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Shinjoh M.,Keio University | Takano Y.,Keio University | Takahashi T.,Keio University | Hasegawa N.,Keio University | And 2 more authors.
Pediatric Infectious Disease Journal | Year: 2012

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. Source

Sugaya N.,Keiyu Hospital
Journal of Infection and Chemotherapy | Year: 2011

Almost all patients with an influenza-like illness in Japan are now tested with rapid diagnostic tests, and when positive, they are treated with a neuraminidase inhibitor (NAI). Japan may have had the lowest case fatality rate for symptomatic illness (\0.001%, 198/20.7 million) in the H1N1/09 pandemic because of the universal implementation of early treatment with NAI. A study of 1,000 children hospitalized because of a H1N1/09 infection revealed that NAIs, primarily oseltamivir, had been used to treat 984 (98.4%) of the 1,000 patients. In 88.9% of the patients, treatment with NAIs was initiated within 48 h after the onset of illness. In addition to oseltamivir and zanamivir, the newly approved inhalant drug, laninamivir, and the newly approved intravenous drug, peramivir, were used in Japan during the 2010-2011 season. Neuropsychiatric disorders that were suspected of being adverse reactions to oseltamivir became a cause of concern in 2007. The Health, Labour and Welfare Ministry issued an emergency instruction to suspend the use of oseltamivir to treat patients between the ages of 10 and 19 years. However, according to the Vital Statistics data, the widespread use of oseltamivir has not caused an increase in deaths as a result of accidental falls or intentional jumps from buildings. Although oseltamivir is widely used in Japan, no outbreaks have been caused by oseltamivir-resistant viruses, and no serious illness caused by oseltamivir-resistant viruses has ever been reported. © Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases 2011. Source

Sugaya N.,Keiyu Hospital | Shinjoh M.,Keio University | Mitamura K.,Eiju General Hospital | Takahashi T.,Keio University
Journal of Infection | Year: 2011

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. Source

In the past, Japan's strategy for controlling influenza was to vaccinate schoolchildren based on the theory that this could reduce influenza epidemics in the community, and a special program to vaccinate schoolchildren against influenza was begun in 1962. However, the program was discontinued in 1994 because of lack of evidence that it had limited the spread of influenza in the community. In 2001, it was reported that a clear decrease in excess mortality had coincided with the timing of the schoolchild vaccination program. This decrease could have potentially occurred because elderly people were protected by herd immunity generated by the program. Moreover, the program protected the younger siblings of schoolchildren against influenza-associated encephalopathy. Finally, the program was effective in reducing the number of class cancellations and absenteeism from school. During the period when the program was in effect, Japanese schoolchildren served as a barrier against influenza in the community. © 2014 Informa UK Ltd. Source

Nakamura Y.,Keiyu Hospital
Asian journal of endoscopic surgery | Year: 2012

Hepatic hydrothorax is defined as the presence of a significant pleural effusion that develops in a patient with cirrhosis of the liver who does not have an underlying cardiac or pulmonary disease. There have been few published case reports dealing with hepatic hydrothorax treated surgically. Recently, we treated a patient with refractory hepatic hydrothorax by directly suturing the diaphragmatic defect during VATS. During surgery, the diaphragmatic defect was identified by using abdominal insufflation with CO(2) . The defect was sutured and the diaphragm was covered by polyglycolic acid felt and fibrin glue. After surgery, the patient's pleural effusion improved, his postoperative course was uneventful and he did not require a drainage tube at discharge. © 2012 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Blackwell Publishing Asia Pty Ltd. Source

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