Tamano Matsui

Effects of Arsenic on Younger Generations

Abstract Health risks caused by the chronic exposure to arsenic-contaminated groundwater has been recognized in many Asian and Latin American countries. While the health effects among adults have been well documented, those among the younger generations including children, infants, babies, and fetus have been scarcely reported. In this minireview, possible effects of chronic arsenic exposure on the younger generations are discussed in terms of skin manifestations among the children, exposure among newborns and infants especially from the breast milk, child growth and development, reproductive performance. For each of the topics, our preliminary results obtained in an arsenic-contaminated area in Bangladesh will be described, followed by a brief overview on the recent publications dealing with the topic. Although there exist some human data that suggest possible effects on some of the above-mentioned endpoints, the data as a whole is too premature to conclude whether the arsenic poses serious threat to younger generations or not. Considering the public health importance of toxic effects imposed during the early life stages, it is clear that much more scientific efforts should be made to elucidate the possible effects of arsenic on the younger generations.

Epidemiological update on the dengue situation in the Western Pacific Region, 2012.

Dengue has caused a substantial public health burden in the Western Pacific Region. To assess this burden and regional trends, data were collated and summarized from indicator-based surveillance systems on dengue cases and deaths from countries and areas in the Western Pacific Region. In 2012, dengue notifications continued to increase with 356,838 dengue cases reported in the Region (relative to 244,855 cases reported in 2011) of which 1248 died. In the Asia subregion, the notification rate was highest in Cambodia, the Philippines and the Lao Peoples Democratic Republic (316.2, 198.9 and 162.4 per 100,000 population, respectively), and in the Pacific island countries and areas, the notification rate was highest in Niue, the Marshall Islands and the Federated States of Micronesia (8556.0, 337.0 and 265.1 per 100,000 population, respectively). All four serotypes were circulating in the Region in 2012 with considerable variabilitiy in distribution. Regional surveillance provides important information to enhance situational awareness, conduct risk assessments and improve preparedness activities.

Epidemiological survey of Vibrio vulnificus infection in Japan between 1999 and 2003

The frequency of Vibrio vulnificus infection is very rare and there are many questions regarding its epidemiology in Japan. To investigate the clinical course and epidemiology of V. vulnificus infection in Japan, we performed a retrospective questionnaire survey in which 1693 hospitals from all over Japan were surveyed, including advanced life saving emergency centers and dermatology institutions. Of the 1693 hospitals, we received answers from 1045. Ninety‐four cases were confirmed as V. vulnificus infections during 1999 and 2003. Sixty‐eight (72.3%) of the 94 patients had the septic type infection with a mortality rate of 75.0% (51/68 patients died). The prognosis of patients with the septic type was worse than that of the wound type (P < 0.001). V. vulnificus infections occurred from June to November and none occurred in winter. Many infections occurred in western Japan with the majority of infections (50/94) occurring in Kyushu. In particular, 43 infections occurred in marine coastal areas of the Ariake and Yatsushiro Seas, which have many tidelands. Seventy‐seven of 89 patients (86.5%) had liver function impairment as an underlying disease, and 53 (59.6%) had liver cirrhosis, of whom nine (10.1%) suffered from liver cancer. The incidence of V. vulnificus infection was different according to districts. Geographic and climatic factors also contributed to the occurrence of V. vulnificus infection.

Salmonella Enteritidis outbreak associated with a school-lunch dessert: cross-contamination and a long incubation period, Japan, 2001.

A Salmonella Enteritidis (SE) outbreak in Japan was investigated with an observational study, analytical epidemiology and bacteriological examination (including phage typing). The outbreak occurred among 96 schoolchildren, and was caused by SE phage type 1. The outbreak source was dessert buns served at a school lunch (RR 42.55, 95 % CI 5.93-305.11, P < 0.001). The buns were probably cross-contaminated from eggs from a factory with a history of SE-contaminated products. The incubation period was longer than usual (3-16 days, median 8 days). A low contaminating dose may account for the long incubation period and low attack rate. Outbreak detection was hampered by the absence of routine Salmonella surveillance in Japan. The investigation was complicated by concurrent illnesses from other SE phage types. It was successful, in part, because adequate food samples were available for microbiological testing.

Incidence of dengue virus infection among Japanese travellers, 2006 to 2010

INTRODUCTION Dengue continues to be a global public health concern. In Japan, although dengue cases are currently seen only among travellers returning from endemic areas, the number of reported cases is rising according to the national case-based surveillance system. We evaluated the characteristics of dengue cases imported into Japan and the relationship between the incidence of infection and season of travel to popular destinations. METHODS Dengue cases reported to the national surveillance system were retrospectively examined. The number of reported cases per number of Japanese travellers to a dengue-endemic country was calculated to estimate the country-specific incidence of imported dengue virus infection. The incidence of dengue infection among Japanese travellers was compared between dengue high season and low season in each country using relative risk (RR) and associated 95% confidence intervals (CI). RESULTS Among 540 Japanese residents who were reported as dengue cases from 2006 to 2010, the majority had travelled to Indonesia, India, the Philippines and Thailand. The RR of dengue infection among Japanese travellers during dengue high season versus low season was 4.92 (95% CI: 3.01-8.04) for the Philippines, 2.76 (95% CI: 1.67-4.54) for Thailand and 0.37 (95% CI: 0.15-0.92) for Indonesia. DISCUSSION Overall, higher incidence of imported cases appeared to be related to historic dengue high seasons. Travellers planning to visit dengue-endemic countries should be aware of historic dengue seasonality and the current dengue situation.

Epidemiologic update of dengue in the Western Pacific Region, 2010.

Dengue is an emerging vectorborne infectious disease that is a major public health concern in the Asia Pacific region. Official dengue surveillance data for 2010 provided by ministries of health were summarized as part of routine activities of the World Health Organization Regional Office for the Western Pacific. Based on reported data, dengue has continued to show an increasing trend in the Western Pacific Region. In 2010, countries and areas reported a total of 353 907 dengue cases, of which 1073 died, for a case fatality ratio of 0.30%. More than 1000 cases were reported each from Australia (North Queensland), Cambodia, the Lao Peoples Democratic Republic, Malaysia, the Philippines, Singapore and Viet Nam. With the exception of Australia, the number of reported cases in 2010 was greater than that reported in 2009 for these countries. The elevated number of cases reported in 2010 in some countries, such as the Philippines, is likely due to several factors, such as enhanced reporting and continued epidemic activity. However, increases in reported number of cases in other areas, such as Singapore and Malaysia, appear to indicate sustained epidemic activity in those countries. The continued epidemic dengue activity in the Region highlights the need for timely and routine regional sharing of information.

Extensive Facial Strawberry Mark Associated with Cerebellar Hypoplasia and Vascular Abnormalities

Strawberry mark is considered a benign hemangioma with a tendency toward spontaneous regression and a benign prognosis (1). Recently, some papers have reported complications of large facial strawberry marks (2–6). We report a infant girl with an extensive strawberry mark on the left side of the face associated with ipsilateral cerebellar hypoplasia and Dandy‐Walker malformation. Abnormal branching of the aortic arch was also found.

Epidemiological and Clinical Features of Severe Fever with Thrombocytopenia Syndrome in Japan, 2013-2014.

Although severe fever with thrombocytopenia syndrome (SFTS) was first reported from Japan in 2013, the precise clinical features and the risk factors for SFTS have not been fully investigated in Japan. Ninety-six cases of severe fever with thrombocytopenia syndrome (SFTS) were notified through the national surveillance system between April 2013 and September 2014 in Japan. All cases were from western Japan, and 82 cases (85%) had an onset between April and August. A retrospective observational study of the notified SFTS cases was conducted to identify the clinical features and laboratory findings during the same period. Of 96 notified cases, 49 (51%) were included in this study. Most case-patients were of advanced age (median age 78 years) and were retired or unemployed, or farmers. These case-patients had a history of outdoor activity within 2 weeks before the onset of illness. The median serum C-reactive protein concentration was slightly elevated at admission. Fungal infections such as invasive aspergilosis were found in 10% of these case-patients. Hemophagocytosis was observed in 15 of the 18 case-patients (83%) whose bone marrow samples were available. Fifteen cases were fatal, giving a case-fatality proportion of 31%. The proportion of neurological abnormalities and serum concentrations of lactate dehydrogenase and aspartate aminotransferase were significantly higher in the fatal cases than in the nonfatal cases during hospitalization. Appearance of neurological abnormality may be useful for predicting the prognosis in SFTS patients.

Dermatological and nutritional/growth effects among children living in arsenic-contaminated communities in rural Bangladesh

While many reports have outlined the health risk of chronic arsenic exposure on adult populations, relatively little is known about the effects on children. We have examined the effects of chronic arsenic exposure through consumption of contaminated groundwater among 241 children (age 4–15 yr) living in two rural villages in northern Bangladesh. The arsenic concentrations of the tubewell waters ranged from less than detection limit to 535 ng/mL, and in 72 of 241 (30%) tubewells, the water arsenic concentration exceeded 50 ng/mL, the provisional guideline of Bangladesh. Approximately half of the examined children exhibited dermatological symptoms with relatively obscured dose-response relationship; an observation suggesting that the children were no more susceptible to the dermatological effects of arsenic than the adults living in the same communities. Proportion of the children with lower BMI significantly increased with increasing arsenic exposure level; the dose-response relationship was consistently observed among the subgroups. These results suggested that while mild dermatological manifestations, potentially associated with arsenic exposure, could be found as much as half of the children, nutritional status of the children, evaluated by BMI, might be a sensitive endpoint than the dermatological manifestations among children in this area.

Ongoing local transmission of dengue in Japan, August to September 2014.

WPSAR Vol 5, No 4, 2014 | doi: 10.5365/wpsar.2014.5.3.007 www.wpro.who.int/wpsar 1 a Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan. b Department of Virology, National Institute of Infectious Diseases, Tokyo, Japan. c Department of Medical Entomology, National Institute of Infectious Diseases, Tokyo, Japan. Submitted: 26 September 2014; Published: 28 October 2014 doi: 10.5365/wpsar.2014.5.3.007 In late August 2014, three autochthonous dengue cases were reported in Japan. Since then, as of 17 September 2014, a total of 131 autochthonous cases have been confirmed. While cases were reported from throughout Japan, the majority were linked to visiting a large park or its vicinity in Tokyo, and the serotype detected has been serotype 1. We report preliminary findings, along with the public health response activities, of the first documented autochthonous dengue outbreak in Japan in nearly 70 years.