SUMMARY:One concern about rotavirus vaccines is its possible association with intussusception. Thus, it is necessary to determine the baseline incidence for intussusception in the first year of life in places where rotavirus vaccines are introduced. However, few safety data exist for the period at which the first dose of Rotarix and RotaTeq are allowed to administer in Japan. The first dose of Rotarix is scheduled to administer at 6-20 weeks of age and that of RotaTeq is scheduled to administer at 6-24 weeks of age; the upper limits for these vaccines is later than the upper limit recommended by the World Health Organization by 5 and 9 weeks, respectively. We performed a retrospective cross-sectional study by reviewing medical charts of all hospitals that provided pediatric beds in Akita Prefecture, Japan, and identifying the cases of intussusception that met the Brighton criteria level 1 in these hospitals between January 2001 and December 2010. During this 10-year period, 122 children younger than 1 year of age were diagnosed with intussusception. The incidence of intussusception was estimated at 158 per 100,000 person-years among children younger than 1 year (95z confidence interval, 131-188), 10 per 100,000 person-years for children aged 0-2 months, 165 for children aged 3-5 months, and 300 for children aged 6-8 months. This rapid and substantial increase in the incidence of intussusception during the first year of life should be considered when formulating the immunization schedule for administering rotavirus vaccines in Japan.

BackgroundIn Japan, rotavirus hospitalisation occurs at a rate from 2.8 to 13.7 per 1000 child-years among children age less than 5 years, and it imposes a substantial burden to the healthcare system in the country. While both monovalent (RV1) and pentavalent (RV5) rotavirus vaccines are licensed in Japan, neither has been incorporated in the national infant immunization programme. In this study, we estimated vaccine effectiveness (VE) in Japan.MethodsThis study was conducted in Yuri-Kumiai General Hospital located in a city in the north-western part of Japan. Age-eligible children for rotavirus vaccination were enrolled if they were hospitalized for rotavirus gastroenteritis between September 2013 and August 2016. Rotavirus gastroenteritis was defined by the detection of rotavirus antigen by immunochromatography. “Vaccinated” was defined as infant inoculated with at least one dose of either RV1 or RV5. A conditional logistic regression analysis was performed by modelling the year of birth, year of admission, residence of the children and vaccination status, and by matching the age of cases with that of test-negative controls. The adjusted odds ratio of the vaccinated over unvaccinated was then used to calculate VE in the formula of (1 – adjusted odds ratio) × 100.ResultsOut of the 244 patients enrolled, rotavirus antigen was detected in 55 (22.5%) of whom 10 (18.2%) were vaccinated, whereas 94 (49.7%) of 189 test-negative controls were vaccinated. During the study period, the vaccine uptake rate in the controls increased from 36.2% to 61.8%. On the other hand, the vaccination coverage over the three years was 64.2% in Yuri-Honjo city (three quarters of the catchment), and 91.4% in Nikaho city (one quarter of the catchment). The VE was calculated to be 70.4% (95% confidence interval: 36.0–86.4%, P = 0.002). The point estimate of the VE was lower but its 95% confidence interval overlaps those of the efficacies obtained from clinical trials in Japan.ConclusionThe rotavirus vaccine was effective in the real-world setting in Japan as in the clinical trials, and the introduction of rotavirus vaccine in the national infant immunization schedule will substantially reduce the number of rotavirus gastroenteritis hospitalisation in Japan.

SUMMARY: Rotavirus is the most common cause of severe gastroenteritis in children worldwide. This retrospective, cross-sectional study was undertaken in a sentinel hospital that provides the only pediatric beds for the local population with an average of 4,400 children aged ＜5 years and determined the incidence of rotavirus hospitalizations. Medical charts that recorded acute gastroenteritis cases occurring in children aged ＜5 years living in the cites of Yuri-Honjo or Nikaho, Akita, Japan between 2001 and 2011 were retrieved and examined to enumerate rotavirus antigen-positive hospitalizations. Of the 1,596 acute gastroenteritis cases retrieved, antigen detection was performed in 834 cases, and 387 were positive; hence, the crude annual incidence rate of rotavirus hospitalizations was 8.8 per 1,000 person-years. The adjusted annual incidence rate of rotavirus hospitalizations was 13.7 per 1,000 person-years when untested samples collected during the peak season were extrapolated to the same rotavirus detection proportion as the tested samples (58.9z). We confirmed a high incidence of rotavirus hospitalizations in Akita Prefecture and revealed a considerable degree of annual fluctuation in the rotavirus hospitalization rates, which exceeded the degree of stochastic fluctuation. Thus, caution must be exercised when interpreting the impact of a rotavirus vaccine on the reduction of the number of rotavirus hospitalizations.

SUMMARY: Variable incidence rates of rotavirus gastroenteritis hospitalizations have been reported in Japan. However, it is not known whether the observed regional differences were due to the real difference in the occurrence of severe disease or other causes. This study aimed to determine the incidence rates of rotavirus hospitalization among children aged ＜5 years in the Yuri district in Akita prefecture and the Nantan district in Kyoto prefecture between March 2012 and February 2013. During this period, rotavirus vaccine uptake rates were equally low in both regions. All specimens were evaluated using the standardized case definition, severity scores, and the same assays. There were 44 rotavirus cases (44z) among 101 acute gastroenteritis-related hospitalizations in the Yuri district with a catchment population of 3,853, and 18 rotavirus cases (47z) among 38 acute gastroenteritis-related hospitalizations in the Nantan district with a catchment population of 5,128. While the severity score at the time of the hospitalizations was 11 in both hospitals, the incidence rates in Akita and Kyoto were 11.7 (95z confidence interval [CI]: 8.5-15.6) and 3.9 (95z CI: 2.1-5.5) per 1,000 child-years, respectively. Thus, there was a real difference in the occurrence rate of severe rotavirus infections between the 2 regions.

Key words bronchopulmonary sequestration, fetal therapies, hydrops fetalis, pleural effusion, thoracostomy.Bronchopulmonary sequestration (BPS) is defined as a mass of abnormal pulmonary tissue that does not have normal bronchial communication with the tracheobronchial tree. 1 BPS is often associated with fetal pleural effusion 2 and the treatment for BPS includes thoracoamniotic shunting of fetal pleural effusions. 3 Thoracoamniotic shunting for BPS with hydrothorax ameliorates fetal hydrops by relieving mediastinal compression. However, thoracoamniotic shunting may cause complications, such as premature labor, premature rupture of the membranes, and chorioamnionitis. 4 We report a case of fetal BPS with pleural effusion, in which postmortem examination revealed