Yoshiki Kawamura

OBJECTIVE: To elucidate the trends and clinical features of virologically diagnosed breakthrough varicella (BV) 9 years after implementation of the universal vaccination program in Japan. PATIENTS AND METHODS: Study participants were patients with suspected varicella less than 15 years of age who visited 1 of 15 pediatric clinics in the Nagoya VZV Study Group between September 2015 and August 2023. Practitioners collected patient samples and information such as background characteristics, clinical symptoms, and immunization status. All patients had varicella confirmed by real-time polymerase chain reaction assays. RESULTS: Of 719 patients with suspected varicella, 512 had laboratory-diagnosed varicella and available information on vaccination status. They were divided into 3 groups: 167 with natural varicella, 250 with BV and 1 dose of vaccine, and 95 with BV and 2 doses. The monthly number of patients with varicella decreased gradually during the observation period. Typical seasonal peaks were observed until the 2019-2020 season. The proportion of patients with BV, particularly BV after 2 doses of vaccine, gradually increased. Patients with BV and 2 doses had a significantly lower median age (5 years) than those with 1 dose (6 years) (p < 0.001). The transmission route for BV was unknown in approximately 30-50 % of patients. Duration of fever was significantly longer (p = 0.0138) and the number of skin eruptions was also significantly higher (p = 0.0013) in the 1-dose group than in the 2-dose group. CONCLUSIONS: Although the number of pediatric patients with varicella declined after implementation of national immunization with 2 doses of varicella vaccine, the proportion of patients with BV, especially those who received 2 doses, gradually increased. Clinical symptoms were significantly milder in patients with BV and 2 doses. Laboratory diagnosis of varicella is becoming increasingly important due to an increase in the proportion of patients with BV who have mild symptoms.

ABSTRACT The recent clinical features of Epstein‐Barr virus (EBV) and cytomegalovirus (CMV) infections in young children in developed countries remain unclear. This study investigated the clinical features of EBV and CMV infections and the latest seroepidemiology in Japan. Seroprevalence was analyzed 303 stored serum samples using commercial Enzyme Immunosorbent Assay kits, and viral infections were investigated in a cohort of febrile children under 5 years of age. After maternal antibody levels declined, the seroprevalences of EBV and CMV gradually increased by adolescence to 42.9% and 57.1%, respectively. Among 2,732 febrile children, serum EBV and CMV DNAs were detected in 1.76% and 1.24%, respectively. Of 25 primary EBV–infected patients, 15 (60.0%) had infectious mononucleosis (IM) with significantly higher IM frequency, WBC, atypical lymphocyte ratios, AST, ALT, LDH, and EBV DNA load compared to EBV–reactivated patients. No CMV DNA–positive patients had IM. Among primary EBV–infected patients, those with IM were older and had more atypical lymphocytes and higher EBV DNA load than those without IM. The age of primary EBV infection appears to have decreased compared to reports from Western countries in the 1990s. Even among children under 5 years of age, 60.0% of those with primary EBV infection developed IM.

ABSTRACT Human herpesvirus 6B (HHV‐6B) encephalitis is a rare but severe complication of hematopoietic cell transplantation. This study investigated the pathogenesis of HHV‐6B encephalitis by comparing plasma proteomic profiles of four pediatric patients with HHV‐6B encephalitis to three with asymptomatic HHV‐6B reactivation following umbilical cord blood transplantation (UCBT). Plasma proteomic profiling was conducted using liquid chromatography‐mass spectrometry. Overall, 260 proteins were identified and quantified in plasma samples. At the onset of HHV‐6B encephalitis and asymptomatic reactivation, 20 and 24 proteins, respectively, were significantly upregulated compared to their respective pre‐onset levels. Of these, 11 proteins were uniquely upregulated in HHV‐6B encephalitis. S100‐A9 and S100‐A8 were the most and second‐most upregulated proteins in HHV‐6B encephalitis, respectively. Elevated plasma S100A8/A9 heterodimer levels were confirmed via enzyme‐linked immunosorbent assay in three of the four patients with HHV‐6B encephalitis. Pathway analysis identified neutrophil degranulation as the most enriched category among upregulated proteins in HHV‐6B encephalitis. Additionally, proteins related to the protein‐lipid complex remodeling pathway were more prominently upregulated in HHV‐6B encephalitis than in asymptomatic reactivation. Proteomic analysis revealed distinct plasma protein profiles between HHV‐6B encephalitis and asymptomatic HHV‐6B reactivation in pediatric UCBT recipients. The inflammatory response mediated by S100A8/A9 proteins may play a critical role in the pathogenesis of HHV‐6B encephalitis. These findings indicate that proteomic analysis may provide novel insights into the host response to HHV‐6B reactivation and the subsequent development of HHV‐6B encephalitis.