Behavioral factors associated with SARS-CoV-2 infection in Japan.

BACKGROUND: The relative burden of COVID-19 has been less severe in Japan. One reason for this may be the uniquely strict restrictions imposed upon bars/restaurants. To assess if this approach was appropriately targeting high-risk individuals, we examined behavioral factors associated with SARS-CoV-2 infection in the community. METHODS: This multicenter case-control study involved individuals receiving SARS-CoV-2 testing in June-August 2021. Behavioral exposures in the past 2 weeks were collected via questionnaire. SARS-CoV-2 PCR-positive individuals were cases, while PCR-negative individuals were controls. RESULTS: The analysis included 778 individuals (266 [34.2%] positives; median age [interquartile range] 33 [27-43] years). Attending three or more social gatherings was associated with SARS-CoV-2 infection (adjusted odds ratio [aOR] 2.00 [95% CI 1.31-3.05]). Attending gatherings with alcohol (aOR 2.29 [1.53-3.42]), at bars/restaurants (aOR 1.55 [1.04-2.30]), outdoors/at parks (aOR 2.87 [1.01-8.13]), at night (aOR 2.07 [1.40-3.04]), five or more people (aOR 1.81 [1.00-3.30]), 2 hours or longer (aOR 1.76 [1.14-2.71]), not wearing a mask during gatherings (aOR 4.18 [2.29-7.64]), and cloth mask use (aOR 1.77 [1.11-2.83]) were associated with infection. Going to karaoke (aOR 2.53 [1.25-5.09]) and to a gym (aOR 1.87 [1.11-3.16]) were also associated with infection. Factors not associated with infection included visiting a cafe with others, ordering takeout, using food delivery services, eating out by oneself, and work/school/travel-related exposures including teleworking. CONCLUSIONS: We identified multiple behavioral factors associated with SARS-CoV-2 infection, many of which were in line with the policy/risk communication implemented in Japan. Rapid assessment of risk factors can inform decision making

Coronavirus Disease 19 (COVID-19) Vaccine Effectiveness Against Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection During Delta-Dominant and Omicron-Dominant Periods in Japan: A Multicenter Prospective Case-control Study (Factors Associated with SARS-CoV-2 Infection and the Effectiveness of COVID-19 Vaccines Study)

Background. Although several coronavirus disease 2019 (COVID-19) vaccines initially showed high efficacy, there have been concerns because of waning immunity and the emergence of variants with immune escape capacity.Methods. A test-negative design case-control study was conducted in 16 healthcare facilities in Japan during the Deltadominant period (August-September 2021) and the Omicron-dominant period (January-March 2022). Vaccine effectiveness (VE) against symptomatic severe acute respiratory syndrome coronavirus 2 infection was calculated for 2 doses for the Deltadominant period and 2 or 3 doses for the Omicron-dominant period compared with unvaccinated individuals.Results. The analysis included 5795 individuals with 2595 (44.8%) cases. Among vaccinees, 2242 (55.8%) received BNT162b2 and 1624 (40.4%) received messenger RNA (mRNA)-1273 at manufacturer-recommended intervals. During the Delta-dominant period, VE was 88% (95% confidence interval [CI], 82–93) 14 days to 3 months after dose 2 and 87% (95% CI, 38–97) 3 to 6 months after dose 2. During the Omicron-dominant period, VE was 56% (95% CI, 37–70) 14 days to 3 months since dose 2, 52% (95% CI, 40–62) 3 to 6 months after dose 2, 49% (95% CI, 34–61) 6+ months after dose 2, and 74% (95% CI, 62–83) 14+ days after dose 3. Restricting to individuals at high risk of severe COVID-19 and additional adjustment for preventive measures (ie, mask wearing/high-risk behaviors) yielded similar estimates, respectively.Conclusions. In Japan, where most are infection-naïve, and strict prevention measures are maintained regardless of vaccination status, 2-dose mRNA vaccines provided high protection against symptomatic infection during the Delta-dominant period and moderate protection during the Omicron-dominant period. Among individuals who received an mRNA booster dose, VE recovered to a high level

COVID-19 vaccine effectiveness against severe COVID-19 requiring oxygen therapy, invasive mechanical ventilation, and death in Japan: A multicenter case-control study (MOTIVATE study).

INTRODUCTION: Since the SARS-CoV-2 Omicron variant became dominant, assessing COVID-19 vaccine effectiveness (VE) against severe disease using hospitalization as an outcome became more challenging due to incidental infections via admission screening and variable admission criteria, resulting in a wide range of estimates. To address this, the World Health Organization (WHO) guidance recommends the use of outcomes that are more specific to severe pneumonia such as oxygen use and mechanical ventilation. METHODS: A case-control study was conducted in 24 hospitals in Japan for the Delta-dominant period (August-November 2021; "Delta") and early Omicron (BA.1/BA.2)-dominant period (January-June 2022; "Omicron"). Detailed chart review/interviews were conducted in January-May 2023. VE was measured using various outcomes including disease requiring oxygen therapy, disease requiring invasive mechanical ventilation (IMV), death, outcome restricting to "true" severe COVID-19 (where oxygen requirement is due to COVID-19 rather than another condition(s)), and progression from oxygen use to IMV or death among COVID-19 patients. RESULTS: The analysis included 2125 individuals with respiratory failure (1608 cases [75.7%]; 99.2% of vaccinees received mRNA vaccines). During Delta, 2 doses provided high protection for up to 6 months (oxygen requirement: 95.2% [95% CI:88.7-98.0%] [restricted to "true" severe COVID-19: 95.5% {89.3-98.1%}]; IMV: 99.6% [97.3-99.9%]; fatal: 98.6% [92.3-99.7%]). During Omicron, 3 doses provided high protection for up to 6 months (oxygen requirement: 85.5% [68.8-93.3%] ["true" severe COVID-19: 88.1% {73.6-94.7%}]; IMV: 97.9% [85.9-99.7%]; fatal: 99.6% [95.2-99.97]). There was a trend towards higher VE for more severe and specific outcomes. CONCLUSION: Multiple outcomes pointed towards high protection of 2 doses during Delta and 3 doses during Omicron. These results demonstrate the importance of using severe and specific outcomes to accurately measure VE against severe COVID-19, as recommended in WHO guidance in settings of intense transmission as seen during Omicron

歯科・口腔外科的手術後の耳鼻咽喉科的合併症に対する内視鏡下鼻内手術の3例

口腔インプラント治療における最も重篤な合併症は上顎洞炎である．インプラント治療後に生じた上顎洞炎に対して，歯科・口腔外科領域ではまず抗生物質の投与が行われる．口腔内から上顎洞を開放し洞内を洗浄する歯科・口腔外科医もいないわけではないが，長期にわたって漫然と抗生物質が投与されていることが珍しくない．短期に上顎洞炎が消褪しなければ埋入したインプラントが脱落することもある．口腔インプラント治療によって引き起こされた上顎洞炎に対する手術治療としては，下鼻道側壁に対孔を設置する手術が行われることがある．しかしこの手術は上顎洞の生理を無視した治療法である．上顎洞内の粘液は中鼻道の篩骨漏斗に開いている自然孔を通じて鼻内に排泄される．この自然孔を開大してこの部位に排泄孔を設置するのが最も自然な治療法である．口腔インプラント治療に関連して生じた上顎洞炎の根治的治療として歯科・口腔外科領域でよく行われるCaldwell-Luc手術では上顎洞内の粘膜が全摘される．露出した上顎洞内の骨面には感染した肉芽組織が増生する．この肉芽組織は瘢痕となり，やがて骨組織で置換される．つまり上顎洞腔が消失する．上顎骨の変形も避けられない．本論文では，耳鼻咽喉科領域で広く行われている内視鏡下鼻内副鼻腔手術によって治療を行った，口腔インプラント治療後に上顎洞炎が併発した2症例と上顎の第三大臼歯の抜歯後に生じた口腔上顎瘻の1症例を報告する．原因が何であれ，上顎洞炎が遷延する原因は上顎洞自然孔の閉塞である．上顎洞自然孔を通じた上顎洞の換気と排泄機能が改善されれば上顎洞炎は治癒する．内視鏡下鼻内副鼻腔手術は上顎洞に元々存在するこの機能を回復させる生理的な治療である．また，Caldwell-Luc手術よりも侵襲が少ない．ただし本手術は十分な修練を積んだ耳鼻咽喉科医でなければ安全に行うことができない．歯科・口腔外科領域の疾患や治療によって上顎洞炎が生じることは珍しくないが，その治療に耳鼻咽喉科医が積極的に参加することを提案したい．Maxillary sinusitis is one of the most serious complications associated with dental implantation. When local dental treatment with or without antibiotics is not effective, Caldwell-Luc operation is often performed by an oral surgeon. We propose that endoscopic sinus surgery should be employed more widely as the first surgical treatment of choice for odontogenic maxillary sinusitis. This surgery aims to restore ventilation and drainage of paranasal sinuses by correcting the anatomical structures in the nasal cavity and paranasal sinuses intranasally. Unlike Caldwell-Luc procedure, the mucosa in the maxillary sinus is not totally removed; only highly polypous tissue is removed without exposing its bone surface. Resection of infected foci in the alveolar ridge or maxillary floor, when necessary, can be achieved intraorally both during or after endonasal sinus surgery. Postoperative care of irrigating the maxillary sinus with a saline solution at home is usually sufficient to eliminate the inflammation. Aeration of the maxillary sinus is restored without its deformation. Thus, endoscopic sinus surgery is much less invasive and more physiologic, as compared with the classic Caldwell-Luc operation. However, this surgery can be performed safely and securely only by an experienced and trained otolaryngologist. The authors strongly advocate a close collaboration between the dentist or oral surgeon and the otolaryngologist in treating maxillary sinusitis that develops in association with dental illness or treatment such as apical periodontitis, tooth extraction, and implantation. Three illustrative cases are reported

Propagation of Rhinovirus C in Differentiated Immortalized Human Airway HBEC3-KT Epithelial Cells

Rhinoviruses (RVs) are classified into three species: RV-A, B, and C. Unlike RV-A and -B, RV-C cannot be propagated using standard cell culture systems. In order to isolate RV-Cs from clinical specimens and gain a better understanding of their biological properties and pathogenesis, we established air–liquid-interface (ALI) culture methods using HBEC3-KT and HSAEC1-KT immortalized human airway epithelial cells. HBEC3- and HSAEC1-ALI cultures morphologically resembled pseudostratified epithelia with cilia and goblet cells. Two fully sequenced clinical RV-C isolates, RV-C9 and -C53, were propagated in HBEC3-ALI cultures, and increases in viral RNA ranging from 1.71 log10 to 7.06 log10 copies were observed. However, this propagation did not occur in HSAEC1-ALI cultures. Using the HBEC3-ALI culture system, 11 clinical strains of RV-C were isolated from 23 clinical specimens, and of them, nine were passaged and re-propagated. The 11 clinical isolates were classified as RV-C2, -C6, -C9, -C12, -C18, -C23, -C40, and -C53 types according to their VP1 sequences. Our stable HBEC3-ALI culture system is the first cultivable cell model that supports the growth of multiple RV-C virus types from clinical specimens. Thus, the HBEC3-ALI culture system provides a cheap and easy-to-use alternative to existing cell models for isolating and investigating RV-Cs

歯科インプラント術後におこりえる上顎洞炎に対する，術前に行う鼻内視鏡手術

Penetration of the maxillary sinus floor membrane during sinus lift occasionally induces maxillary sinusitis. However, maxillary sinusitis may still develop even when its floor membrane has been kept intact during such procedures. The decisive factor for the occurrence of maxillary sinusitis is not the integrity of the membrane ; more important is the patency of the maxillary sinus natural ostium. The occlusion of the natural ostium presumably results from the expansive edema of the sinus membrane induced by surgical manipulations to the maxillary sinus floor. We propose a minimally invasive endoscopic sinus surgery which conceivably is useful to prevent potential occlusion of the natural ostium associated with maxillary sinus floor augmentation procedures. Although our technique is not a new concept, this is the first report to propose this kind of procedure as an adjunct to dental implantation. Our method is cost-effective and can be performed under topical anesthesia as a same-day surgery. In addition, it brings about no serious complications, such as orbital injuries or cerebrospinal fluid leakage. It aims to correct anatomical deviations, such as septal deviation, concha bullosa, hypertrophied uncinate process, and excessively pneumatized ethmoid bulla, all of which precipitate the occlusion of the natural ostium. Our method consists of a combination of resection of the uncinate process, widening of the natural ostium, and excision of the anterior and inferior edge of the middle turbinate. First, the anterior and inferoposterior segments of the uncinate process are resected with a curved rongeur, leaving the agger nasi cell intact (caution must be exercised to avoid injury to the nasolacrimal duct). This enables visualization of the maxillary natural ostium. The ostium is widened in all directions, using a forceps and/or a scalpel. The resultant widened ostium is bordered anteriorly by the nasolacrimal duct, inferiorly by the base of the inferior turbinate, posteriorly by the anterior surface of the ethmoid bulla, and superiorly by the medio-inferior angle of the orbit. Then the anterior and inferior edge of the middle turbinate is trimmed to prevent its adhesion to the lateral nasal wall or narrowing of the middle meatus. This surgery does not cause cerebrospinal fluid leakage and, at the same time, minimizes the risk for olfactory dysfunction. The antrostomy window thus formed is large enough to secure drainage and ventilation of the maxillary sinus. Moreover, the middle meatus, now deprived of the antero-inferior aspect of the middle turbinate, enables the patient to irrigate the maxillary sinus with a saline solution at home. Septal deviation can also be corrected simultaneously, if postoperative packing of bilateral nasal cavities is tolerable to the patient. Our experiences in treating over 100 patients are encouraging; although postoperative care such as irrigation of the maxillary sinus at home was mandatory and the start of dental implantation was delayed for 2-6 months, no patient who underwent surgery at our clinic developed maxillary sinusitis during the following course of dental implantation. We believe that collaboration between the otorhinolaryngologist and the dentist/oral surgeon is required to minimize the risk of maxillary sinusitis associated with dental implantation in the maxilla.上顎のインプラント治療の合併症として最も頻度が高いのは上顎洞炎である．インプラント治療によって上顎洞底の粘膜に穿孔が生じても必ずしも上顎洞炎が生じる訳ではない．逆に，上顎洞底粘膜に穿孔が生じなくとも上顎洞炎が起きることがある．上顎のインプラント治療後に上顎洞炎が生じるかどうかを決定するのは，上顎洞自然孔である．上顎洞底挙上術などによって生じる洞内の粘膜の浮腫が自然孔にまで及び，自然孔が閉塞されたならば上顎洞炎が生じる．上顎洞自然孔の鼻腔側は鈎状突起や篩骨胞に挟まれており，軽度の粘膜浮腫によっても閉塞されやすい．鈎状突起の過剰発育，篩骨胞の過剰な含気化，中甲介の含気化や外側への彎曲などが認められる患者では，上顎洞自然孔周囲の粘膜浮腫によって一層，自然孔が閉塞されやすい．したがって上顎洞底挙上術を行う場合には，あらかじめこれらのリスクファクターを除去しておくのが好ましい．今回我々は，日帰り手術が可能な保存的な内視鏡下手術を提案する．鈎状突起の下方から後方を切除して上顎洞自然孔を明視下に置き，上顎洞自然孔を四方に広げる．このようにして開大されたウィンドウの前縁は鼻涙管隆起の後縁，上縁は眼窩下壁・内側壁移行部，後縁は篩骨胞の前面，そして下縁は下甲介の付着部になる．次いで，中鼻道前端付近のスペースを確保するために中甲介の前縁〜前下方をトリミングする．本術式は重篤な合併症が生じにくい．手術侵襲も少なく，上顎洞内に高度の病変が認められない症例では，上顎洞底挙上術を行う前の上顎洞炎予防処置として優れた術式と考えられる．ただし，高度の鼻中隔彎曲症がある症例には本手術は適さない