COVID-19 in Japan during 2020-2022: Characteristics, responses, and implications for the health care system

Quality of Life in Japanese Patients with Primary Immunodeficiency Disease is Disrupted throughout the Year

Patients with primary immunodeficiency disease (PID) have an increased susceptibility to infection and may experience negative impacts on health-related quality of life (HR-QOL) and activities of daily living. This prospective observational study of patients aged ≥ 12 years with PID assessed HR-QOL, work impairment, and disease-related daily burden over a full year, with a focus on seasonal variation. The study period was from October 2021 to November 2023. Data were collected using an online system. HR-QOL was assessed using EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), work impairment with the Work Productivity and Activity Impairment (WPAI) questionnaire, and disease-related burden with a questionnaire designed for this study. In patients with PID (N = 56) and healthy volunteers (N = 43), no significant seasonal variation was observed in EQ-5D-5L, SF-36, or WPAI scores. With few exceptions, patients with PID had significantly lower EQ-5D-5L, SF-36, and WPAI scores than healthy volunteers in all seasons. In patients with PID, disease-related symptoms and limitations of daily living persisted throughout the year, regardless of season. In conclusion, patients with PID had lower quality of life and were more socially, physically, and mentally stressed in all seasons compared with healthy individuals.

Healthcare utilization among Japanese older adults during later stage of prolonged pandemic

This study examines healthcare utilization patterns among Japan's older population (aged 75 and above) during a prolonged public health emergency, focusing on the later phase of the COVID-19 pandemic (November 2021-September 2022). This period was characterized by the Omicron variant, widespread vaccination coverage, and adapted public health measures. Using a comprehensive dataset of 189,841,257 medical claims linked with income tax records, we analyze how healthcare utilization correlates with public health measures, pandemic severity, and income levels. Our findings reveal distinct utilization patterns: moderate decreases in healthcare visits during periods of public health measures, with the association between pandemic severity and healthcare use varying based on whether these measures are in place. Despite fluctuations in visit frequency, healthcare costs remain stable, indicating consistent service intensity. While income-related differences in general healthcare access are modest, dental care shows more pronounced socioeconomic variations. These patterns suggest a transition from initial widespread healthcare avoidance to more stable healthcare engagement, indicating adaptation to prolonged crisis conditions. Our findings provide insights for maintaining healthcare access during extended public health emergencies, particularly in aging societies where balancing healthcare needs with public health measures is crucial.

Seasonal variation in intravenous broad-spectrum antimicrobial use in Japan from 2018 to 2023

BACKGROUND

To date, no studies have specifically addressed seasonal variation in the use of intravenous broad-spectrum antimicrobials. This study aimed to examine the seasonal patterns of the use of intravenous broad-spectrum antimicrobials by utilizing a nationwide Japanese infection control surveillance database.

METHODS

This retrospective cohort study extracted the days of therapy (DOT) for intravenous broad-spectrum antimicrobials and the detection rates of drug-resistant bacteria from the database between 2018 and 2023. Seasonal variation was analyzed using these values through seasonal and trend decomposition using loess.

RESULTS

The DOT for carbapenems, tazobactam/piperacillin, fourth-generation cephalosporins, and fluoroquinolones showed seasonal variation, peaking in fall. Conversely, no significant seasonal variation was observed in the DOT for anti-methicillin-resistant Staphylococcus aureus (MRSA) agents. The detection rates of Pseudomonas aeruginosa, Klebsiella aerogenes, and Enterobacter cloacae exhibited seasonal variation and peaked in fall. The detection rates of Enterococcus faecium exhibited seasonal variation as well, though no distinct peaks were observed. There was no significant seasonal variation in the detection rates of third-generation cephalosporin-resistant Escherichia coli or MRSA.

CONCLUSION

The findings of this study indicate seasonal variation in the use of intravenous broad-spectrum antimicrobials. This seasonality was likely influenced by various factors, including the detection rates of drug-resistant bacteria. The study underscores the importance of appropriate antimicrobial stewardship and interventions against drug-resistant organisms, particularly during fall.

Treatment patterns and clinical outcomes of immunocompromised patients with COVID-19 receiving remdesivir in the inpatient setting in Japan

INTRODUCTION

Remdesivir (RDV) was approved in Japan for the treatment of coronavirus disease 2019 (COVID-19) in May 2020. However, large-scale research describing the characterized use of RDV in the inpatient setting in Japan is limited. This study aimed to describe the treatment patterns and clinical outcomes of immunocompromised patients with COVID-19 treated with RDV.

METHODS

We used a secondary nationwide administrative claims database of acute care hospitals in Japan. The study period was from October 19, 2020, to September 30, 2022. Patients with COVID-19 treated with RDV during hospitalization were included, and the proportion of patients with death and disease progression were calculated.

RESULTS

The analysis included a total of 2171 immunocompromised patients treated with RDV. The mean (standard deviation) age at index date was 75.1 (13.6) years. The median time to RDV initiation from hospitalization was 1.0 days (Q1-Q3: 1.0-2.0), and the median duration of RDV treatment was 5.0 days (Q1-Q3: 3.0-5.0). At RDV initiation, 53.02% (n=1151) of patients required non-invasive positive pressure ventilation, nasal high-flow or low-flow oxygen, and 2.26% (n=49) required mechanical ventilation, extracorporeal membrane oxygenation, or intensive care unit admission. Inpatient mortality rate by day 28 was 8.98% (95% confidence interval, 7.81-10.26). By day 28, the rate of disease progression was 9.86% (n=214), and 76.83% (n=1668) were discharged.

CONCLUSION

This study presents practical information on outcomes and treatment patterns of RDV in immunocompromised inpatients diagnosed with COVID-19.

Cutaneous Adverse Events Following COVID-19 Vaccination in Japan: A Questionnaire Survey

We conducted a nationwide survey in Japan to clarify the clinical spectrum of these events. An initial questionnaire was sent to 126 dermatology facilities, and responses were obtained from 66 (52.4%). Among these responding facilities, the most commonly identified cutaneous adverse events after COVID-19 vaccination were urticaria (49 (74.2%)), delayed local reactions (37 (56.1%)), erythema multiforme (31 (47.0%)), and alopecia (30 (45.5%)). In the detailed survey, the primary adverse events were EM (19 (20.9%)), bullous pemphigoid (7 (7.7%)), and alopecia (6 (6.6%)). The mean latency from vaccination to onset was 13.1 days, and the mean duration of symptoms was 74.2 days. Although this study cannot establish a direct causal relationship between vaccination and adverse events, it highlights the need for dermatologists to recognize potential cutaneous reactions and provide appropriate care.

Lessons learned from Taiwan's response to the COVID-19 pandemic: successes, challenges, and implications for future pandemics

This study aims to provide an investigation of the containment and mitigation strategies encompassing the entirety of the pandemic in Taiwan. This descriptive, observational study used COVID-19 data from Taiwan, Japan, and South Korea, and analysed news releases from the Taiwanese health authority. Statistics provided evidence of outbreak severity through infection and mortality rates, while qualitative results from the document review offered insights on the actions taken by the government chronologically from 2 February 2020 to 31 December 2022. All three countries experienced significant infection peaks in 2022. Taiwan had two distinct peaks, one in late May and another in October. South Korea had a single, high peak in late March, while Japan experienced multiple smaller waves, the biggest wave in August. Similarly, weekly mortality rates peaked in 2022 for all three countries after a surge in their infected cases, with Taiwan (5.15/100 000) and South Korea (4.69/100 000) having higher rates than Japan (1.65/100 000). Results from qualitative analysis showed that Taiwan's early containment measures might have delayed the epidemic curve, allowing time for better preparation and proactive responses. However, the lack of a clear transition plan and the vulnerability of the elderly population contributed to higher mortality and infection rates. Despite ongoing challenges, Taiwan avoided nationwide lockdowns and relied on targeted restrictions to control transmission of the virus. Results of this article offer the narratives, reflections, and experiences from the case of Taiwan which may potentially present promising opportunities for impact in other settings and for future pandemics.

Symptoms of post COVID-19 condition and diseases/conditions diagnosed after COVID-19 in Japanese patients: A real-world study using a claims database

BACKGROUND

More than 200 symptoms of post coronavirus disease (COVID-19) condition (PCC) impacting patients' quality of life have been reported. This study describes the symptoms of well-known PCC and diseases/conditions diagnosed after COVID-19 and analyzes the trends in well-known PCC according to the epidemic waves in the Japanese population.

METHODS

Patients with a COVID-19 diagnosis in the JMDC claims database were matched 1:1 with individuals without COVID-19 diagnosis (controls) based on sex, year and month of birth, and risk factors for aggravation. The first month of COVID-19 diagnosis from January 2020-March 2022 was the index month, and the observation period was from July 2019 to 6 months from the index month (patients) and July 2019-September 2022 (controls).

RESULTS

Of 263,456 each of patients and controls after matching, 51.8 % were aged 18-49 years, 56.3 % were male, and 24.5 % had risk factors for aggravation. One in 18 patients experienced well-known PCC 2-3 months after severe acute respiratory syndrome cornonavirus 2 infection, with the highest odds ratio (OR) being for pulmonary thromboembolism (29.37), followed by smell/taste disorder (13.34) and respiratory failure (8.28). Some of the common diseases/conditions diagnosed after COVID-19 comprised those of the genitourinary system, eye and adnexa, and ear and mastoid process and certain infectious and parasitic diseases. Overall, the risk difference decreased from the first to the sixth wave, but the OR was >1.00 for most symptoms even during the sixth wave.

CONCLUSIONS

PCC symptoms showed a declining trend over time but persisted. Physicians and patients need to recognize PCC symptoms.

Effect of perceived workplace health support on absenteeism and presenteeism among Japanese workers: a prospective cohort study

OBJECTIVES

This study aimed to investigate the impact of perceived workplace health support (PWHS) on absenteeism and presenteeism among Japanese workers to determine the significance of health and productivity management in improving labor productivity.

METHODS

This prospective cohort study, using data from the Work Systems & Health Internet Research (WSHIR) study, involved 1879 Japanese workers aged 20-69 years. The intensity of PWHS was assessed using self-administered questionnaires. The participants were followed up from October 2021 to October 2022 to evaluate the incidence of absenteeism and presenteeism based on the level of PWHS.

RESULTS

The study findings revealed that higher PWHS significantly correlated with lower presenteeism, indicating better work productivity. Conversely, the relationship between PWHS and absenteeism was less clear, with no consistent trend observed across different levels of PWHS intensity.

CONCLUSIONS

Enhanced PWHS was associated with reduced presenteeism among Japanese workers, underscoring the importance of workplace health support for improving employee productivity. This finding emphasizes the need for companies to focus on health promotion activities and recognize the potential of PWHS as a performance indicator in corporate health management.

Active surveillance vs. surgery in low-risk papillary thyroid microcarcinoma patients and the risk of loss to follow-up

BACKGROUND

Papillary thyroid microcarcinoma (PTMC) management has evolved, with active surveillance (AS) gaining prominence as a management option. However, a key concern for both clinicians and patients is the potential for patient loss to follow-up during AS.

AIMS

This study aimed to determine adherence and loss-to-follow-up rates in low-risk PTMC patients undergoing AS versus surgical intervention, in order to gain insights into clinical pathways and safety profiles.

MATERIALS AND METHODS

This cohort study analyzed the 2016 data from a single registered institution of Japan's public National Cancer Registry.

RESULTS

We identified and retrospectively analyzed the cases of 327 patients diagnosed with low-risk PTMC; 227 patients chose to undergo AS while the other 100 underwent PTMC surgery. Main outcomes were the adherence rate and loss-to-follow-up rate of each group, factors influencing discontinuation, and safety considerations. The rate of AS adoption was substantial in the complete series of 327 low-risk PTMC patients (69.4%). There was a significantly higher loss-to-follow-up rate at 5 years in the AS group (28.6%) compared to the Surgery group (17.8%) (HR 1.62, 95% CI: 1.01-2.61; p = 0.046). Both univariate and multivariate analyses confirmed the significantly higher loss-to-follow-up rate in the AS group as well as in older patients. No deaths due to PTMC progression were observed in the cases lost to follow-up.

CONCLUSION

Despite concerns about loss to follow-up, active surveillance remains a safe option for low-risk PTMCs. Consistent follow-up strategies are crucial, and further research is needed to enhance patient counseling and care for the management of patients with PTMC.

One-year follow-up of the immunogenicity and safety of a primary series of the NVX-CoV2373 (TAK-019) vaccine in healthy Japanese adults: Final report of a phase I/II randomized controlled trial

BACKGROUND

In the interim report of this phase I/II randomized, placebo-controlled trial in Japanese adults, a two-dose primary series of NVX-CoV2373 (5 µg SARS-CoV-2 recombinant nanoparticle spike protein [rS]; 50 µg Matrix-M) administered 21 days apart induced robust anti-SARS-CoV-2 immune responses up to day 50 and had an acceptable safety profile.

METHODS

Following the double-blind phase of this study (day 1-50), participants were informed about their assignment to NVX-CoV2373 or placebo, and their reconsent was required for continuation in the open-label phase (day 51-387). This final report evaluated immunogenicity on days 202 and 387, and safety findings from the 1-year follow-up.

RESULTS

In total, 131/150 participants in the NVX-CoV2373 arm and 4/50 in the placebo arm completed the study. The most common reason for discontinuation was because the participant requested a publicly available COVID-19 vaccine. At 6 months and 1 year after the second vaccine dose, both the geometric mean titres of anti-SARS-CoV-2 rS serum immunoglobulin G and serum neutralizing antibodies against the SARS-CoV-2 ancestral strain were numerically higher than before the second dose. There were no deaths, adverse events (AEs) leading to participant withdrawal, or AEs of special interest throughout the trial. During follow-up, 2.0 % (1/50) of participants in the placebo arm reported COVID-19 approximately 1 month after the second vaccine dose (serious AE requiring hospitalisation, already presented in the interim report) and 2.7 % (4/150) in the NVX-CoV2373 arm after approximately 10 months (mild [2/4] or moderate [2/4] in severity).

DISCUSSION

A primary series of NVX-CoV2373 induced persistent immune responses up to 1 year after the second dose. The vaccine was well tolerated and had an acceptable safety profile. We believe our findings offer important insights for determining dosing intervals between primary and booster vaccinations.

The International Transfer of Patients With Positive SARS-CoV-2 Test Using a Framework

The Japanese Fellowship Program at the U.S. Naval Hospital Yokosuka has served as a liaison with Japanese hospitals during the transfer of acutely ill U.S. Navy patients since 1952. The SARS-CoV-2 pandemic has complicated this process and prompted the creation of a new framework that involves the Public Health Center. We present two international transfer cases of patients with positive SARS-CoV-2. The creation of a framework enabled a safe and smooth transfer process of patients with a favorable outcome. This report can help guide future cases of international transfer, especially for patients who need infectious disease surveillance. To our knowledge, we describe the first report of an international transfer of patients with positive SARS-CoV-2 test using a framework.

Bridging the Language Gap: The Role of Human-Mediated Translation in Japanese Medical Settings

Introduction Foreign residents in Japan often face challenges accessing healthcare due to language barriers, potentially leading to health inequities. This study aimed to assess the utilization and impact of human-mediated translation services in a specific medical setting in Tokyo. Methods A retrospective investigation was conducted on medical records of foreign patients who utilized human-mediated translation services at Navitas Clinic Tachikawa (Tachikawa, Tokyo, Japan) from November 2017 to December 2021. Data on age, gender, language used, department visited, diagnosis, insurance status, and booking methods were analyzed. Results Out of the 124 foreign patients who utilized the human-mediated translation services during the study period, 69 (56%) were male, and 55 (44%) were female. The median age was 35 years, with a range from 3 to 61 years. English was the predominant language used by 34 patients (59%), followed by Chinese for nine patients (16%) and Spanish for four patients (7%). The majority, 107 patients (86%) visited the internal medicine department, nine patients (7%) consulted dermatology, and six patients (5%) visited pediatrics. Regarding insurance status, 47 patients (81%) were insured, three patients (5%) were uninsured by the Japanese national health insurance system, and eight patients (14%) were self-pay. The primary mode of appointment booking was at the reception desk, with 112 patients (90%) using this method, while 12 patients (10%) made reservations online. Conclusions The findings of this study underscore the importance of human-mediated translation services for improving healthcare accessibility for foreign residents in Japan, emphasizing the need to address language barriers and promote health equity in clinical settings. Future studies should also explore challenges faced in patient-physician interactions from a linguistic perspective and potential technological solutions to enhance these services.

Peculiar weather patterns effects on air pollution and COVID-19 spread in Tokyo metropolis

As a pandemic hotspot in Japan, between March 1, 2020-October 1, 2022, Tokyo metropolis experienced seven COVID-19 waves. Motivated by the high rate of COVID-19 incidence and mortality during the seventh wave, and environmental/health challenges we conducted a time-series analysis to investigate the long-term interaction of air quality and climate variability with viral pandemic in Tokyo. Through daily time series geospatial and observational air pollution/climate data, and COVID-19 incidence and death cases, this study compared the environmental conditions during COVID-19 multiwaves. In spite of five State of Emergency (SOEs) restrictions associated with COVID-19 pandemic, during (2020-2022) period air quality recorded low improvements relative to (2015-2019) average annual values, namely: Aerosol Optical Depth increased by 9.13% in 2020 year, and declined by 6.64% in 2021, and 12.03% in 2022; particulate matter PM2.5 and PM10 decreased during 2020, 2021, and 2022 years by 10.22%, 62.26%, 0.39%, and respectively by 4.42%, 3.95%, 5.76%. For (2021-2022) period the average ratio of PM2.5/PM10 was (0.319 ± 0.1640), showing a higher contribution to aerosol loading of traffic-related coarse particles in comparison with fine particles. The highest rates of the daily recorded COVID-19 incidence and death cases in Tokyo during the seventh COVID-19 wave (1 July 2022-1 October 2022) may be attributed to accumulation near the ground of high levels of air pollutants and viral pathogens due to: 1) peculiar persistent atmospheric anticyclonic circulation with strong positive anomalies of geopotential height at 500 hPa; 2) lower levels of Planetary Boundary Layer (PBL) heights; 3) high daily maximum air temperature and land surface temperature due to the prolonged heat waves (HWs) in summer 2022; 4) no imposed restrictions. Such findings can guide public decision-makers to design proper strategies to curb pandemics under persistent stable anticyclonic weather conditions and summer HWs in large metropolitan areas.

Insights into the Impact of Hesitancy on Cancer Care and COVID-19

World Health Organization findings indicate that the COVID-19 pandemic adversely affected cancer diagnosis and management. The COVID-19 pandemic disrupted the optimal management of outpatient appointments, scheduled treatments, and hospitalizations for cancer patients because of hesitancy among patients and health-care providers. Travel restrictions and other factors likely affected medical, surgical, and radiation treatments during the COVID-19 pandemic. Cancer patients were more likely to be affected by severe illness and complications if they contracted COVID-19. A compromised immune system and comorbidities in cancer patients may have contributed to this increased risk. Hesitancy or reluctance to receive appropriate therapy or vaccination advice might have played a major role for cancer patients, resulting in health-care deficits. The purpose of this review is to evaluate the impact of COVID-19 on screening, entry into clinical trials, and hesitancy among patients and health-care professionals, limiting adjuvant and metastatic cancer treatment.