Faculty Profiles - Kazuhiro Uda

Papers - Kazuhiro Uda

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Long-term Effectiveness of Financial Incentives for Not Prescribing Unnecessary Antibiotics to Children with Acute Respiratory and Gastrointestinal Infections: A Japan's Nationwide Quasi-Experimental Study. Reviewed International journal

Yusuke Okubo, Kazuhiro Uda, Isao Miyairi

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2024.11

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: To address antibiotic overuse, the Japanese government implemented a novel financial incentive policy in 2018. The policy enables eligible healthcare facilities to claim 800 JPY (≈5.7 USD) per case wherein a rationale to not prescribe antibiotics is offered to children aged <3 years with acute upper respiratory tract infections or gastroenteritis. Although the short-term effect of this policy was observed in our previous study, its long-term effects have not been evaluated nationwide. METHODS: We conducted a quasi-experimental study using a staggered difference-in-differences design with propensity score matching. Data from 165,113 children born between April 2017 and March 2019 were extracted from two nationwide administrative databases. The study tracked these children until May 2022, comparing those exposed to the policy with those who were not. RESULTS: The introduction of financial incentives led to a 44.9% reduction (95%CI, 41.1% to 47.7%) in total antibiotic prescriptions within the first month and 19.5% reduction (95%CI, 8.7% to 29.1%) over 48 months. Broad-spectrum antibiotic use also decreased by 24.4% (95%CI, 14.0% to 33.6%) over the same period. The policy did not result in increased hospitalizations, after-hours visits, or healthcare costs, but was associated with a slight increase in the number of office visits. A dose-response relationship was observed, with reductions in antibiotic use leveling off after approximately five incentives. CONCLUSIONS: Financial incentives effectively reduced antibiotic prescriptions in children without adverse health outcomes, demonstrating sustained benefits over four years. This antimicrobial stewardship intervention offers a scalable model for other countries aiming to curb antibiotic overuse and combat antimicrobial resistance.

DOI： 10.1093/cid/ciae577

Nationwide Epidemiology and Outpatient Healthcare Resource Use of Children with Respiratory Syncytial Virus from 2005 to 2021. Reviewed International journal

Yusuke Okubo, Kazuhiro Uda, Yuki Yoshikawa, Chikara Ogimi, Yosuke Nakabayashi, Kenta Ito

Journal of the Pediatric Infectious Diseases Society 2024.11

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Respiratory syncytial virus (RSV) poses a global health challenge, particularly among younger children. While the disease burden in Japan has been preliminarily quantified in short-term or inpatient settings, a comprehensive understanding of outpatient settings at a national level is still lacking. METHODS: In this retrospective cohort study, we followed 697,802 children until they reached 60 months of age, amounting to 25,680,468 million person-months, using two nationally representative databases from the fiscal years 2005-2021. We analyzed trends in the epidemiology of RSV infections and associated outpatient health resource use. RESULTS: Incidence rates of RSV and associated hospitalizations among infants showed fluctuations of 50-100 cases and 20-30 hospitalizations per 1000 person-years, respectively, during the 2010s. These rates dropped to 8.7 cases and 2.2 hospitalizations per 1000 person-years in 2020, then returned to the same levels in the 2010s. Similar patterns were noted for RSV testing, outpatient visits, healthcare cost and the proportion of cases hospitalized (case-hospitalization risk). Whereas antibiotic use decreased from 56.4% in 2005 to 27.8% in 2021, palivizumab use increased from 95.2-195.9 days of therapy per 1000 person-years. Applying the calculated incidence rates to national data, annual outpatient healthcare costs for RSV infections were estimated to be 7-9 billion JPY (50-64 million USD) for children aged <60 months in the late 2010s. CONCLUSIONS: Our study highlights the changes in epidemiology and outpatient health resource utilization for children with RSV infections. These findings are valuable for policymakers and clinicians aiming to develop strategies, including newly developed maternal vaccines and single-dose long-acting monoclonal antibodies.

DOI： 10.1093/jpids/piae115

Idiopathic Pulmonary Hemosiderosis. Reviewed International journal

Kazuhiro Uda, Masato Yashiro

The New England journal of medicine 2023.6

Correlation between national surveillance and search engine query data on respiratory syncytial virus infections in Japan. Reviewed International journal

Kazuhiro Uda, Hideharu Hagiya, Takashi Yorifuji, Toshihiro Koyama, Mitsuru Tsuge, Masato Yashiro, Hirokazu Tsukahara

BMC public health 22 ( 1 ) 1517 - 1517 2022.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The respiratory syncytial virus (RSV) disease burden is significant, especially in infants and children with an underlying disease. Prophylaxis with palivizumab is recommended for these high-risk groups. Early recognition of a RSV epidemic is important for timely administration of palivizumab. We herein aimed to assess the correlation between national surveillance and Google Trends data pertaining to RSV infections in Japan. METHODS: The present, retrospective survey was performed between January 1, 2018 and November 14, 2021 and evaluated the correlation between national surveillance data and Google Trends data. Joinpoint regression was used to identify the points at which changes in trends occurred. RESULTS: A strong correlation was observed every study year (2018 [r = 0.87, p < 0.01], 2019 [r = 0.83, p < 0.01], 2020 [r = 0.83, p < 0.01], and 2021 [r = 0.96, p < 0.01]). The change-points in the Google Trends data indicating the start of the RSV epidemic were observed earlier than by sentinel surveillance in 2018 and 2021 and simultaneously with sentinel surveillance in 2019. No epidemic surge was observed in either the Google Trends or the surveillance data from 2020. CONCLUSIONS: Our data suggested that Google Trends has the potential to enable the early identification of RSV epidemics. In countries without a national surveillance system, Google Trends may serve as an alternative early warning system.

DOI： 10.1186/s12889-022-13899-y

The consequence of financial incentives for not prescribing antibiotics: a Japan's nationwide quasi-experiment. Reviewed International journal

Yusuke Okubo, Akihiro Nishi, Karin B Michels, Hiroki Nariai, Robert J Kim-Farley, Onyebuchi A Arah, Kazuhiro Uda, Noriko Kinoshita, Isao Miyairi

International journal of epidemiology 2022.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: For addressing antibiotic overuse, Japan designed a health care policy in which eligible medical facilities could claim a financial reward when antibiotics were not prescribed for early-stage respiratory and gastrointestinal infections. The policy was introduced in a pilot manner in paediatric clinics in April 2018. METHODS: We conducted a quasi-experimental, propensity score-matched, difference-in-differences (DID) design to determine whether the nationwide financial incentives for appropriate non-prescribing of antibiotics as antimicrobial stewardship [800 JPY (≈7.3 US D) per case] were associated with changes in prescription patterns, including antibiotics, and health care use in routine paediatric health care settings at a national level. Data consisted of 9 253 261 cases of infectious diseases in 553 138 patients treated at 10 180 eligible or ineligible facilities. RESULTS: A total of 2959 eligible facilities claimed 316 770 cases for financial incentives and earned 253 million JPY (≈2.29 million USD). Compared with ineligible facilities, the introduction of financial incentives in the eligible facilities was associated with an excess reduction in antibiotic prescriptions [DID estimate, -228.6 days of therapy (DOTs) per 1000 cases (95% CI, -272.4 to -184.9), which corresponded to a relative reduction of 17.8% (95% CI, 14.8 to 20.7)]. The introduction was also associated with excess reductions in drugs for respiratory symptoms [DID estimates, -256.9 DOTs per 1000 cases (95% CI, -379.3 to -134.5)] and antihistamines [DID estimate, -198.5 DOTs per 1000 cases (95% CI, -282.1 to -114.9)]. There was no excess in out-of-hour visits [DID estimate, -4.43 events per 1000 cases (95% CI, -12.8 to 3.97)] or hospitalizations [DID estimate, -0.08 events per 1000 cases (95% CI, -0.48 to 0.31)]. CONCLUSIONS: Our findings suggest that financial incentives to medical facilities for not prescribing antibiotics were associated with reductions in prescriptions for antibiotics without adverse health care consequences. Japan's new health policy provided us with policy options for immediately reducing inappropriate antibiotic prescriptions by relatively small financial incentives.

DOI： 10.1093/ije/dyac057

Kawasaki disease following coronavirus disease 2019 with prolonged fecal viral shedding. Reviewed International journal

Kazuhiro Uda, Keiko Okita, Keiko Soneda, Kimihiro Taniguchi, Yuho Horikoshi

Pediatrics international : official journal of the Japan Pediatric Society 63 ( 5 ) 597 - 599 2021.5

Kawasaki disease or Kawasaki-like disease: Influence of SARS-CoV-2 infections in Japan. Reviewed International journal

Kazuki Iio, Kazuhiro Uda, Hiroshi Hataya, Fumihiko Yasui, Tomoko Honda, Takahiro Sanada, Kenzaburo Yamaji, Michinori Kohara, Masanari Itokawa, Masaru Miura

Acta paediatrica (Oslo, Norway : 1992) 110 ( 2 ) 600 - 601 2021.2

Language：English Publishing type：Research paper (scientific journal)

The coronavirus disease 2019 (COVID-19) pandemic witnessed several clusters of children with fever and multisystem inflammation resembling Kawasaki disease (KD). Due to the evidence of a preceding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in most of these patients, post-viral immunological reactions were thought to play an important role in the pathogenesis.1,2 The condition, called "pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS)", has thus far been reported mainly from Europe and the United States,1,2 and no cases have been diagnosed in Asia. We herein analyzed the clinical data on patients in whom KD was diagnosed during a local COVID-19 epidemic to investigate the relationship between KD and SARS-CoV-2 infections in Japan, which has the highest KD incidence in the world.

DOI： 10.1111/apa.15535

High proportion of multidrug-resistant organisms in children hospitalized abroad. Reviewed International journal

Kazuhiro Uda, Takanori Funaki, Kensuke Shoji, Akira Kato, Isao Miyairi

American journal of infection control 48 ( 5 ) 578 - 580 2020.5

Language：English Publishing type：Research paper (scientific journal)

Our infection control team initiated active screening for multidrug-resistant organisms (MDROs) among children who had been hospitalized abroad before their admission to our hospital. MDROs were detected in 19 of 34 cases (56%), including 3 isolates of Enterobacteriaceae harboring carbapenemase genes still rare in Japan. Early recognition of MDROs by screening this population may be required to avoid the introduction of new modes of resistance into the hospital environment.

DOI： 10.1016/j.ajic.2019.08.013

Nationwide survey of indications for oral antimicrobial prescription for pediatric patients from 2013 to 2016 in Japan. Reviewed International journal

Kazuhiro Uda, Yusuke Okubo, Noriko Kinoshita, Naho Morisaki, Masahi Kasai, Yuho Horikoshi, Isao Miyairi

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 25 ( 10 ) 758 - 763 2019.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Antimicrobial resistance is a major public health concern. In 2016, the Japanese government launched a national action plan aimed at achieving a 33% and 50% reduction in the number of total and oral antimicrobial prescriptions (cephalosporins, macrolides, and quinolones) from the 2013 figures by 2020, respectively. The purpose of this study was to investigate the indications for recent antimicrobial prescriptions and to identify the primary targets for intervention to achieve the aims of the government's action plan. METHODS: Using the national health claims database, we retrospectively analyzed oral antibiotic prescriptions for Japanese children aged ≦ 15 years from 2013 to 2016. The trends were analyzed based on days of therapy (DOT) per infectious disease-related visit for each antibiotic. For patients whose chief diagnosis was an infectious disease, the number of antimicrobial prescriptions per diagnosis, their proportion, and the details of the type of antimicrobial were investigated. RESULTS: In total, 297,197,328 infectious disease-related visits were identified during 2013-2016. Total antimicrobial prescriptions showed a 3.7% reduction from 1.519 DOT/visitor in 2013 to 1.463 DOT/visitor in 2016 (Ptrend < 0.001). Antimicrobials were prescribed for 31.7% and 36.9% of children with upper and lower respiratory tract infection, accounting for 54.6% and 26.2% of all antimicrobial prescriptions, respectively. Third generation cephalosporins and macrolides comprised the majority of these prescriptions. CONCLUSIONS: Antimicrobials were commonly prescribed for children with respiratory infections. Therefore, promoting appropriate antimicrobial use in this population is required to achieve the 2020 goals set by the action plan.

DOI： 10.1016/j.jiac.2019.03.004

Targets for Optimizing Oral Antibiotic Prescriptions for Pediatric Outpatients in Japan. Reviewed

Kazuhiro Uda, Noriko Kinoshita, Naho Morisaki, Masashi Kasai, Yuho Horikoshi, Isao Miyairi

Japanese journal of infectious diseases 72 ( 3 ) 149 - 159 2019.5

Language：English Publishing type：Research paper (scientific journal)

In Japan, 92.6% of antibiotics consumed are oral agents; most of these are for outpatients. A significant proportion is known to be dispensed for children; however, the specific pattern of antibiotic prescription in accordance with clinical specialty is still unclear. The aim of our study was to identify the key targets for the optimization of oral antibiotic use in children. We analyzed data on oral antimicrobial prescription patterns for children ＜ 16 years old of age in 3 urban districts by using a national database in Japan. Oral prescriptions were categorized according to their class, spectrum, clinical specialty, and type of clinical setting. The antibiotic spectrum was categorized as narrow, broad, or ultra-broad. In total, 132,869,332 antibiotic prescriptions were collected for analysis. The proportions of narrow-spectrum, broad-spectrum, and ultra-broad-spectrum antibiotics were 10.9%, 73.7%, and 15.4% in primary care clinics and 23.4%, 71.1%, and 5.4% in hospitals, respectively. Prescriptions from pediatricians and otolaryngologists in primary care clinics were predominant in the 3 studied areas. Third-generation cephalosporins, quinolones, penems, and carbapenems were prescribed mostly by pediatricians and otolaryngologists. Ultra-broad spectrum antibiotics used in primary care clinics and antibiotics particular to each specialty were identified as key targets for the optimization of oral antibiotic use for pediatric outpatients.

DOI： 10.7883/yoken.JJID.2018.374

Mycobacterium intracellulare Infection in a Japanese Patient with Signal Transducer and Activator of Transcription-3 Gain-of-Function Syndrome: A Case Report.

Hideharu Hagiya, Yoshiaki Soejima, Kazuki Tokumasu, Yoji Hirai, Yuki Otsuka, Marina Kawaguchi, Shinnosuke Fukushima, Kenta Nakamoto, Kohei Oguni, Yusuke Shiode, Kazuhiro Uda, Masato Yashiro, Kousei Hasegawa, Koji Iio, Fumio Otsuka

Internal medicine (Tokyo, Japan) 2025.10

Language：English Publishing type：Research paper (scientific journal)

Signal transducer and activator of transcription-3 (STAT3) gain-of-function (GOF) syndrome predisposes patients to autoimmunity diseases. Yet, nontuberculous mycobacterial (NTM) infections have rarely been described. We herein report a teenage Japanese patient with genetically confirmed STAT3-GOF syndrome who developed Mycobacterium intracellulare disease. Combination antimycobacterial chemotherapy reduced the bacterial burden; however, the refractory NTM infection relapsed after initiation of adjunctive tofacitinib therapy. The present case demonstrates that host-directed therapy must be combined with prolonged antimycobacterial regimens to control drug-resistant NTM in patients with inborn errors of immunity.

DOI： 10.2169/internalmedicine.6174-25

Factors influencing influenza vaccination among childcare and education professionals: A nationwide survey (2023-2024). International journal

Yusuke Okubo, Risa Honjo, Kazuhiro Uda, Isao Miyairi, Masahiko Sakamoto

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 31 ( 10 ) 102808 - 102808 2025.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Influenza remains a major public health issue, leading to millions of severe cases and many deaths annually. Although educational and childcare institutions are key transmission points for the spread of the virus in communities, few studies have comprehensively examined the vaccination rates and their determinants in these settings. METHODS: We conducted a nationwide web-based survey to assess influenza knowledge, perceptions, and determinants of vaccine hesitancy based on the 5C model among childcare and educational professionals in Japan. Multivariable modified Poisson regression, machine learning method of classification and regression tree (CART), and network analysis were employed to identify factors influencing vaccination behavior. RESULTS: Influenza vaccination rates were 74.1 % in 2023 and 78.8 % in 2024. Younger age (RR, 1.33; 95 %CI, 1.04-1.70), perceived unnecessity (RR, 1.31; 95 %CI, 1.01-1.70), concerns over adverse reactions (RR, 1.57; 95 %CI, 1.23-2.01) were associated with consistent non-vaccination, while agreement with collective responsibility (RR, 0.02; 95 %CI, 0.01 to 0.06) and recognition of the importance of vaccination for infection prevention (RR, 0.77; 95 %CI, 0.62 to 0.95) served as protective factor. CART and network analyses further highlighted collective responsibility as the key determinant for receiving vaccination consistently among educational and childcare professionals. CONCLUSIONS: Our study highlights that collective responsibility (willingness to get vaccinated to protect others) and specific hesitancy factors play a pivotal role in influenza vaccination uptake among childcare and educational professionals. Tailored public health strategies addressing these determinants may enhance vaccine coverage and reduce influenza transmission in high-risk settings.

DOI： 10.1016/j.jiac.2025.102808

Skin Infections Caused by Panton-Valentine Leukocidin and Methicillin-Susceptible Staphylococcus aureus in Child, Japan. Reviewed International journal

Kensuke Shoji, Kazue Yoshida, Marie Takenouchi, Junzo Hisatsune, Shoko Kutsuno, Chika Arai, Kanako Masuda, Motoyuki Sugai, Takashi Ishikawa, Toshinao Kawai, Kazuhiro Uda, Isao Miyairi

Emerging infectious diseases 31 ( 6 ) 1227 - 1230 2025.6

Language：English Publishing type：Research paper (scientific journal)

We describe a pediatric case of recurrent skin infections caused by a Panton-Valentine leukocidin and exfoliative toxin E double-positive methicillin-susceptible Staphylococcus aureus clonal complex 188 clone. Most of the patient's family members were infected with the same strain, and intrafamilial transmission was strongly suspected. Decolonization procedures were not effective.

DOI： 10.3201/eid3106.241955

Maternal smoking during infancy increases the risk of allergic diseases in children: a nationwide longitudinal survey in Japan. Reviewed International journal

Kenji Shigehara, Naomi Matsumoto, Mitsuru Tsuge, Kazuhiro Uda, Yukie Saito, Masato Yashiro, Takashi Yorifuji, Masanori Ikeda, Hirokazu Tsukahara

Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology 21 ( 1 ) 4 - 4 2025.1

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The incidence of allergic diseases has been increasing in Japan. In particular, a serious decline in the age of onset of allergic rhinitis has been observed. Passive smoking from parental smoking has a significant impact on children's health; however, it is difficult to restrict smoking in the home. While various studies have previously reported on the relationship between passive smoking and the development of allergic diseases in children. However, there have been no reports on passive smoking and allergic diseases on a national scale. METHODS: Using Japanese national longitudinal survey data (n = 38,444) for newborns born between May 10 and 24, 2010, we assessed parental smoking habits when their children were 6 months old and investigated the association with the development of allergic diseases until the age of 5.5 years. The risk ratios and 95% confidence intervals for the development of different allergic diseases were analyzed after adjusting for potential confounders using Poisson regression with a robust error variance. RESULTS: The risk ratio for developing allergic rhinitis/allergic conjunctivitis (AR/AC) in children was significantly higher in the maternal smoking groups ( ≦ 10 cigarettes/day; RR 1.15, 95% CI 1.02-1.30; ≧11 cigarettes/day; RR 1.16, 95% CI 0.93-1.44). Furthermore, associations were found between the maternal smoking group in the presence of paternal smoking and the risk of developing bronchial asthma ( ≦ 10, RR 1.33 95% CI 1.17-1.52; ≧11, RR 1.71 95% CI 1.38-2.1), food allergy ( ≦ 10, RR 1.36 95% CI 1.12-1.63; ≧11, RR 1.25 95% CI 0.84-1.86), atopic dermatitis ( ≦ 10, RR 1.42 95% CI 1.22-1.66; ≧11, RR 1.6 95% CI 1.2-2.13), and AR/AC ( ≦ 10, RR 1.21 95% CI 1.07-1.36; ≧11, RR 1.35 95% CI 1.09-1.67). CONCLUSIONS: Maternal smoking during infancy increases the risk of developing AR/AC in children. Considering paternal smoking, maternal smoking further increased the risk of developing allergic diseases in children, suggesting that reducing parental smoking at home may reduce the risk of developing allergic diseases in children.

DOI： 10.1186/s13223-025-00952-9

School infection control strategy during and after the COVID-19 pandemic: Nationwide trends (2022-2024). International journal

Yusuke Okubo, Risa Honjo, Kazuhiro Uda, Isao Miyairi

Pediatrics international : official journal of the Japan Pediatric Society 67 ( 1 ) e70243 2025

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic required schools, densely populated settings with diverse age groups, to dynamically adjust infection control strategies in response to evolving public health challenges. Despite substantial documentation of such strategies in healthcare facilities, detailed data from school environments remain limited during and after the COVID-19 pandemic. METHODS: A nationwide web-based survey was conducted using a random sample of schools (N = 854) to examine changes in infection control strategies, the implementation of school events, and decision-making influences over fiscal years 2022-2024. To identify longitudinal patterns in preventive behavior, we applied time-series clustering based on dynamic time warping. RESULTS: Between 2022 and 2024, key mitigation efforts such as compulsory mask usage (from 84.3% to 2.2%) and routine disinfection of shared spaces (from 89.7% to 12.3%) saw a steep decline. Meanwhile, hand hygiene and classroom ventilation remained consistently prioritized. The proportion of schools hosting events without restrictions (e.g., sports days, excursions) increased substantially. Around 50% of schools reported using infection prevention tools not officially recommended. While the proportion of schools implementing 7-10 infection prevention measures decreased from 93.4% in 2022 to 50.2% in 2023, schools with 0-3 measures increased from 16.2% in 2023 to 64.8% in 2024. CONCLUSIONS: This study provides nationwide insights into how Japanese schools adjusted their infection control strategies across three academic years. These findings highlight the need for evidence-informed decision-making and closer partnerships with infectious disease experts to improve preparedness for future public health crises.

DOI： 10.1111/ped.70243

突発性発疹関連脳症における免疫応答に関連した宿主遺伝子発現解析

津下充, 濃野優, 宇田和宏, 茂原研司, 塚原宏一

日本小児感染症学会総会・学術集会プログラム・抄録集 56回 211 - 211 2024.11

Pediatric Severe Febrile Thrombocytopenia Syndrome: A Case Report and Literature Review. Reviewed

Yusuke Toyota, Kazuhiro Uda, Komei Shirabe, Tadashi Moriwake

Acta medica Okayama 78 ( 5 ) 401 - 405 2024.10

Language：English Publishing type：Research paper (scientific journal)

Severe febrile thrombocytopenia syndrome (SFTS) is a tick-borne infectious disease that is endemic in parts of eastern Asia. Few pediatric cases have been reported. We describe a case of SFTS in a seven-year-old girl who presented with prolonged fever and gastrointestinal symptoms. Leukopenia and thrombocytopenia on hematology, and a history of outdoor activity led us to diagnose SFTS, although the patient had no tick bite marks. We also review the literature and discuss the characteristics of pediatric SFTS. Physicians should consider SFTS in the differential diagnosis of fever with thrombocytopenia in children living in endemic areas.

DOI： 10.18926/AMO/67664

Nationwide epidemiology and health resource use among children with COVID-19 in Japan. Reviewed International journal

Yusuke Okubo, Yosuke Nakabayashi, Kenta Ito, Kazuhiro Uda, Isao Miyairi

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2024.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The COVID-19 pandemic posed substantial challenges to healthcare systems. Understanding the responses of pediatric health services is crucial for future pandemic planning and preparedness, yet such data remains limited. METHODS: In this retrospective cohort study, we analyzed data from administrative databases developed by Japan Medical Data Center and DeSC Healthcare Inc. The dataset comprised records of 2,612,511 children, totaling 60,224,888 person-months, from January 2020 to May 2022. Multivariate generalized estimation equations were used to examine the incidence rates of COVID-19 and associated health resource use. RESULTS: Our analysis revealed that the incidence rates of COVID-19 gradually increased from Wave I (2.2 cases per 100,000 person-months) to Wave V (177.8cases per 100,000 person-months), with a notable elevation during Wave VI (2367.7 cases per 100,000 person-months). While nucleic acid amplification tests were primarily used during Waves I-V, the use of rapid antigen tests markedly increased in Wave VI. The hospitalization rates increased gradually from 0.2 in Wave I to 10.2 events per 100,000 person-months in Wave VI, and the case-hospitalization risk decreased from 14.9% in Wave II to 0.7% in Wave VI. Additionally, we observed decreasing trends in the use of antibiotics (Wave I, 31.8%; Wave VI, 9.0%), whereas antipyretic use rose from Wave I (56.1%) to Wave VI (86.6%). CONCLUSIONS: Our study highlighted essential changes in the nationwide pediatric healthcare system's response to the COVID-19 pandemic. These findings provide valuable insights into the future pandemic planning and preparedness.

DOI： 10.1016/j.jiac.2024.04.005

Structural and organizational determinants of the capacity for COVID-19 testing and diagnoses in children: Insights from the 2009 influenza and COVID-19 pandemics. Reviewed International journal

Yusuke Okubo, Kazuhiro Uda

Respiratory investigation 62 ( 3 ) 426 - 430 2024.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: This study explored factors associated with testing and diagnoses for children with COVID-19 at the hospital level and investigated whether the capacity of testing and diagnoses during the 2009 influenza pandemic was associated with that during COVID-19 pandemic. METHODS: In this observational study, we analyzed data obtained from the Japan Medical Data Center database, comprising 4906 medical facilities and 1.7 million infectious disease-related visits among children aged <20 years in 2020-2021. Multivariable generalized linear models were used to explore determinants of testing and diagnoses capacity for COVID-19 and investigate the association between the capacity during the 2009 influenza and COVID-19 pandemics. RESULTS: Public hospitals (adjusted incidence rate ratio [aIRR], 1.52; 95%CI, 1.26-1.82) and university hospitals (aIRR, 1.44; 95%CI, 1.14-1.80) were more likely to perform testing for COVID-19 among children, compared to clinics. The highest testing rate was observed in the department of internal medicine (aIRR, 1.64; 95%CI, 1.32-2.04), followed by pediatrics (aIRR, 1.40; 95%CI, 1.10-1.78) and otolaryngology (aIRR, 1.21; 95%CI, 0.89-1.64). Cubic spline models demonstrated the dose-response relationships between testing rate for influenza in 2009 and testing rates for COVID-19. Compared to the medical facilities in the lowest quartile of testing rate for influenza in 2009, those in the highest quartile were more likely to perform testing for COVID-19 (aIRR, 1.62; 95%CI, 1.43-1.83). CONCLUSIONS: Our study provides insights into the capacity of testing and diagnoses for children, highlighting the dose-response relationship between the 2009 influenza and COVID-19 pandemics, which could be valuable in preparing healthcare systems for future pandemics.

DOI： 10.1016/j.resinv.2024.03.001

Successful use of dupilumab for egg-induced eosinophilic gastroenteritis with duodenal ulcer: a pediatric case report and review of literature. Reviewed International journal

Mitsuru Tsuge, Kenji Shigehara, Kazuhiro Uda, Seiji Kawano, Masaya Iwamuro, Yukie Saito, Masato Yashiro, Masanori Ikeda, Hirokazu Tsukahara

Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology 19 ( 1 ) 103 - 103 2023.12

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Non-esophageal eosinophilic gastrointestinal disorder (non-EoE-EGID) is a rare disease in which eosinophils infiltrate parts of the gastrointestinal tract other than the esophagus; however, the number of patients with non-EoE-EGID has been increasing in recent years. Owing to its chronic course with repeated relapses, it can lead to developmental delays due to malnutrition, especially in pediatric patients. No established treatment exists for non-EoE-EGID, necessitating long-term systemic corticosteroid administration. Although the efficacy of dupilumab, an anti-IL-4/13 receptor monoclonal antibody, for eosinophilic esophagitis, has been reported, only few reports have demonstrated its efficacy in non-EoE EGIDs. CASE PRESENTATION: A 13-year-old boy developed non-EoE-EGID with duodenal ulcers, with chicken eggs as the trigger. He was successfully treated with an egg-free diet, proton pump inhibitors, and leukotriene receptor antagonists. However, at age 15, he developed worsening upper abdominal pain and difficulty eating. Blood analysis revealed eosinophilia; elevated erythrocyte sedimentation rate; and elevated levels of C-reactive protein, total immunoglobulin E, and thymic and activation-regulated chemokines. Upper gastrointestinal endoscopy revealed a duodenal ulcer with marked mucosal eosinophilic infiltration. Gastrointestinal symptoms persisted even after starting systemic steroids, making it difficult to reduce the steroid dose. Subcutaneous injection of dupilumab was initiated because of comorbid atopic dermatitis exacerbation. After 3 months, the gastrointestinal symptoms disappeared, and after 5 months, the duodenal ulcer disappeared and the eosinophil count decreased in the mucosa. Six months later, systemic steroids were discontinued, and the duodenal ulcer remained recurrence-free. The egg challenge test result was negative; therefore, the egg-free diet was discontinued. Blood eosinophil count and serum IL-5, IL-13, and eotaxin-3 levels decreased after dupilumab treatment. The serum levels of IL-5 and eotaxin-3 remained within normal ranges, although the blood eosinophil counts increased again after discontinuation of oral prednisolone. CONCLUSIONS: Suppression of IL-4R/IL-13R-mediated signaling by dupilumab may improve abdominal symptoms and endoscopic and histologic findings in patients with non-EoE-EGID, leading to the discontinuation of systemic steroid administration and tolerance of causative foods.

DOI： 10.1186/s13223-023-00859-3

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