There was a constant and steady increase of nontuberculous mycobacteriosis-related mortality in Japan, and this mortality rate showed significant geographical variation. The prevalence of environmental mycobacterial disease in Japan is higher than reported in most other countries.

This investigation is the first laboratory-based study in which a large number of NTM isolated from clinical samples in Japan have been assessed. Although the calculated prevalence of NTM disease might be underestimated, the approach may prove useful for monitoring relative epidemiological data for NTM lung disease.

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We used 2 commercially available antibody tests to estimate seroprevalence of severe acute respiratory syndrome coronavirus 2 infection in Japan during June 2020. Of 7,950 samples, 8 were positive by both assays. Using 2 reliable antibody tests in conjunction is an effective method for estimating seroprevalence in low prevalence settings.

Objective and methodManagement of latent tuberculosis infection (LTBI) is one of the core elements of End TB Strategy. Japan is one of the few countries in which notification of LTBI is mandatory, yet so far, the data has not been analyzed in detail. We thus conducted a cross-sectional study to examine the trend of LTBI, its treatment outcome and factors predicting treatment non-completion in Japan for the period of 2007 and 2014, using the data from the electronic Japan Tuberculosis Surveillance system. Treatment completion was defined as those whose reason for terminating the treatment was recorded as “treatment completed” and whose treatment duration was 180 days or more.ResultsDuring the study period, a total of 50,268 LTBI patients were notified, of which 49,525, who had started treatment, were analyzed for characteristics. 57.5% were females, and 38.5% were aged 25–44 years. As for the job category, healthcare professionals, that is medical doctors, nurses and other healthcare workers, consisted the largest group (30.4%). Overall, the number of LTBI notification has been on an increase, with a large increase observed among those aged 65 years and above. Of the 49,525 patients, the information regarding reason for termination of treatment was available for 46,128 (93.1%). Of them, 33,156 (71.9%) had completed treatment as according to the study definition. The risk factors for not completing LTBI treatment included being aged 65 years and above (adjusted odds ratio [aOR] 1.27, 95% confidence interval [95%CI] 1.10–1.47), foreign-born (aOR 1.14, 95%CI 1.02–1.28), healthcare professional (aOR 1.44, 95%CI 1.24–1.69), full-time and part-time worker (aOR 1.40, 95%CI, 1.20–1.63) and detected via contact investigation (aOR 1.26, 95%CI 1.12–1.41).ConclusionsOur study results revealed that the treatment completion rate was 71.9%, falling short of the national target of 85%, and also that the treatment duration was recorded as less than 180 days for approximately 20% of those who were reported as having completed treatment. Further studies may be built on ours to explore the reasons for not completing the treatment across different population groups, and identify those who benefit the most, and who has the greatest impact on ending TB, by receiving LTBI treatment.

Reasons for the high proportion of "HIV status unknown" should be investigated and improved. Contact tracing among foreign cases with MDR-TB should be a priority. Homeless persons should be screened for DM together with TB. Programs to enhance health and nutrition status may benefit tuberculosis prevention among the elderly. Tuberculosis screening and TB education are important for HCW.

BackgroundIdentifying ongoing tuberculosis infection sites is crucial for breaking chains of transmission in tuberculosis-prevalent urban areas. Previous studies have pointed out that detection of local accumulation of tuberculosis patients based on their residential addresses may be limited by a lack of matching between residences and tuberculosis infection sites. This study aimed to identify possible tuberculosis hotspots using TB genotype clustering statuses and a concept of “activity space”, a place where patients spend most of their waking hours. We further compared the spatial distribution by different residential statuses and describe urban environmental features of the detected hotspots.MethodsCulture-positive tuberculosis patients notified to Shinjuku city from 2003 to 2011 were enrolled in this case-based cross-sectional study, and their demographic and clinical information, TB genotype clustering statuses, and activity space were collected. Spatial statistics (Global Moran’s I and Getis-Ord Gi* statistics) identified significant hotspots in 152 census tracts, and urban environmental features and tuberculosis patients’ characteristics in these hotspots were assessed.ResultsOf the enrolled 643 culture-positive tuberculosis patients, 416 (64.2%) were general inhabitants, 42 (6.5%) were foreign-born people, and 184 were homeless people (28.6%). The percentage of overall genotype clustering was 43.7%. Genotype-clustered general inhabitants and homeless people formed significant hotspots around a major railway station, whereas the non-clustered general inhabitants formed no hotspots. This suggested the detected hotspots of activity spaces may reflect ongoing tuberculosis transmission sites and were characterized by smaller residential floor size and a higher proportion of non-working households.ConclusionsActivity space-based spatial analysis suggested possible TB transmission sites around the major railway station and it can assist in further comprehension of TB transmission dynamics in an urban setting in Japan.

BackgroundThe treatment success rate of pulmonary tuberculosis (PTB) patients aged 64 years and below in Japan, a tuberculosis (TB) middle-burden country with a notification of 13.9 per 100,000 populations in 2016, has been fluctuating around 70% for some years. In order to improve treatment outcome, it is critical to address those lost to follow-up (LTFU). The objective of the study therefore was to describe the characteristics of, and analyze the risk factors for those LTFU among pulmonary TB patients aged between 15 and 64, and discuss policy implications.MethodsThe study used a mixed method of quantitative and qualitative approach, and was conducted in two phases. The first involved analysis of cohort data from the national TB surveillance of PTB patients newly notified between 1 January 2006 and 31 December 2015. The second phase involved focus group (FGD) discussions with public health nurses, who are responsible for supporting TB patients’ adherence to medication, on the possible reasons why some patients become lost to follow-up.ResultsAnalysis of the surveillance data suggested that among all patients, positive sputum smear (adjusted odds ratio, [aOR] 0.52, 95% confidence interval [CI] 0.47–0.58) and cavitary lesion on chest x-ray (aOR 0.79, 95%CI 0.72–0.85) decreased the risk, while not requiring hospitalization increased the risk of LTFU (aOR 1.46, 95%CI 1.33–1.60). Among females, being a physician (aOR 2.07 95%CI 1.23–3.48) and nurse (aOR 1.18, 95%CI 1.91–1.37) were identified as additional risk factors for LTFU. The analysis of focus group discussions revealed three possible themes which may be useful in understanding why nurses and physicians were at a higher risk of becoming LTFU–firstly, the possibility that physicians and nurses were finding it difficult to make medication taking a routine, secondly, their low risk perception towards TB is affecting their adherence behavior, and thirdly, their unwillingness to accept DOTS was increasing their risk of becoming LTFU.ConclusionsThe analysis of surveillance data and FGD transcripts indicated that patient education for those starting their treatment as an outpatient, and establishing DOTS that is both acceptable and realistic to physicians and nurses, may be two issues which need to be addressed urgently.