteristic amino acid substitution. These substitutions were not found in the previously reported encephalopathy/encephalitis-derived influenza B viruses, and we could not find any common characteristic amino acid changes in SAG99 and these viruses. Similarly, among the internal proteins studied, only the M2 protein of SAG99 was found to contain a single novel amino acid change when compared with other recent isolates. Thus, it was apparent that SAG99 contained very few amino acid differences when compared with other epidemic viruses. The association of recent B/Yamagata/16/88-like viruses with encephalitis/encephalopathy observed in the present study and previously suggest that these viruses may have a higher potential for causing neurological complications in certain individuals. © 2001 Wiley-Liss, Inc.

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In vitro growth profiles of respiratory syncytial virus in the presence of influenza virus

Shinjoh M., Omoe K., Saito N., Matsuo N., Nerome K.

Acta Virologica 44 ( 2 ) 91 - 97 2000

ISSN 0001-723X

To elucidate epidemiological interference between respiratory syncytial (RSV) and influenza viruses, the influence of influenza A (H1N1) virus on the growth of RSV was examined. Although RSV grew in MDCK cells, coinfection with influenza A virus led to a reduction of progeny RSV. The degree of growth interference depended on the time of infection with influenza A virus post infection (p.i.) with RSV. In fact, infection with influenza A virus 12 hrs p.i. with RSV did not influence growth of the latter virus. On the contrary, growth suppression of influenza A virus by RSV was observed when the coinfection began at the later stages of RSV infection. Suppression of the growth of RSV by influenza A infection was further demonstrated at the level of viral protein synthesis. An indirect immunofluorescence (IF) test revealed that a large proportion of infected cells synthesized both RSV and influenza A Virus antigens. Scanning electron microscopic (SEM) examination demonstrated that influenza A and RSV virions possessing surface antigens specific for each virus were selectively released from dually infected cells. In the present study, we proved for the first time that the growth of RSV is blocked by competitive infection with influenza A Virus in a susceptible cell population, competitive protein synthesis and selective budding of RSV and influenza Viruses from the same infected cells.

Phylogenetic analysis of the three polymerase genes (PB1, PB2 and PA) of influenza B virus

Hiromoto Yasuaki, Saito Takehiko, Lindstrom Stephen E., Li Yixing, Nerome Reiko, Sugita Shigeo, Shinjoh Masayoshi, Nerome Kuniaki

Journal of General Virology 81 ( 4 ) 929 - 937 2000

ISSN 0022-1317

Phylogenetic patterns of the three polymerase (PB2, PB1 and PA) genes of a total of 20 influenza B viruses isolated during a 58 year period, 1940-1998, were analysed in detail in a parallel manner. All three polymerase genes consistently showed evolutionary divergence into two major distinct lineages and their amino acid profiles demonstrated conserved lineage-specific substitutions. Dendrogram topologies of the PB2 and PB1 genes were very similar and contrasted with that of the PA gene. It was of particular interest to reveal that even though the PA gene evolved into two major lineages, that of three recent Asian Victoria/1/87-like strains formed a branch cluster located in the same lineage as that of recent Yamagata/16/88-like isolates. Differences in the phylogenetic pathways of three polymerase genes were not only a reflection of genetic reassortment between co-circulating influenza B viruses, but also an indication that the polymerase genes were not co-evolving as a unit. As a result, comparison of the phylogenetic patterns of the three polymerase genes with previously determined patterns of the HA, NP, M and NS genes of is viruses defined the existence of eight distinct genome constellations. Also, similar phylogenetic profiles among the PA, NP and M genes, as well as between the PB2 and PB1 genes, were observed, suggesting possible functional interactions among these proteins. Completion of evolutionary analysis of the six internal genes and the HA gene of influenza B viruses revealed frequent genetic reassortment among co-circulating variable strains and suggested co-dependent evolution of genes.

Influenza A-associated encephalopathy with bilateral thalamic necrosis in Japan

Shinjoh M., Bamba M., Jozaki K., Takahashi E., Koinuma G., Sugaya N.

Clinical Infectious Diseases 31 ( 2 ) 611 - 613 2000

ISSN 1058-4838

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Acute encephalitis and encephalopathy associated with influenza virus

Shinjoh Masayoshi, Nerome Kuniaki

Brain and Nerve 51 ( 10 ) 851 - 860 1999

ISSN 0006-8969

Contraction of vascular smooth muscle by Na⁺ channel activators

Shinjoh M., Nakaki T., Otsuka Y., Sasakawa N., Kato R.

Japanese Journal of Pharmacology 58 ( SUPPL. 2 ) 1992

ISSN 0021-5198

Vascular smooth muscle contraction induced by Na⁺ channel activators, veratridine and batrachotoxin

Masayoshi Shinjoh, Toshio Nakaki, Yukari Otsuka, Nobuyuki Sasakawa, Ryuichi Kato

European Journal of Pharmacology 205 ( 2 ) 199 - 202 1991.11

ISSN 0014-2999

The effects of the sodium channel activators veratridine and batrachotoxin on isolated rat aorta were investigated. Veratridine caused gradual contraction, independent of the presence of endolhelium, with an EC₅₀ of 35 μM. Batrachotoxin (1 μM) also induced contraction. Both effects were completely inhibited by the sodium channel blocker tetrodotoxin (1 μM). The veratridine (60 μM)-induced contraction was inhibited by nifedipine (0.1 μM). In the absence of extracellular Ca²⁺, veratridine (60 μm) did not cause contraction. Sodium nitroprusside (80 nM), acetylcholine (10 μM) and isoproterenol (1 μM) caused relaxation of rings precontracted with veratridine (60 μM). An inhibitor of endothelium-derived relaxing factor (EDRF) synthase, N^ω-nitro-L-arginine methyl ester (L-NAME) (0.65 mM). enhanced the veratridine-induced contraction in rings with an intact endothelium, which suggests that EDRF was being released during the veratridine-induced contraction. These results show that the activation of sodium channels on smooth muscle cells induces a contraction that is probably mediated by Ca²⁺ influx through voltage-dependent Ca²⁺ channels.

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