#Respiratory #illness and acute flaccid #myelitis in the #Tokai district in 2018 (Pediatr Int., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Pediatr Int. 2019 Dec 30. doi: 10.1111/ped.14128. [Epub ahead of print]

Respiratory illness and acute flaccid myelitis in the Tokai district in 2018.

Okumura A1, Numoto S1, Iwayama H1, Kurahashi H1, Natsume J2, Saitoh S3, Yoshikawa T4, Fukao T5, Hirayama M6, Takahashi Y2; Aichi Pediatric Clinical Study Group.

Author information: 1 Department of Pediatrics, Aichi Medical University, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan. 2 Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan. 3 Department of Pediatrics, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan. 4 Department of Pediatrics, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. 5 Department of Pediatrics, Gifu University Graduate School of Medical Sciences, 1-1 Yanagido, Gifu City, 501-1194, Japan. 6 Department of Pediatrics, Mie University Graduate School of Medical Sciences, 2-174 Edobashi, Tsu, Mie, 5148507, Japan.




An outbreak of acute flaccid myelitis was chronologically correlated with that of severe respiratory illness in Japan in 2015. We hypothesized that increases in children hospitalized with severe respiratory illnesses might be associated with increase in acute flaccid myelitis also in autumn 2018.


We explored the temporal correlations between respiratory illness outbreaks and acute flaccid myelitis during autumn season between 2016 and 2018 using questionnaire surveys. One questionnaire explored the monthly numbers of children with acute flaccid myelitis, Guillain-Barre syndrome, and other acute flaccid paralyses. The other questionnaire explored the monthly numbers of children hospitalized with respiratory illnesses associated with wheezing. A correlation between the monthly numbers of children with acute flaccid myelitis and those with respiratory illness was analyzed by the Pearson correlation test.


Although the number of patients hospitalized with respiratory illness did not correlate with the number of those admitted with myelitis, increases in children aged 7-12 and 13-19 years requiring ICU admission correlated temporally with an outbreak of acute flaccid myelitis.


An increase in intensive care unit admissions to treat respiratory disease occurred in association with a cluster of acute flaccid myelitis. An increase in the number of ICU admission due to respiratory illness may be a clue to expect the occurrence of acute flaccid myelitis.

© 2019 Japan Pediatric Society.

KEYWORDS: acute flaccid myelitis; enterovirus D68; outbreak; respiratory illness; temporal correlation

PMID: 31886594 DOI: 10.1111/ped.14128

Keywords: EV-D68; Pediatrics; Japan; AFM.


#Influenza D Virus of New Phylogenetic #Lineage, #Japan (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 1—January 2020 / Research Letter

Influenza D Virus of New Phylogenetic Lineage, Japan

Shin Murakami, Ryota Sato, Hiroho Ishida, Misa Katayama, Akiko Takenaka-Uema, and Taisuke Horimoto

Author affiliations: University of Tokyo, Tokyo, Japan (S. Murakami, H. Ishida, M. Katayama, A. Takenaka-Uema, T. Horimoto); Yamagata Livestock Hygiene Service Center, Yamagata, Japan (R. Sato)



Influenza D virus (IDV) can potentially cause respiratory diseases in livestock. We isolated a new Japan IDV strain from diseased cattle; this strain is phylogenetically and antigenically distinguished from the previously described IDVs.

Keywords: Influenza D; Cattle; Japan.


#Influenza A #variants with reduced susceptibility to #baloxavir isolated from #Japanese patients are fit and transmit through respiratory #droplets (Nat Microbiol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Nat Microbiol. 2019 Nov 25. doi: 10.1038/s41564-019-0609-0. [Epub ahead of print]

Influenza A variants with reduced susceptibility to baloxavir isolated from Japanese patients are fit and transmit through respiratory droplets.

Imai M1, Yamashita M2, Sakai-Tagawa Y2, Iwatsuki-Horimoto K2, Kiso M2, Murakami J2, Yasuhara A2, Takada K2, Ito M2, Nakajima N3, Takahashi K3, Lopes TJS2,4, Dutta J5, Khan Z5, Kriti D5, van Bakel H5, Tokita A6,7, Hagiwara H7,8, Izumida N7,9, Kuroki H10, Nishino T7,11, Wada N7,12, Koga M13, Adachi E14, Jubishi D2,15, Hasegawa H3,16, Kawaoka Y17,18,19.

Author information: 1 Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan. mimai@ims.u-tokyo.ac.jp. 2 Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan. 3 Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan. 4 Influenza Research Institute, Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA. 5 Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 6 Clinic Bambini, Tokyo, Japan. 7 Members of the Tokyo Pediatric Association Public Health Committee, Tokyo, Japan. 8 Hagiwara Clinic, Tokyo, Japan. 9 Akebonocho Clinic, Tokyo, Japan. 10 Sotobo Children’s Clinic, Chiba, Japan. 11 Alpaca Kids Ent Clinic, Tokyo, Japan. 12 Wada Pediatric Clinic, Tokyo, Japan. 13 Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan. 14 Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of the Institute of Medical Science, University of Tokyo, Tokyo, Japan. 15 Nezu Clinic, Tokyo, Japan. 16 Influenza Virus Research Center, National Institute of Infectious Diseases, Tokyo, Japan. 17 Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan. yoshihiro.kawaoka@wisc.edu. 18 Influenza Research Institute, Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, USA. yoshihiro.kawaoka@wisc.edu. 19 Department of Special Pathogens, International Research Center for Infectious Diseases, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo, Japan. yoshihiro.kawaoka@wisc.edu.



Here we report the isolation of the influenza A/H1N1 2009 pandemic (A/H1N1pdm) and A/H3N2 viruses carrying an I38T mutation in the polymerase acidic protein-a mutation that confers reduced susceptibility to baloxavir marboxil-from patients before and after treatment with baloxavir marboxil in Japan. These variants showed replicative abilities and pathogenicity that is similar to those of wild-type isolates in hamsters; they also transmitted efficiently between ferrets by respiratory droplets.

PMID: 31768027 DOI: 10.1038/s41564-019-0609-0

Keywords: Antivirals; Drugs Resistance; H1N1pdm09; H3N2; Seasonal Influenza; Japan.


#Effectiveness of four types of #neuraminidase #inhibitors approved in #Japan for the #treatment of #influenza (PLoS One, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

PLoS One. 2019 Nov 7;14(11):e0224683. doi: 10.1371/journal.pone.0224683. eCollection 2019.

Effectiveness of four types of neuraminidase inhibitors approved in Japan for the treatment of influenza.

Mawatari M1, Saito R1, Hibino A1, Kondo H1, Yagami R1, Odagiri T1,2, Tanabe I1, Shobugawa Y1; Japanese Influenza Collaborative Study Group.

Author information: 1 Division of International Health (Public Health), Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. 2 Division of Infectious Diseases and Immunology, Department of Microbiology, School of Medicine, Iwate Medical University, Iwate, Japan.




Neuraminidase inhibitors (NAIs) effectively treat influenza. The clinical effectiveness of four NAIs (oseltamivir, zanamivir, laninamivir, and peramivir) was evaluated against influenza A/H1N1pdm09, A/H3N2, and B viruses. Additionally, fever duration in patients infected with oseltamivir-resistant influenza A/H1N1pdm09 with the H275Y mutation was evaluated.


Patients aged <20 years who visited outpatient clinics in Japan with influenza-like illnesses were enrolled during 4 influenza seasons from 2012/2013 to 2015/2016. After obtaining informed consent, patients who tested positive for influenza with rapid tests received one of the four NAIs. Patients recorded their body temperature daily for 8 days from the first visit. The influenza strain was identified using real-time polymerase chain reaction. Univariate and multivariable analyses were used to evaluate factors influencing fever duration. In children aged ≤5 years treated with oseltamivir, fever duration in oseltamivir-resistant A/H1N1pdm09-infected patients was compared to that in oseltamivir-sensitive A/H1N1pdm09-infected patients.


Of the 1,368 patients analyzed, 297 (21.7%), 683 (49.9%), and 388 (28.4%) were infected with influenza A/H1N1pdm09, A/H3N2, and B, respectively. In multivariable analysis factors associated with significantly prolonged fever duration included: treatment with laninamivir (hazard ratio [HR]: 0.78, p = 0.006, compared to oseltamivir), influenza B (HR: 0.58, p<0.001, compared to influenza A/H1N1pdm09), and a higher body temperature at the clinic visit (HR: 0.87 per degree Celsius, p<0.001). Increasing age was associated with a significantly shorter duration of fever (HR: 1.31 for 6-9 years old, p<0.001; and HR: 1.65 for 10-19 years old, p<0.001, respectively, compared to 0-5 years old). Following treatment with oseltamivir, fever duration was significantly longer for oseltamivir-resistant A/H1N1pdm09-infected patients (n = 5) than for oseltamivir-sensitive A/H1N1pdm09 infected patients (n = 111) (mean, 89 versus 40 hours, p<0.001).


Our results revealed characteristic information on the effectiveness of the four NAIs and also on oseltamivir-resistant viruses that may affect patients’ clinical care.

PMID: 31697721 DOI: 10.1371/journal.pone.0224683

Keywords: Seasonal Influenza; Antivirals; Drugs Resistance; Oseltamivir; Zanamivir; Peramivir; Laninamivir; Japan.


#Adult #influenza A (#H3N2) with reduced susceptibility to #baloxavir or #peramivir cured after switching anti-influenza agents (IDCases, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

IDCases. 2019 Oct 1;18:e00650. doi: 10.1016/j.idcr.2019.e00650. eCollection 2019.

Adult influenza A (H3N2) with reduced susceptibility to baloxavir or peramivir cured after switching anti-influenza agents.

Seki M1, Sakai-Tagawa Y2, Yasuhara A2, Watanabe Y3.

Author information: 1 Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan. 2 Department of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan. 3 Laboratory for Clinical Microbiology, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan.



We describe two adults with A/H3N2 influenza with (patient 1), and without (patient 2) polymerase acidic (PA) subunit I38 T substitution during the same season. Patient 1 had a reduced clinical response to baloxavir, a cap-dependent endonuclease inhibitor (CEI), but was cured by peramivir, a neuraminidase inhibitor. Baloxavir was clinically effective for patient 2, for whom peramivir had been ineffective. Susceptibility to baloxavir can be decreased by a PA unit mutation, but response to treatment can be increased by switching and/or combination with a neuraminidase inhibitor, even though CEI are clinically effective against influenza in adults.

© 2019 The Authors.

KEYWORDS: Baloxavir; Peramivir; Polymerase; Polymerase acidic subunit; Viral infection

PMID: 31692637 PMCID: PMC6804930 DOI: 10.1016/j.idcr.2019.e00650

Keywords: Seasonal Influenza; Antivirals; Drugs Resistance; H3N2; Japan; Baloxavir; Peramivir.


Identification of a #mecA/mecC-positive #MRSA ST1-t127 isolate from a #racehorse in #Japan (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Identification of a mecA/mecC-positive MRSA ST1-t127 isolate from a racehorse in Japan

Tsuyoshi Sekizuka, Hidekazu Niwa, Yuta Kinoshita, Eri Uchida-Fujii, Yuba Inamine, Masanori Hashino, Makoto Kuroda

Journal of Antimicrobial Chemotherapy, dkz459, https://doi.org/10.1093/jac/dkz459

Published: 06 November 2019




MRSA is a known pathogen that affects horses. We investigated an equine MRSA isolate for potential antimicrobial resistance genes, classified the staphylococcal cassette chromosome mec (SCCmec) and identified the strain-specific dissemination in the horse community based on WGS.


WGS, using short-read sequencing, and subsequent long-read sequencing by hybrid assembly, was conducted to obtain a complete genome sequence. Pairwise sequence alignment of relative SCCmec sequences and core-genome phylogenetic analysis were performed to highlight transmission routes of the SCCmec and MRSA strain-specific lineages.


In 2018, we isolated the MRSA JRA307 strain from the pus of a wound on a racehorse and the complete genome sequence suggests that it is a clinically relevant pvl-negative ST1-t127 MRSA that harbours both mecA and mecC on SCCmec-307. SCCmec-307 exhibited marked sequence identity to the previously reported SCCmec–mecC in the Staphylococcus sciuri GVGS2 strain isolated from cattle. The JRA307 mecC gene was classified as a mecC allotype of S. sciuri rather than that of Staphylococcus aureus.


We demonstrated the complete genome sequence of equine isolate JRA307, which is a clinically relevant MRSA harbouring mecA and mecC on SCCmec-307. The finding of mecC MRSA suggests a possible SCCmec transmission between distinct staphylococcal species. To the best of our knowledge, this is the first report of mecC detection in Japan.


© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; MRSA; Staphylococcus aureus; Horses; Japan.


#Outbreaks of highly pathogenic #avian #influenza in #zoo #birds caused by HA clade #H5N6 subtype viruses in #Japan in winter 2016 (Transbound Emerg Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Transbound Emerg Dis. 2019 Oct 11. doi: 10.1111/tbed.13386. [Epub ahead of print]

Outbreaks of highly pathogenic avian influenza in zoo birds caused by HA clade H5N6 subtype viruses in Japan in winter 2016.

Usui T1, Soda K1, Sumi K1, Ozaki H1, Tomioka Y2, Ito H1, Murase T1, Kawamoto T3, Miura M3, Komatsu M3, Imanishi T4, Kurobe M4, Ito T1, Yamaguchi T1.

Author information: 1 Avian Zoonosis Research Center, Tottori University, 4-101, Koyama Minami, Tottori, 680-8553, JAPAN. 2 Laboratory of Experimental Animal, Tottori University, 4-101, Koyama Minami, Tottori, 680-8553, JAPAN. 3 Akita Omoriyama Zoo, Katabata 154, Hamada, Akita, 010-1654, Japan. 4 Nagoya Higashiyama Zoo and Botanical Gardens, 3-70 Higashiyama Motomachi, Chikusa-ku, Nagoya, Aichi, 464-0804, JAPAN.



In late 2016, two zoos, one in northern Japan and the other in central Japan, experienced highly pathogenic avian influenza (HPAI) outbreaks, in which multiple zoo birds were infected with H5N6 subtype HPAI virus (HPAIV). Here, we report an overview of these HPAI outbreaks. HPAIV infections were confirmed by virus isolation in three black swans (Cygnus atratus) and three snowy owls (Bubo scandiacus) kept in the Omoriyama Zoo hospital. At Higashiyama Zoo and Botanical Gardens, following the death of a black swan at a zoo pond, nine waterfowl, including two black swans, four cackling geese (Branta hutchinsii leucopareia), two mallards (Anas platyrhynchos), and a wigeon (Anas penelope), died after HPAIV infection in isolation facilities. Based on the presence of H5-specific antibodies in their sera, two surviving black swans and a surviving mallard at Higashiyama Zoo appeared to have HPAIV infection, although the virus was not isolated. Detectable levels of antibodies (≥10 HI) were maintained for at least five to nine months, as determined by hemagglutinin inhibition test. Isolation of two H5N6 subtype HPAIVs from an open-air pond where affected zoo birds were previously housed at Higashiyama Zoo strongly indicates that wild waterfowl associated with aquatic environments brought the virus to the zoo. The phylogenetic relationships of the 18 isolates indicated direct viral transmission among birds within each zoo. In both zoos, containment of suspected birds in isolation facilities might have allowed the virus spread among birds inside the facility. However, maintaining containment measures and strict sanitation procedures could facilitate successful physical containment and clearance of HPAIV in both zoos.

© 2019 Blackwell Verlag GmbH.

KEYWORDS: H5N6 clade; HPAI in zoo birds; Japan; cackling geese; snowy owl; viral antibodies

PMID: 31605424 DOI: 10.1111/tbed.13386

Keyword: Avian Influenza; H5N6; Captive Birds; Japan.