Nosocomial Mycobacterium tuberculosis transmission by brief casual contact identified using comparative genomics.

This paper reports a case of nosocomial transmission of Mycobacterium tuberculosis by brief casual contact. Routine variable number tandem repeat typing in Yamagata Prefecture, Japan found that M. tuberculosis clinical isolates from two patients showed indistinguishable genotypes. The patients had an epidemiological relationship of sharing a waiting room in a hospital on the same day. As comparative genomics detected only two single nucleotide variants between the isolates, it was concluded that recent tuberculosis transmission occurred in the waiting room. These results indicate that the physical separation of infectious tuberculosis patients is an essential control measure for preventing unpredictable nosocomial transmission by casual contact.

A case of laboratory cross-contamination of Mycobacterium tuberculosis identified using comparative genomics.

BACKGROUND: Two false-positive tuberculosis (TB) cases in Yamagata Prefecture, Japan, 2016. OBJECTIVE: To report the effectiveness of comparative genomics of Mycobacterium tuberculosis for identification of cross-contamination cases. DESIGN: Case report of laboratory cross-contamination. RESULTS: Beginning with detection of an identical genotype in two M. tuberculosis strains using variable number of tandem repeat typing, we suspected M. tuberculosis cross-contamination of specimens collected in a mycobacteriology laboratory based on epidemiological investigations. This suspicion was confirmed using comparative genomics of the two M. tuberculosis strains and a strain from an epidemiologically unrelated specimen from the same batch as the two strains in the mycobacteriology laboratory. All strains had an identical genomic sequence with no single nucleotide variants. CONCLUSION: Comparative genomics, which offers the highest discrimination power, is a potent tool for identifying laboratory cross-contamination using epidemiological investigations.

Duration of norovirus excretion and the longitudinal course of viral load in norovirus-infected elderly patients.

To prevent dissemination of norovirus in semiclosed environments such as aged-care facilities, it is important to know the period of infectivity in norovirus-infected individuals. We recruited 13 elderly patients aged 60-98 years with norovirus gastroenteritis (11 residents in aged-care facilities and two healthy adults) for this study, and measured the viral loads for norovirus in a total of 63 follow-up faecal samples using a real-time quantitative polymerase chain reaction assay. The average period of norovirus excretion was 14.3 days (range: 9-32 days; median: 13 days). All of the follow-up samples collected between 7 and 10 days after the onset of symptoms tested positive. Viral loads in samples collected between 14 and 18 days after the onset of symptoms were divided into three groups: those testing negative, those with <10(4) copies/g stool, and those with >10(4) copies/g stool. Stools from the group with <10(4) copies/g stool were found to be negative for norovirus up to 21-24 days after the onset of symptoms; however, the group with >10(4) copies/g stool showed prolonged norovirus excretion (up to 32 days) in stools. Although the period of infectivity of excreted viruses has not yet been clarified, these results suggest that careful attention should be taken for at least 14 days after the onset of symptoms and that the measurement of viral load in stools around 16 days after onset might be a useful method for following the course of viral shedding for each patient infected with norovirus.

Cross-antigenicity among EV71 strains from different genogroups isolated in Yamagata, Japan, between 1990 and 2007.

We isolated and identified six subgenogroups (B2, B4, B5, C1, C2, and C4) of enterovirus 71 (EV71) between 1990 and 2007 in Yamagata, Japan. We measured neutralizing antibody (NT Ab) titers against those subgenogroup strains and the BrCr reference strain for antigenic analysis. Serological analysis of 83 residents in Yamagata in 2004 showed that differences in the NT Ab titer of each individual against the different subgenogroups were mostly within 4-fold. Furthermore, sera from guinea pigs, immunized with the B2 and C1 strains indicated cross-antigenicity among the seven different subgenogroups. In conclusion, our results showed that cross-antigenicity exists among EV71 strains from different subgenogroups circulating in the community through genomic evolution. Our results also suggest that eliciting neutralizing antibodies against one genotype is likely to confer cross-neutralization against other genotypes.

Factors relating to place of death of Japanese people from a small town in a rural area.

The objective of our retrospective study was to clarify factors relating to place of death of Japanese people from a small town in a rural area who had been bedridden for at least one week before dying. The caregivers of subjects aged 40 and above who died during a three-year period were surveyed by trained interviewers. Of 352 subjects who died, 312 caregivers responded and agreed to a face-to-face interview. A total of 213 subjects were considered as an eligible sample. The main outcome measures were odds ratios for death at home in relation to age, pain, cause of death, and home visit service. One hundred and two people died at home, while 112 people died in a hospital. Multivariate logistic regression analysis showed that the probability of home death increased with age of the bedridden, lack of pain during the bedridden period, not having cancer as a cause of death, having senility as a cause of death, and receiving regular home visits by a Public Health Nurse. In conclusion, expansion of the home visit programs by Public Health Nurses may enable people to die at home as they so desire. Further prospective research is needed to explore the association between the attitude toward terminal care and the place of death.

[Outcomes of stroke survivors in Yamagata Prefecture].

PURPOSE: To clarify the long-term outcomes of Stroke survivors registered for the first onset of Stroke in Yamagata Prefecture and to find out problems in community-based-rehabilitation (CBR). SUBJECTS AND METHODS: The present study was performed using stroke survivors as of September 1, 1991 as subjects from residents registered for the onset of Stroke in 1985 and 1989. The subjects were composed of 1,013 residents registered in 1989 (2 years after onset) and 626 registered in 1985 (6 years after onset). RESULTS: The percent of functionally-independent Stroke survivors at 2 and 6 years (indicated in parentheses) after onset is shown by ADL items as follows: 82% (81%) for urination, 78% (78%) for eating, 78% (78%) for walking, 76% (78%) for dressing, and 66% (64%) for bathing. The lowest percent was seen in Bathing. Percentage of cases maintaining the ability to have functionally-independent ADL for all items examined (expressed as persons independent for personal care) were 62% (60%). Of the the cases 91% (91%) resided at home (their own houses or relatives' houses). With regard to overall locomotion, an item used to evaluation the range of going out doors, 45% (44%) could go out alone to visit neighbors or use public transportation. Among persons independent for personal care, 99% (98%) were living at homo, 70% (69%) used public transportation, 23% (23%) went out alone to visit neighbors and 7% (8%) did not go out. CONCLUSION: The results of the present research indicate a great in CBR for that bothpsychological and social health approaches in cooperation with public health centers, medical centers, and welfare agencies not only for persons with decreased ADL, but also for those maintaining high activity potential.

[Factors related to survival rate, and life satisfaction in stroke patients in Yamagata Prefecture, Japan].

This study was designed to identify survival rate, and life satisfaction of stroke patients living in Yamagata Prefecture. Subjects for the survival rate analysis were composed of 2214 patients who were registered after suffering their first stroke in 1989. Observation was continued over 2-years survival rate by the Cutler-Ederer method. In 1991, survivors were interviewed in their home by public health nurses or public health physicians. Locomotion and Activities of daily living (ADL) were investigated in 1015 survivors, and global life satisfaction was investigated in the 623 who were capable of answering questions by themselves. The results obtained were as follows: 1) One month survival rate was 74.0%, one year survival rate was 57.2%, and two-year survival rate was 50.6% in the total patients. The survival rate according to type of stroke was compared between two age groups (< 65 and > or = 65 years). Type of stroke was associated with survival rate in the patients < 65 years old, but not in those > or = 65 years old, especially for long-term outcome. 2) Of the survivors, 10.8% were bedridden over the two years post stroke, whereas 75.4% were competent in locomotion. Dependence of bathing was most common in terms of all activities of daily living, which were considered burdensome to family members. 3) Global life satisfaction as measured by visual analogue scale (VAS) in survivors two years after stroke was maintained well. The strongest determinant of global life satisfaction was contact with friends after stroke for those < 65 years old, while it was competence in eating for those > or = 65 years old.

[The examination of tuberculosis contacts: the current situations and perspective in Japan].

Contacts of active tuberculosis cases are the most easily identified high-risk group for tuberculosis in Japan. Thus, examination of the contacts is one of the most useful methods for finding persons with disease or with infection. The purpose of this study is to analyze recent problems in the examination. Program assessment and evaluation for the contact examination were administered by a mail questionnaire to 74 Health Centers (HCs) in Tohoku District. The response rate was 100%. The Service Report of Activities of HCs (1992) was also utilized as the basic data for estimating statistical indices concerning contact examination. Results obtained are as follows: 1. At a rough estimate, the number of persons who underwent the contact examination accounted for 1.6 per newly diagnosed cases with tuberculosis in Japan. This index remarkably varied according to the region, e.g., maximum was 6.6 in Okinawa and minimum was 0.9 in Yamaguchi. The contacts had a high incidence rate (0.65%) with active tuberculosis. This rate was twenty-five times higher than that by periodic mass X-ray examinations. 2. In Tohoku District, only 17 HCs (23%) carried out the examination fitting "guidelines" that had been published by the Ministry of Health and Welfare. Results from the program assessment suggested that HCs should give priority of the examination to the contacts because they were risky. The risk of manifestation is mainly influenced by bacteriological severity of source cases. 3. Main planners of the examination were public health nurses.(ABSTRACT TRUNCATED AT 250 WORDS)

[Risk factors for falls among the elderly living in a Japanese rural community].

The purpose of the present study is to explore risk factors for falls among the elderly in a Japanese rural community. Subjects comprised 658 elderly persons aged 65 and over living in a rural village of Akita Prefecture (response rate; 96.1%). In 1988, the baseline medical health examinations and an interview survey were performed and repeated at the follow-up survey one year later. Results obtained were as follows; 1) The rate of falls at the follow-up survey was 17.3% in men, 15.6% in women. There was no difference in rate of falls between sexes. The rate of falls in the old-old did not significantly differ from that in the young-old in both sexes. 2) Chi square test or Cochran-Armitage test was performed by sex to examine the relationship between the factors investigated at the baseline survey and occurrence of falls at the follow-up survey. Significant factors in men were income, spouse, need for assistance in daily living, history of stroke, fall experience within one year preceding the baseline survey, ECG abnormalities, standing time with eyes open, grip strength, TMIG (Tokyo Metropolitan Institute of Gerontology) index of competence. In women, mobility, need for assistance in daily living, admission to a hospital within one year preceding the baseline survey, fall experience within one year preceding the baseline survey, standing time with eyes open, grip strength, TMIG index of competence were significant. 3) Using the significant variables in univariate analysis, multivariate logistic regression analysis controlling for age was performed by sex. Significant risk factors for falls in men were fall experience within one year preceding the baseline survey and ECG abnormalities, while for women fall experience within one year preceding the baseline survey was significant. The present longitudinal study revealed that falls experience within one year preceding the baseline survey was the highest risk factor for falls in the elderly residents in the community. This indicates that even a simple interview on fall experience can identify high risk elderly.

[Preventable tuberculosis cases in Japan--a new approach to the assessment of tuberculosis control problems].

I defined cases of tuberculosis which could not be prevented from infection or development of disease among infected, or could not be detected in the early stages as "preventable cases" in order to evaluate tuberculosis control efforts in the community, Japan. Among 241 bacteriologically confirmed cases with pulmonary tuberculosis newly registered from 1988 through 1989 in Yamagata Prefecture, 80 (33%) were defined as preventable cases by observing their course and the process of diagnosis. That is to say, one-third of bacillary cases could have been prevented in Yamagata where the incidence of tuberculosis was lowest in Japan, if existing prevention and control methods had been effectively used. Causes of prevention failure were investigated in detail. The most common cause was tardy detection of cases, especially due to delayed confirmation of diagnosis (so called "doctor's delay"). The delayed confirmation of diagnosis resulted from neglecting chest X-ray and sputum examination and from ignoring high risk groups. In the younger age group, it was mainly attributed to insufficient family contact examinations. Tuberculin skin tests are necessary not only for those aged 15 years and younger but also for those aged 16-29, when they are found to be household contacts of smear-positive cases. An evaluation of tuberculosis control program defining preventable cases would be a beneficial approach to the surveillance of tuberculosis.

[Incidence of and circumstances related to falls among the elderly in a Japanese community].

In order to determine incidence of and the circumstances related to falls among the elderly in a community in Japan, general health surveys were carried out in 1988 and in 1989. Subjects for the first survey were 685 elderly residents (276 men, 409 women) aged 65 years and over, living in a rural village of Akita Prefecture. Subjects who were confined to bed almost all day were excluded from analysis. Subjects were interviewed regarding falls at both surveys. Results obtained were as follows; 1) Incidence of falls were 19.2% for men, and 20.3% for women at the first survey. There was no significant difference in incidence between sexes. 2) Age had no significant effect on incidence in either sex. 3) The incidence at the follow-up survey was significantly higher among those who had reported falls at the first survey than in those who had not (relative risk; men; 2.71, women 2.40, p less than 0.05). 4) Most falls occurred during the daytime in either sex, with approximately 90% of falls for men and 60% of falls for women occurring outdoors. The cause of falls was mainly extrinsic. Compared to men, falls of women had a greater tendency to lead to major injury.

[Analysis of factors affecting hepatic dysfunction during group health checks for local inhabitants].

During health checks within the framework of the Geriatric Health Law, hepatic dysfunction was detected at a high incidence in inhabitants of K town. The factors affecting hepatic dysfunction in these cases were explored. The number of inhabitants who received health checks in 1989 in this town was 4,491 (78.5% of all inhabitants aged over 35 years). A diagnosis of hepatic dysfunction was made if GOT was equal to or higher than 41 IU/l or GPT was equal to or higher than 39 IU/l. On this basis, hepatic dysfunction was detected in 418 inhabitants (9.8%). The incidence of hepatic dysfunction was higher in males than in females. Inhabitants younger than 50 years had a higher incidence than those 50 years or older. The percentage of inhabitants with either a history of alcohol consumption or of receiving blood transfusion was significantly higher for inhabitants with hepatic dysfunction (29% and 10%, respectively) than for healthy inhabitants (10% and 3%, respectively). HBs antigen and anti HCV antibody positive rates for inhabitants with hepatic dysfunction were 3.3% and 36.1% respectively. These results suggest that the relatively high rate of hepatic dysfunction in this town is related to alcohol consumption, blood transfusion and hepatitis C virus (HCV) infection. Of these three factors, the influence of HCV infection seemed to be the most influential. The study additionally disclosed variations in the incidence of hepatic dysfunction among the different regions of the town probably related to regional differences in the anti-HCV antibody positive rate.

[Family contact examination for tuberculosis--the current situations and perspective].

To clarify the recent problems of family contact examination for tuberculosis, studies were conducted from August 1989 through to Mach 1990. 1) The examinations were carried out in 405 (94%) out of 431 household contacts of 119 index cases with bacillary pulmonary tuberculosis who were newly registered in 1988 in Yamagata prefecture. The contacts of smear-positive cases had a significantly higher incidence rate of active tuberculosis (4.8%) and a markedly shorter interval between discovery of the index cases and their household examinations than did the contacts of smear-negative cases (i.e. bacilli positive only on culture). 2) The study on the disease history of 129 cases with bacillary pulmonary tuberculosis, newly registered in 1988 in Yamagata, revealed that one-third of them might be have been "preventable", if the existing prevention and control methods had been effectively used. Especially, the preventable cases under 20 years of age occurred among those with inadequate family contact examinations. 3) 21 families were specially investigated because they had more than one active tuberculosis. Half of them underwent insufficient family contact examinations. It was indicated that tuberculin skin tests were necessary even to those aged 16 and above as well as to those aged 15 and below, when they were family contacts of smear-positive cases. 4) The policy and methods of family contact examination were evaluated by a mail questionnaire to 74 Health Centers in Tohoku Districts. The response rate was 95% (70/74).(ABSTRACT TRUNCATED AT 250 WORDS)

[Bedridden period before death (BPbd) and factors relating to it in a rural community in Yamagata Prefecture].

The purpose of this study is to analyze the 'Bedridden period before death (BPbd)' and factors relating to it in a community. In the period from January 1986 through December 1988, 352 persons aged 40 years and over were recorded as having died in a rural town with a population of 13,000 in Yamagata Prefecture. The care-givers of 312 subjects (88.6%) were interviewed regarding the BPbd, and demographic, medical, social and familial factors were also investigated. Results obtained are as follows; 1) Subjects who had more than six months BPbd were more frequent in females than in males. 2) Neither age of death nor age of the bedridden had any significant relationship to BPbd in either sex. 3) Positive significant factors relating to BPbd were, occupation (male), history of cerebrovascular diseases (both sexes), care-giver knowledge of health or social services in the town (both sexes) and the presence of pressure sores (both sexes). 4) About half of the subjects had less than two weeks BPbd, though less than 20% of the subjects had more than six months BPbd. This result agreed with that of the national report, "TSUI-NO MITORI CHOSA", where subjects ranged in age from 70 to 85. These results indicate that in the study community most of the adults, including the elderly, have a fairly short BPbd.