A total of 921 fecal specimens collected from 44 infants in a day care center (DCC) in Tokyo, Japan during June 1999 to July 2000 were tested for the presence of rotavirus, norovirus, sapovirus, astrovirus and adenovirus by reverse-transcription-multiplex polymerase chain reaction (RT-multiplex PCR) and sequence analysis. Of 88 fecal specimens from infants with acute gastroenteritis, 51.1% (45) were found to be positive for diarrheal viruses. Astrovirus was the most prevalent (15.9%, 14 of 88), followed by norovirus GII (14.8%, 13 of 88), adenovirus (12.5%, 11 of 88), and sapovirus (2.3%, 2 of 88). Viral mixed infection accounted for 5.7% (5 of 88). Interestingly, 230 of 833 (27.6%) fecal specimens collected from asymptomatic infants were also infected with diarrheal viruses. Of these, astrovirus, norovirus GII, adenovirus and sapovirus were identified in 53, 46, 96 and 22 fecal specimens (23%, 20%, 41.7%, and 9.6%, respectively). Moreover, 13 of 833 (1.6%) normal specimens showed mixed viral infections. Surprisingly, no rotavirus (known as the most common causative agent of acute gastroenteritis in DCCs) was detected in those subjects. Another interesting feature was the demonstration of five separate outbreaks of acute gastroenteritis identified in a single DCC. Outbreak A was associated with both astrovirus serotype 1 and norovirus GII/3 (known as Toronto virus cluster); Outbreak B with adenovirus 12; Outbreak C with norovirus GII/4 (Lordsdale virus cluster); Outbreak D with sapovirus GIV and Outbreak E with astrovirus serotype 1. To our knowledge, this is the first proof of multiple outbreaks of viral gastroenteritis in Japanese infants in a single DCC. Our results confirm the presence as well as the importance of these viruses and warn of the threat they pose.
In addition to the serotype-specific primers described previously (1 to 7), a new serotype 8-specific primer has been designed, allowing detection of all astrovirus serotypes. A total of 1,382 diarrheal stool samples in 5 regions in Japan were examined by reverse transcription-polymerase chain reaction (RT-PCR). The incidence of astrovirus infection in all 5 regions was 5.9% (82 of 1,382 samples) and infection occurred mainly from November to April. Serotypes 1, 3, and 4 were detected in 66, 14, and 2 of the 82 positive samples, respectively. None of the other serotypes was detected. The highest detection rate was from 0 to 1 year old, 39.0%, and the next highest was from 1 to 2 years old, 34.1%. The primers provide a useful approach for study of the epidemiology of astroviruses.
A total of 921 fecal specimens collected from 44 infants in a day care center in Tokyo, Japan during June 1999 to July 2000 were tested for the presence of sapovirus by reverse transcription-polymerase chain reaction (RT-PCR). Of 88 fecal specimens from infants with acute gastroenteritis, 2.3% (2) were found to be positive for sapovirus. Twenty-two of 833 (2.6%) fecal specimens collected from asymptomatic infants were also infected with this virus. Another interesting feature was the demonstration of high incidence of sapovirus infection (95.5%, 21 of 22) identified in a single day care center, which was not due to viral shedding after the latest acute gastroenteritis. Sapovirus was subjected to genetic analysis by sequencing. Up to 4 of 24 sapoviruses (16.7%) were clustered into genogroup IV known as a rare group. Remarkably, majority (79.2%, 19 of 24) of sapovirus isolates detected in this study turned out to present one novel sapovirus genotype tentatively called GI/8. It was noteworthy to point out that the GI/8 sapovirus infection was apparently confined only within the period of 9 weeks (44th through 52nd weeks). This pattern of infection implied the outbreak of asymptomatic GI/8 sapovirus infection in these subjects. The findings clearly indicate genogroup I sapovirus can be classified into eight genotypes. This is the first report to underscore that sapovirus pathogen causes not only clinical manifestations of acute gastroenteritis but also asymptomatic infection in infants in day care centers in Japan.
Norovirus (NoV) is recognized as one of the most common causative agent of diarrheal disease in young children worldwide. The current study was undertaken to determine the distribution of NoV genotypes in Japan. A total of 3,864 fecal specimens from children with acute gastroenteritis in five regions (Tokyo, Maizuru, Saga, Sapporo, and Osaka) of Japan from July 1995 to June 2001 were collected and then tested for the presence of NoV by RT-PCR. Three hundred sixty four were found to be positive for NoV, accounting for 11%. The highest prevalence of NoV infection was in November, December, and January as the early winter months in Japan. NoV was subjected to be further characterized to sequencing analysis. All NoVs belonged to two different genogroups I and II and these represented 3% and 97%, respectively. This finding indicated that NoV genogroup II was the dominant group causing acute gastroenteritis in Japan. Interestingly, NoV strains were classified into 16 distinct genotypes including genogroup II genotype 9 that was firstly identified in Japan. Of these, NoV genogroup II genotypes 3 and 4 dominated over other genotypes and became the leading strains in Japanese pediatric population. In conclusion, diarrhea due to NoV infection is still a health burden in Japan. This report also stresses the great genetic diversity as well as the importance of NoV causing the diarrhea in Japan.
BackgroundDiabetes and periodontitis are interrelated, and patient education and guidance are important. Therefore, we conducted a periodontitis care program for patients with type 2 diabetes to provide education about diabetes and periodontitis and to promote self‐care skills, and we evaluated the effectiveness of this program.MethodsThis was a randomized controlled trial. Thirty‐eight and 39 adult patients diagnosed with type 2 diabetes were allocated to the intervention and control groups, respectively. The program comprised content that promoted optimal behavior for the improvement of diabetes and periodontitis. Periodontitis status, diabetes status, tumor necrosis factor‐α levels, self‐efficacy in relation to periodontitis, and teeth‐brushing behaviors were evaluated before and after the intervention program.ResultsAfter the intervention program, the intervention group demonstrated significant improvements in bleeding on probing, which was used to evaluate periodontitis status (F=7.919; P<.01), and in clinic visit (F=11.765; P<.01), brushing teeth (F=21.606; P<.01), and meal (F=10.884; P<.01) scores on the Self‐Efficacy Scale for Self‐care among Periodontal Disease Patients; patients in the intervention group also exhibited improvements in dental health‐related behaviors (F=7.141; P<.01).ConclusionsThese results suggest that the intervention program was effective at improving periodontitis, self‐efficacy in relation to periodontitis, and dental health‐related behaviors in patients with type 2 diabetes.
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