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More than a year into the coronavirus-19 pandemic, intensified infection control measures have controlled most viral respiratory infections in Tokyo, Japan. As of July 2021, however, an unusually high number of respiratory syncytial virus infections were reported in Tokyo. This resurgence may have resulted from restarting social activities for children.

Background Like other countries, Japan experiences a seasonal influenza epidemic every year. In order to return to school after a influenza-related absence, most Japanese students are required to submit a recovery certificate ( chiyu-shoumeisyo in Japanese). The objective of this study was to estimate the economic consequences of this practice. Methods A cost analysis was conducted to estimate the additional costs incurred by the issuance of recovery certificates from a restricted societal perspective. The estimated number of influenza patients under 15 years old from the 2013/14 season to the 2017/18 season, the proportion of working mothers were used to calculate the estimated total number of recovery certificates issued per year. The cost of return visits to physicians and the cost for issuing certificates were included in the direct costs. Productivity loss was estimated using the mean monthly salary of women and was included in indirect costs. Results The recovery certificate policy imposed an additional cost of 0.94 million USD per one million population. One-way deterministic sensitivity analysis demonstrated that the additional cost of the recovery certificate policy amounted to between 0.55 and 2.27 million USD per one million population. Probabilistic sensitivity analysis showed similar results. Conclusions The recovery certificate policy has a substantial negative economic impact on the Japanese healthcare system and society from a restricted societal perspective.

Background This study aimed to make a quantitative assessment of the management of influenza-like illnesses (ILI) in Japanese healthcare settings. Methods We analysed participants’ healthcare-seeking behaviour and physicians’ practice in January 2019 using an online survey of 200 households in Japan. Quality of life score, quality-adjusted life years lost, the duration of symptoms, and the duration of absence from work were compared between the influenza ILI group and the non-influenza ILI group with one-to-one propensity score matching. Missing data were imputed using multiple imputation. Results In total, 261 of the 600 (43.5%) participants had at least one episode of influenza-like illness during January 2019. Of these, 194 (75.5%) visited healthcare facilities, 167 (86.1%) within 2 days of onset of symptoms. A total of 169 out of 191 (88.5%) received a rapid influenza diagnostic test and 101 were diagnosed with influenza, of whom 95.0% were treated with antivirals. The median quality-adjusted life-years (QALYs) lost was 0.0055 (interquartile range, IQR 0.0040–0.0072) and median absence from work for a single episode of influenza-like illness was 2 days (IQR 1–5 days). Albeit QALYs lost per episode was not different between two groups, the influenza ILI group showed longer duration of absence from work (5 days, IQR 4–6 days) than the non-influenza ILI group (2 days, IQR 1–3 days). Conclusions In Japan, most people with influenza-like illnesses visit healthcare facilities soon after symptoms first occur and receive a diagnostic test. Those with influenza are usually treated with antivirals. Absence from work was longer for influenza than other similar illnesses.

Background Evidence regarding a preventive impact of antiviral medication for influenza on hospitalization or mortality among non-severe cases is scarce. The objective of this study was to assess the association between the use of antiviral medications in non-hospitalized patients with influenza and their subsequent hospitalization and mortality. Methods This multi-center retrospective cohort study used TriNetX, a global database to assess the clinical impact of antiviral medications (oseltamivir, laninamivir, zanamivir, peramivir, and baloxavir) for influenza among non-hospitalized patients. The outcomes included hospitalization, emergency department visit, intensive care unit (ICU) admission, and mortality between 3 and 30 days following influenza diagnosis with the 2-day window period between diagnosis and antiviral administration. Propensity score matching with a 1:1 ratio was conducted to estimate the risk ratio (RR). Results A total of 1,016,581 patients with influenza were identified. After matching, 426,275 patients from each cohort were compared. The antiviral-treated group was associated with lower risks of hospitalization (RR 0.91; 95% confidence interval 0.85–0.95; p  < 0.001); emergency department visits (RR 0.80; 95% CI 0.79–0.82; p  < 0.001), ICU admission (RR 0.84; 95% CI 0.73–0.97; p  = 0.016); and mortality (RR 0.60; 95% CI 0.47–0.77; p  < 0.001). The sensitivity analysis revealed that the statistical significance in hospitalization was maintained by replacing the 2-day window period with 0 days (RR 0.82; 95% CI 0.79–0.84; p  < 0.001). The sensitivity analysis limited to those aged 2 to 64 years without any high-risk comorbidities in the antiviral-treated group compared to the antiviral-untreated group showed fewer outcome events for hospitalization (RR 0.76; 95% CI 0.68–0.85; p  < 0.001); ED visit (RR 0.68; 95% CI 0.65–0.71; p  < 0.001); and ICU admission (RR 0.48; 95% CI 0.30–0.78; p  = 0.002). Conclusions Antiviral treatment was negatively associated with hospitalization, ICU admission, and mortality. The results need to be interpreted with caution, given limitations.

Background The empirical basis for a quantitative assessment of the disease burden imposed by long-COVID is currently scant. We aimed to inform the disease burden caused by long-COVID in Japan. Methods We conducted a cross sectional self-report questionnaire survey. The questionnaire was mailed to 526 eligible patients, who were recovered from acute COVID-19 in April 2021. Answers were classified into two groups; participants who have no symptom and those who have any ongoing prolonged symptoms that lasted longer than four weeks at the time of the survey. We estimated the average treatment effect (ATE) of ongoing prolonged symptoms on EQ-VAS and EQ-5D-3L questionnaire using inverse probability weighting. In addition to symptom prolongation, we investigated whether other factors (including demography, lifestyle, and acute severity) were associated with low EQ-VAS and EQ-5D-3L values, by multivariable linear regression. Results 349 participants reported no symptoms and 108 reported any symptoms at the time of the survey. The participants who reported any symptoms showed a lower average value on the EQ-VAS (69.9 vs 82.8, respectively) and on the EQ-5D-3L (0.85 vs 0.96, respectively) than those reporting no symptoms considering the ATE of ongoing prolonged symptoms. The ATE of ongoing prolonged symptoms on EQ-VAS was − 12.9 [95% CI − 15.9 to − 9.8], and on the EQ-5D-3L it was − 0.11 [95% CI − 0.13 to − 0.09], implying prolonged symptoms have a negative impact on patients’ EQ-VAS and EQ-5D-3L score. In multivariable linear regression, only having prolonged symptoms was associated with lower scores (− 11.7 [95% CI − 15.0 to − 8.5] for EQ-VAS and − 0.10 [95% CI − 0.13 to − 0.08] for EQ-5D-3L). Conclusions Due to their long duration, long-COVID symptoms represent a substantial disease burden expressed in impact on health-related quality of life.

ObjectivesTo investigate the risk factors contributing to severity on admission. Additionally, risk factors of worst severity and fatality were studied. Moreover, factors were compared based on three points: early severity, worst severity and fatality.DesignAn observational cohort study using data entered in a Japan nationwide COVID-19 inpatient registry, COVIREGI-JP.SettingAs of 28 September 2020, 10480 cases from 802 facilities have been registered. Participating facilities cover a wide range of hospitals where patients with COVID-19 are admitted in Japan.ParticipantsParticipants who had a positive test result on any applicable SARS-CoV-2 diagnostic tests were admitted to participating healthcare facilities. A total of 3829 cases were identified from 16 January to 31 May 2020, of which 3376 cases were included in this study.Primary and secondary outcome measuresPrimary outcome was severe or nonsevere on admission, determined by the requirement of mechanical ventilation or oxygen therapy, SpO2 or respiratory rate. Secondary outcome was the worst severity during hospitalisation, judged by the requirement of oxygen and/orinvasive mechanical ventilation/extracorporeal membrane oxygenation.ResultsRisk factors for severity on admission were older age, men, cardiovascular disease, chronic respiratory disease, diabetes, obesity and hypertension. Cerebrovascular disease, liver disease, renal disease or dialysis, solid tumour and hyperlipidaemia did not influence severity on admission; however, it influenced worst severity. Fatality rates for obesity, hypertension and hyperlipidaemia were relatively lower.ConclusionsThis study segregated the comorbidities influencing severity and death. It is possible that risk factors for severity on admission, worst severity and fatality are not consistent and may be propelled by different factors. Specifically, while hypertension, hyperlipidaemia and obesity had major effect on worst severity, their impact was mild on fatality in the Japanese population. Some studies contradict our results; therefore, detailed analyses, considering in-hospital treatments, are needed for validation.Trial registration numberUMIN000039873. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045453

Purpose For future health technology assessment, an assessment of the utility value of influenza-like illnesses (ILIs) is crucial. Therefore, the objective of this study was to evaluate the impact of ILIs on utility value in a Japanese population. Methods We conducted an online survey between March and June 2024 to evaluate the impacts of ILIs on health-related quality of life, using a Japanese version of the EuroQol 5 Dimensions 5 Levels (EQ-5D-5 L) and EuroQol visual analog scale (EQ-VAS). Participants were children and adults aged < 80 years who experienced ILI symptoms or required home isolation due to a respiratory infection. A follow-up survey was conducted 2–3 weeks after the first survey to assess recovery. For children, we asked their parents or guardians to answer as the child’s proxy. A generalized linear model was used to assess the impact of patient demographics, type and onset of symptoms and diagnosis on disutility. Results In total, 392 participants answered the first survey, and 264 participants answered the follow-up survey (134 adult participants and 130 parents or guardians). Compared with those who only answered the first survey, those who also answered the follow-up survey were older and more likely to be male in adult participants. The mean differences in the utility value and VAS scores between the first and follow-up surveys were − 0.055 and − 10.6 in the adult samples and − 0.079 and − 17.9 in the pediatric samples, respectively. In the generalized linear model, symptom onset within 7 days in the first survey was significantly associated with disutility value (coefficient − 0.049 [95% confidence interval [CI] − 0.086 to − 0.012], p  = 0.010). However, none of the patient demographics were significantly associated with disutility value. Conclusion Utility values were lower during the symptomatic phase compared with the recovery phase. Our results are useful for disease burden assessment, health technology assessment, and cost-effectiveness analysis, which can support decision-making on the preventive and therapeutic management of respiratory infections. Plain English summary Influenza-like illnesses, the so-called common cold, are a non-negligible cause of disease burden worldwide. As quantitative disease burden assessments for these diseases have not been established in Japan, the aim of this study was to do it. Questionnaire surveys showed that health state utility value, a value representing a health state on a scale from 0 (death) to 1 (perfect health), was on average 0.055 and 0.079 lower during symptoms of influenza-like illnesses than after recovery in adults and children, respectively. The results of this study can be applied to the evaluation of future infectious disease control measures, such as vaccinaion policies, school closure, movement restrictions, and so forth.

The risk factors specific to the elderly population for severe coronavirus disease 2019 (COVID-19) caused by the Omicron variant of concern (VOC) are not yet clear. We performed an exploratory analysis using logistic regression to identify risk factors for severe COVID-19 illness among 4,868 older adults with a positive severe acute respiratory coronavirus 2 (SARS-CoV-2) test result who were admitted to a healthcare facility between 1 January 2022 and 16 May 2022. We then conducted one-to-one propensity score (PS) matching for three factors – dementia, admission from a long-term care facility and poor physical activity status – and used Fisher's exact test to compare the proportion of severe COVID-19 cases in the matched data. We also estimated the average treatment effect on treated (ATT) in each PS matching analysis. Of the 4,868 cases analysed, 1,380 were severe. Logistic regression analysis showed that age, male sex, cardiovascular disease, cerebrovascular disease, chronic lung disease, renal failure and/or dialysis, physician-diagnosed obesity, admission from a long-term care facility and poor physical activity status were risk factors for severe disease. Vaccination and dementia were identified as factors associated with non-severe illness. The ATT for dementia, admission from a long-term care facility and poor physical activity status was −0.04 (95% confidence interval −0.07 to −0.01), 0.09 (0.06 to 0.12) and 0.17 (0.14 to 0.19), respectively. Our results suggest that poor physical activity status and living in a long-term care facility have a substantial association with the risk of severe COVID-19 caused by the Omicron VOC, while dementia may be associated with non-severe illness.

Men who have sex with men (MSM) have been disproportionally affected by the HIV epidemic in many countries, including Japan. Although pre-exposure prophylaxis (PrEP) is a strong prevention tool, it is not yet approved in Japan. A Markov model was developed to describe HIV infection and disease progression in an MSM cohort (N = 1000) in Japan receiving a PrEP program. The model was used to evaluate the cost-effectiveness of a PrEP program. HIV/AIDS treatment, screening, hospitalization due to AIDS, and PrEP were considered as costs and quality-adjusted life-years (QALYs) gained as utilities. Cost-effectiveness was assessed by comparing the incremental cost-effectiveness ratio (ICER) over a 30-year period against the willingness to pay (WTP) threshold. One-way sensitivity and probabilistic sensitivity analyses were performed. With 50% PrEP coverage, the PrEP program became dominant against the program without PrEP, using a threshold of 5.0 million JPY/QALY (45,455 USD). The probabilistic sensitivity analysis revealed that the PrEP program was dominant or at least cost-effective in most cases of 10,000 simulations. Therefore, preparing cheaper PrEP pills, which results in PrEP being dominant or ICER being lower than the WTP threshold, is important to make the program cost-effective. Introduction of PrEP to an MSM cohort in Japan would be cost-effective over a 30-year time horizon.