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Okabe H, Hashimoto K, Norito S, Kume Y, Chishiki M, Hasegawa S, Sakai Y, Nomura K, Shibata T, Suzuki Y, Sunagawa T, Takao M, Hosoya M. Patients With Subacute Sclerosing Panencephalitis in Japan: A 2022 Nationwide Survey. Pediatr Infect Dis J 2024; 43:313-319. [PMID: 38134374 DOI: 10.1097/inf.0000000000004234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
BACKGROUND In Japan, the incidence of subacute sclerosing panencephalitis (SSPE) has reduced; however, the medical conditions and factors associated with disease progression remain unclear. METHODS A nationwide survey of SSPE was conducted using a questionnaire in 2022. We conducted a descriptive analysis of the patients with SSPE in 2022 and Cox proportional hazards analyses for disease progression. We compared the patients with SSPE with those in a 2007 survey. RESULTS A total of 37 surviving patients with SSPE were enrolled [median age: 32 years (range: 16-52 years)]. No new cases have been identified since 2017 in the survey. Jabbour stage IV was the most common stage (66.7%). The hazard ratios (95% confidence intervals) of male sex and age at the time of measles infection (years) were 2.56 (1.13-5.76) and 0.57 (0.34-0.93), respectively. Compared with those in 2007, the proportion of patients in hospitals decreased from 13.7% to 2.7%, whereas that of patients in nursing facilities increased from 17.6% to 29.7%. The proportions of patients prescribed inosine pranobex, interferon and ribavirin at the time of the survey decreased from 96.1% to 79.4%, 74.8% to 14.3% and 25.3% to 0%, respectively. The proportions of patients with gastrostomy, tracheostomy and ventilator use increased from 5.9% to 69.7%, 23.3% to 60.0% and 10.8% to 32.4%, respectively. CONCLUSIONS Decreased measles cases in Japan reduced new SSPE cases. However, surviving patients in 2022 had advanced disease stages and needed medical care. Male sex and early measles infection were significantly associated with disease progression.
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Affiliation(s)
- Hisao Okabe
- From the Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Koichi Hashimoto
- From the Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Sakurako Norito
- From the Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yohei Kume
- From the Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mina Chishiki
- From the Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiko Nomura
- Department of Pediatrics, School of Medicine, Kumamoto University, Kumamoto, Japan
| | - Takashi Shibata
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Okayama, Japan
| | - Yasuhiro Suzuki
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Tomimasa Sunagawa
- Center for Field Epidemic Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masaki Takao
- Department of Clinical Laboratory, National Center of Neurology and Psychiatry, kodaira, Tokyo, Japan
| | - Mitsuaki Hosoya
- From the Department of Pediatrics, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Srivastava K, Agarwal E, Rajadhyaksha S. Resurgence of Subacute Sclerosing Panencephalitis: Case Series and Global Epidemiological Trends. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1728774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractResurgence of subacute sclerosing panencephalitis (SSPE)—case series and global epidemiological trends. We noted a recent increase in cases of SSPE admitted in our institute, even though they had received measles vaccination. We did a detailed study of our cases and compared with global epidemiological trends of SSPE in preimmunization and era of developed immunity. Out of total 23 cases of SSPE, 12 presented in the year 2017 alone, reflecting a steep rise in incidence. Sixteen patients had received measles vaccine and never had prior measles infection. Mean age of onset was 8.2 years and average time of progression to advanced stage of disease was 65 days. Global data showed similar trends, that is, earlier age of onset with a faster rate of progression in the postvaccination era as compared with prevaccine era. Possible mechanisms to account for this trend include an early wild measles infection in the critical age of 6 to 9 months, before vaccination. There is a changing epidemiological trend of SSPE in terms of lower age of onset and faster rate of progression, also reflected in global data. There is a need for multicenter studies to verify the findings and explore possible measures like lowering the age of measles vaccination to halt this alarming trend.
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Affiliation(s)
- Kavita Srivastava
- Pediatric Neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Ekta Agarwal
- Pediatric Neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
| | - Surekha Rajadhyaksha
- Pediatric Neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India
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Abe Y, Hashimoto K, Iinuma K, Ohtsuka Y, Ichiyama T, Kusuhara K, Nomura K, Mizuguchi M, Aiba H, Suzuki Y, Mizusawa H, Hosoya M. Survey of subacute sclerosing panencephalitis in Japan. J Child Neurol 2012; 27:1529-33. [PMID: 22408143 DOI: 10.1177/0883073811436250] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Investigators conducted a retrospective epidemiological study of subacute sclerosing panencephalitis, a fatal disease caused by measles infection, over the past few years in Japan. Data on 118 cases obtained from a questionnaire sent to attending physicians were analyzed. The annual incidence of subacute sclerosing panencephalitis was approximately 0.03 cases per million from 2001 to 2005. Children infected with measles at a young age (<12 months) showed a high incidence of subacute sclerosing panencephalitis, and those infected before 6 months of age showed earlier onset. Because a positive correlation was found between the prevalence of measles and the onset of subacute sclerosing panencephalitis, particularly among children infected at an early age, it is vital to eradicate measles infection by vaccination.
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Affiliation(s)
- Yusaku Abe
- Department of Pediatrics, Fukushima Medical University, Japan
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Campbell H, Andrews N, Brown KE, Miller E. Review of the effect of measles vaccination on the epidemiology of SSPE. Int J Epidemiol 2007; 36:1334-48. [DOI: 10.1093/ije/dym207] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Campbell C, Levin S, Humphreys P, Walop W, Brannan R. Subacute sclerosing panencephalitis: results of the Canadian Paediatric Surveillance Program and review of the literature. BMC Pediatr 2005; 5:47. [PMID: 16356180 PMCID: PMC1343569 DOI: 10.1186/1471-2431-5-47] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 12/15/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subacute Sclerosing Panencephalitis (SSPE) is so rare in developed countries with measles immunization programs that national active surveillance is now needed to capture sufficient number of cases for meaningful analysis of data. Through the Canadian Paediatric Surveillance Program (CPSP), the SSPE study was able to document a national incidence and determine the epidemiology of affected Canadian children. METHODS Between 1997 and 2000, the CPSP surveyed monthly 1978 to 2294 Canadian pediatricians and sub-specialists for SSPE cases. The response rate varied from 82-86% over those years. RESULTS Altogether, four SSPE cases were reported to the CPSP: one case before, two during and one after the study period. The incidence of SSPE in Canadian children was 0.06/million children/year. Of the four cases, diagnosed between ages four and 17 years, three children had measles infection in infancy. All children showed a progressive course of dementia, loss of motor skills and epilepsy. Two children were treated with isoprinosine and intraventricular interferon but died in less than three years from disease onset. One child did not have any treatment and died after seven years of illness. One child received intraventricular ribavirin and remains alive, but markedly impaired, nine years following diagnosis. CONCLUSION The CPSP has demonstrated that Canadian paediatricians and paediatric neurologists may encounter cases of SSPE. This report highlights the clinical course of affected Canadian children and provides a review of the disease and its management.
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Affiliation(s)
- Craig Campbell
- Section of Pediatric Neurology, Department of Pediatrics, Children's Hospital of Western Ontario, University of Western Ontario, London, Canada
| | - Simon Levin
- Section of Pediatric Neurology, Department of Pediatrics, Children's Hospital of Western Ontario, University of Western Ontario, London, Canada
| | - Peter Humphreys
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Wikke Walop
- Public Health Agency of Canada, Government of Canada, Ottawa, Canada
| | - Renee Brannan
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize important papers concerning measles disease and measles-containing vaccines published in 2004. RECENT FINDINGS Endemic measles has been successfully controlled in the Americas and, to a lesser extent, in Europe. This has been achieved with a high uptake of two doses of a measles-containing vaccine. Even in industrialized countries, where vaccine uptake is poor, for example Japan, the disease is still a significant cause of morbidity and mortality. Vaccine failure is predominantly due to primary vaccine failure, which may, in part, be genetic in origin and related to HLA type. Measles-containing vaccines have been shown to be associated with febrile convulsions, but there is no strong evidence of a link with atopy. There is considerable evidence that there is no causal relationship with autistic disorders. In spite of this, many parents and some professionals have concerns about the safety of the vaccines, which may lead to their underuse. SUMMARY It is possible to eliminate measles with a high uptake of two doses of measles-containing vaccine, but concerns about safety persist and need to be tackled. More research is required into how to do this effectively and also to elucidate the causes of vaccine failure.
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Affiliation(s)
- David Elliman
- Islington PCT and Great Ormond Street Hospital, London, UK.
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