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Travelers’ vaccines and their adverse events in Nara, Japan

  • Taku Ogawa EMAIL logo , Nobuyasu Hirai , Natsuko Imakita , Hiroyuki Fujikura , Akihiro Kajita , Yuichiro Imai , Tomoko Onishi , Masahiro Takeyama and Kei Kasahara
Published/Copyright: June 30, 2021
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Open Medicine
From the journal Open Medicine Volume 16 Issue 1

Abstract

Background:

It is important to analyze the types of vaccines in travel clinics to determine the focus points in future practice.

Methods

We retrospectively reviewed the electronic medical records of all patients who visited the travel clinic of Nara Medical University between June 2013 and December 2019 to determine their background and the vaccines administered. The information regarding adverse events of the unapproved vaccines in Japan (Havrix®, Verorab®, Boostrix®, Priorix®, Typhim Vi®, and Mencevax®) was also collected.

Results

Of 645 patients, 58.6% were men and the median age was 31 years. Business was the most common travel purpose (34.9%), and Southeast Asia was the most common destination (40.2%). More than 80% of travelers to low- and middle-income countries were vaccinated against hepatitis A, while the rabies vaccination rate was approximately 50%. Typhoid vaccination coverage among travelers to South Asia was approximately 50%. The incidence of adverse events requiring medical consultation, telephonic consultation, or prolonged stay in the examination room was less than 5% for all unapproved vaccines in Japan.

Conclusion

More patient education is needed to increase the vaccination rate of rabies and typhoid vaccines. Adverse events to unapproved vaccines in Japan were not high and were well-tolerated.

Keywords: typhoid vaccine; rabies vaccine; hepatitis A vaccine; cost payer; unapproved vaccine

1 Introduction

Until the global pandemic of coronavirus disease, which originated in Wuhan in 2019, the number of international travelers from Japan continued to increase, with the number of international travelers exceeding 20 million in 2019. Compared to other developed countries, the practice of visiting travel clinics for pretravel health consultations, including vaccinations, was less widespread in Japan. To improve this situation, Nara Medical University opened a travel clinic in June 2013 and has been operating it following the center for disease control and prevention and the Japanese society of travel health recommendations [1,2]. We believe that it is important to analyze the content of the vaccines and other medical care provided to our clients for better care in the future. The data will also be of interest to doctors, nurses, and other healthcare professionals who run other travel clinics. For the aforementioned reasons, we compiled a list of the characteristics of clients who visited our travel clinic, the areas they traveled to, and vaccines and their forms that were finally administered. We also analyzed the extent to which vaccine adverse events occurred and how factors such as who paid for the visit affected the vaccines administered.

2 Materials and methods

The Nara Medical University Center for Infectious Diseases established a travel clinic in June 2013. The travel clinic is open on Monday and Thursday afternoons by appointment only, and the available vaccines are listed in Table 1; all vaccines are kept in stock at the pharmaceutical department of our hospital for immediate use. Vaccines not approved for manufacture in Japan (Havrix®, Typhim Vi®, Mencevax®, Verorab®, Priorix®, and Boostrix®) were imported individually with the approval of the Nara Medical University Ethics Committee and used after obtaining patient consent. We retrospectively reviewed the medical records of all medical clients who had an initial consultation between June 2013 and December 2019 to determine age, sex, nationality, region of residence, occupation, destination, the purpose of travel, cost payer, planned duration of travel, whether a medical certificate was required, post-vaccination adverse events, and information on the type of vaccine given and prophylactic oral medications administered and the adverse events (beyond the extended stay in the examination room or the need for telephonic consultation). Destinations were categorized by geographic region as well as by the income level of the country. The country’s income level was classified into three categories according to the annual gross national income (GNI) per capita in 2017: high-income countries (≥12,746 USD), middle-income countries (1046–12,745 USD), and low-income countries (≤1045 USD). When visiting more than one country, the country with the lowest GNI per capita was considered the destination. We then tabulated the vaccines administered in each destination region. To examine the effect of cost-sharing on vaccination rates, we used Fisher’s exact probability test to determine whether there were differences in vaccination rates depending on whether or not people had to pay for the vaccine themselves. Specifically, we examined whether there was a difference in the proportion of recipients whose costs were paid for by others, including their companies or schools, for hepatitis A, rabies, and typhoid vaccines among travelers to low- and middle-income countries in the vaccination and non-vaccination groups. Calculations were performed using the Microsoft Excel 2019 software. All P-values were two-sided, and P-values ≤ 0.05 were considered to be statistically significant. For adverse events as this was a retrospective study, we were only able to count adverse events with prolonged stay in the examination room just after inoculation of vaccines and with a telephonic or face-to-face consultation. The use of unauthorized vaccines in Japan and in this study was conducted with the approval of the Ethical Review Committee of Nara Medical University Ethics Committee (approval number 660).

Table 1

Vaccines available at Nara Medical University Travel Clinic

Types of vaccines Product name Manufacturing approval in Japan
Hepatits A vaccine Aimmugen 〇
Havrix ✖
Hepatitis B vaccine Bimmugen 〇
Heptavax-II 〇
Rabies vaccine (JRV) Inactivated tissue culture rabies vaccine 〇
(PVRV) Verorab ✖
(PCEC) Rabipur 〇
Japanese encephalitis vaccine (JE) JEBIK-V 〇
Diphteria, tetanus, pertussis, poliomyelitis vaccine (DTaP) Quattorovac 〇
Diphteria, tetanus, pertussis vaccine (Tdap) Boostrix ✖
Tetanus toxoid (TT) ADSORBED TETANUS TOXOID 〇
Inactivated poliomyelitis vaccine (IPV) IMOVAX POLIO subcutaneous 〇
Measles, Rubella, Mumps combined vaccine (MMR) Priorix ✖
Japanese bivalent MR combined vaccine (bMR) FREEZE-DRIED LIVE ATTENUATED MEASLES AND RUBELLA COMBINED VACCINE 〇
Japanese monovalent measles vaccine (mMe) DRIED LIVE ATTENUATED MEASLES VACCINE 〇
Japanese monovalent rubella vaccine (mR) DRIED LIVE ATTENUATED RUBELLA VACCINE 〇
Japanese monovalent mumps vaccine (mMu) DRIED LIVE ATTENUATED MUMPS VACCINE 〇
Japanese monovalent varicella vaccine (mV) VARICELLA VACCINE LIVE ATTENUATED “BIKEN” 〇
Meningococcal vaccine (MCV4) Menactra 〇
(MPSV4) Mencevax ✖
Typhoid fever (ViCPS) Typhim Vi ✖
Pneumococcal vaccine (PCV13) Prevenar 13 〇
(PPSV23) Pneumovax NP 〇
Haemophilus influenaze b vaccine ActHIB 〇
Influenza virus vaccine (IIV4) Influenza HA vaccine “SEIKEN” 〇

Tdap, tetanus and reduced diphtheria toxoids and acellular pertussis vaccine for adults; IIV4, inactivated quadrivalent influenza vaccine; MR, Measles-rubella combined; JRV, Japanese rabies vaccine; PVRV, purified vero cell rabies vaccines; PCEC, primary chick embryo cell vaccine; MCV4, quadrivalent conjugate meningococcal vaccine; MPSV4, quadrivalent polysaccharide meningococcal vaccine; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine; ViCPS, Vi capsular polysaccharide vaccine.

3 Results

3.1 Characteristics of clients who visited our travel clinic

A total of 645 patients visited the Nara Medical University Travel Clinic between June 2013 and December 2019. Of whom, 378 (58.6%) were men and 267 (41.4%) were women. The median age was 31 years, the youngest was 0 years old, the oldest was 82 years old, and the interquartile range (IQR) ranged from 19 to 40 years. The breakdown of nationalities was 636 Japanese, two Vietnamese, one Malaysian, and five unknowns. The most common purpose of travel was tourism for 96 (14.88%), followed by the business for 225 (34.9%), accompanying the family to business travelers for 174 (27.0%), studying abroad for 107 (16.6%), volunteering for 24 (3.72%), visiting friends and relatives for 10 (1.55%), participation in sports events for five (0.8%), and participation in religious events for four (0.6%). The breakdown of travel duration was 135 (20.9%) planned to travel for 2 weeks or less, 161 (24.9%) for longer than 2 weeks and up to 1 year, and 349 (54.1%) for longer than 1 year.

Southeast Asia was the most popular destination with 259 (40.2%) individuals, followed by South Asia with 109 (16.9%), North America with 90 (14.0%), East Asia with 71 (11.0%), Africa with 29 (4.5%), Latin America with 24 (3.72%), Oceania with 20 (3.1%), West Asia with 11 (1.71%), Central Asia with four (0.62%), and South America with three (0.47%) individuals. Three (0.47%) individuals were planning a round-the-world trip, and one (0.2%) had not yet decided on a destination. A hundred and seventy (26.4%) respondents traveled to high-income countries, 206 (31.9%) to middle-income countries, and 269 (41.71%) to low-income countries (travelers who had not yet decided on a destination and were planning to travel to low-income countries).

3.2 Vaccination rate by destination and type of vaccine

Hepatitis A vaccine (including both Japanese hepatitis A vaccine and Havrix®) coverage was highest among travelers to Southeast Asia, East Asia, South Asia, Central Asia, and Latin America (>80%). More than 80% of low- and middle-income countries had been vaccinated against hepatitis A. The percentage of travelers who received the hepatitis B vaccine was highest among travelers to East Asia (47.9%); however, it did not reach 50%. The overall hepatitis B vaccination rate was 29.6%.

Rabies (including both Japanese rabies vaccine and Verorab®) vaccination rates exceeded 50% among travelers to Southeast Asia, South Asia, East Asia, West Asia, and Central Asia; however, the overall vaccination rate was 45.1%. Typhoid vaccine coverage was 50.5% among travelers in South Asia, followed by West Asia (36.4%) and Africa (31.0%). Vaccination rates for measles and rubella-containing vaccines were highest in Europe (32.4 and 23.5%, respectively), followed by Southeast Asia (17.0 and 14.7%, respectively) and South Asia (22.9 and 20.2%, respectively). The overall vaccination coverage was 17.1 and 15.2%, respectively. Pertussis-containing vaccine coverage was relatively high in travelers to Oceania (40.0%) and North America (35.6%) and was higher in travelers to high-income countries (29.4%) than in low-income countries (13.8%). Tables 2–5 show the results of vaccines administered and preventive medications prescribed by the destination.

Table 2

Sex, age, nationality, and travel duration of travelers who visited the Nara Medical University Travel Clinic

Age (years) Minimum 0.5
Maximum 82
Median 31
Sex Male 378 58.6%
Female 267 41.4%
Nationality Japan 636 98.6%
Vietnam 2 0.3%
Malaysia 1 0.1%
Pakistan 1 0.1%
Unknown 5 0.8%
Travel duration <2 weeks 135 20.9%
≥2 weeks, <1 year 161 25.0%
≥1 year 349 54.1%
Table 3

Travel destinations for persons vaccinated against hepatitis A, rabies, hepatitis B, and typhoid

All clients Hepatits A Rabies Hepatits B Typhoid fever
Destination Aimmu-gen Havrix Total JRV or Rabipur Verorab Total Bimugen or Heptavax-II Typhim Vi
n % n n n % n n n % n % n %
Southeast Asia 259 40.2 33 192 225 86.9 21 131 152 58.7 79 30.5 38 14.7
East Asia 71 11 25 34 59 83.1 6 35 41 57.7 34 47.9 2 2.8
South Asia 109 16.9 23 65 88 80.7 7 53 60 55 30 27.5 55 50.5
West Asia 11 1.7 1 4 5 45.5 1 5 6 54.5 3 27.3 4 36.4
Central Asia 4 0.6 1 3 4 100 0 4 4 100 1 25 1 25
Africa 29 4.5 8 15 23 79.3 1 7 8 27.6 9 31 9 31
Europe 34 5.3 2 16 18 52.9 1 1 2 5.9 2 5.9 3 8.8
North America 90 14 4 12 16 17.8 1 6 7 7.8 27 30 1 1.1
Latin America 24 3.7 6 14 20 83.3 2 8 10 41.7 8 33.3 3 12.5
Oceania 20 3.1 1 5 6 30 0 3 3 15 2 10 3 15
Round-the-world trip 3 0.5 1 1 2 66.7 0 3 3 100 1 33.3 0 0
Undecided 1 0.2 0 0 0 0 0 0 0 0 0 0 0 0
High-income countries 170 26.4 8 48 56 32.9 2 23 25 14.7 40 23.5 6 3.5
Middle-income countries 206 31.9 46 129 175 85 15 103 118 57.3 80 38.8 19 9.2
Low-income countries 269 41.7 49 176 225 83.6 25 123 148 55 71 26.4 92 34.2
Total 645 100 103 353 456 70.7 42 249 291 45.1 191 29.6 117 18.1

JRV, Japanese rabies vaccine (inactivated tissue culture rabies vaccine).

Table 4

Travel destinations for tetanus, pertussis, polio, and meningococcal vaccine recipients

All clients Tetanus, pertussis, diphtheria, poliomyelitis Meningococcal
Destination Tetanus toxoid Japanese DTaP-IPV Japanese DTaP Boostrix Tetanus-containing total pertussis-containing total Mencevax Menactra Total
n % n n n n n % n % n n n %
Southeast Asia 259 40.2 62 4 1 33 100 38.6 38 14.7 0 5 5 1.9
East Asia 71 11 17 1 0 19 37 52.1 20 28.2 0 0 0 0
South Asia 109 16.9 29 3 0 10 42 38.5 13 11.9 0 1 1 0.9
West Asia 11 1.7 2 0 0 2 4 36.4 2 18.2 0 3 3 27.3
Central Asia 4 0.6 1 1 0 1 3 75 2 50 0 1 1 25
Africa 29 4.5 10 3 0 2 15 51.7 5 17.2 1 2 3 10.3
Europe 34 5.3 4 1 0 4 9 26.5 5 14.7 1 1 2 5.9
North America 90 14 8 3 0 29 40 44.4 32 35.6 7 20 27 30
Latin America 24 3.7 9 2 0 1 12 50 3 12.5 1 0 1 4.2
Oceania 20 3.1 2 1 0 7 10 50 8 40 0 0 0 0
Round-the-world trip 3 0.5 0 0 1 0 1 33.3 0 0 0 0 0 0
Undecided 1 0.2 0 0 0 0 0 0 0 0 1 0 0 100
High-income countries 170 26.4 17 4 1 45 67 39.4 50 29.4 8 25 33 19.4
Middle-income countries 206 31.9 54 5 0 36 95 46.1 41 19.9 1 4 5 2.4
Low-income countries 269 41.7 67 8 1 28 104 38.7 37 13.8 2 4 6 2.2
Total 645 100 138 17 2 109 266 41.2 128 19.8 11 33 44 6.8

DTaP-IPV, diphtheria-tetanus-pertussis-poliomyelitis combined vaccine; DTaP, diphtheria-tetanus-pertussis combined vaccine.

Table 5

Travel destinations for persons vaccinated against measles, rubella, mumps, varicella, and Japanese encephalitis

All clients Measles, rubella, varicella, mumps Japanese encephalitis
Destinations Priorix bMR mMe mRu mMu mV Measles total Rubella total JEBIK-V
n % n n n n n n n % n % n %
Southeast Asia 259 40.2 22 11 11 3 8 5 44 17 38 14.7 91 35.1
East Asia 71 11 10 1 1 0 6 1 12 16.9 11 15.5 31 43.7
South Asia 109 16.9 13 8 4 1 4 1 25 22.9 22 20.2 31 28.4
West Asia 11 1.7 0 2 0 1 1 0 2 18.2 2 18.2 2 18.2
Central Asia 4 0.6 0 0 0 0 1 0 0 0 0 0 1 25
Africa 29 4.5 0 0 0 0 0 0 0 0 0 0 2 6.9
Europe 34 5.3 5 2 2 0 2 0 11 32.4 8 23.5 0 0
North America 90 14 5 6 1 1 25 12 12 13.3 12 13.3 2 2.2
Latin America 24 3.7 2 0 0 0 0 1 2 8.3 0 0 2 8.3
Oceania 20 3.1 4 0 0 1 2 0 4 20 4 20 2 10
Roud-the-world trip 3 0.5 0 0 0 0 0 0 0 0 0 0 0 0
Undecided 1 0.2 0 0 0 0 0 0 0 0 0 0 0 0
High-income countries 170 26.4 15 10 5 1 30 12 30 17.6 26 15.3 14 8.2
Middle-income countries 206 31.9 22 8 4 3 11 7 34 16.5 33 16 78 37.9
Low-income countries 269 41.7 23 13 10 3 9 2 46 17.1 45 16.7 68 25.3
Total 645 100 60 31 19 7 50 21 110 17.1 98 15.2 160 24.8

bMR, bivalent measles-rubella combined vaccine; mMe, monovalent measles vaccine; mRu, monovalent rubella vaccine; mMu, monovalent mumps vaccine; mV, monovalent varicella vaccine.

3.3 Association between vaccine cost-sharers and vaccination coverage

Among travelers traveling to low- and middle-income countries, there was a statistically significant difference between vaccinated and nonvaccinated travelers in the proportion of the cost of rabies vaccine borne by someone other than themselves, such as a company or school (P = 0.001). The P-values for hepatitis A and typhoid fever were 1.0 and 0.098, respectively, with no significant difference.

3.4 Adverse events

Fifteen patients (2.3%) experienced adverse events after vaccination. Adverse events included vasovagal reflex in five (33.3%) patients, redness and pain at the vaccination site in four (26.7%) patients, and prolonged bleeding due to venous puncture, the appearance of skin rash, fever, quadriceps pain (adult case), numbness of the left fifth finger, and cervical lymphadenopathy in one (6.7%) patient each. There were 10 (2.8%) adverse events after Havrix®, nine (3.6%) with Verorab®, four (3.4%) with Typhim Vi®, four (3.7%) with Boostrix®, two (3.3%) with Priorix®, and 0 (0%) with Mencevax®. Adverse events are summarized in Table 6.

Table 6

Frequency of adverse events after vaccination and their specific symptoms

Presence of adverse events Present 15 2.3%
None 617 95.7%
No vaccination 13 2.0%
Symptom of adverse events Vaso-vagal reflex 5
Erythema and pain* 4
Bleeding at the puncture site 1
Skin rash* 1
Fever (<37.5℃)* 1
Pain in the quadriceps* 1
Numbness in the fifth finger of the left hand* 1
Cervical lymphadenopathy* 1
Frequency of adverse events Havrix# 10 2.8%
Verorab# 9 3.6%
Typhim Vi# 4 3.4%
Boostrix# 4 3.7%
Mencevax# 0 0.0%
Priorix# 2 3.3%
Heptavax-II 1 0.5%
JEBIK-V 3 1.9%
ADSORBED TETANUS TOXOID 5 3.6%
DRIED LIVE ATTENUATED MUMPS VACCINE 1 2.0%

*All symptoms resolved within a few days; #Unapproved vaccines in Japan.

4 Discussion

The hepatitis A vaccine should be administered to citizens of developed countries who travel to middle- and low-income countries [2]. The vaccination rate has not reached 100%; however, this is due to a previous vaccination history or vaccination at another hospital. The results suggest that the hepatitis A vaccine is generally inoculated to those who travel to the country where it is needed and that clients of travel clinics and healthcare providers share the same consensus that the hepatitis A vaccine is, at least, mandatory for travelers to low- and middle-income countries.

The risk groups for hepatitis B include medical personnel, adventure travelers, Peace Corps volunteers, missionaries, military personnel, and medical travelers [2]. It is also believed that the administration of the hepatitis B vaccine should be considered for travelers who may come into contact with blood or bodily fluid secretions during travel, with potential for sexual contact or with a need for medical or dental procedures. In our experienced clients, there are not many within these categories, and it is our opinion that this is related to the low vaccination rate in our study. However, the hepatitis B vaccine has already been incorporated into the routine immunization program in Japan since 2016, and it is necessary to recommend it more aggressively as a catch-up vaccination.

Regarding meningococcal and pertussis-containing vaccines (particularly Tdap), vaccination rates are higher among travelers in high-income countries. This may be related to the fact that many students studying in developed countries in Europe and the United States are often required by their prospective schools to provide proof of Tdap and quadrivalent meningococcal conjugate vaccine (MCV4) vaccination. Meningococcal infection and whooping cough are not only prevalent in developed countries; however, meningococcal infections are also prevalent in middle-and low-income countries [3]. Therefore, travelers to low- and middle-income countries must be educated to be vaccinated against MCV4 in the future. Additionally, the MCV4 vaccine we are currently using is effective against four serotypes (A, C, Y, and W-135), however, not on serotype B. As the latter has been reported to be the most common serotype in Europe, the United States, and Latin America [4], a system must be established to provide vaccinations against serotype B in Japan.

Rabies vaccines are recommended for travelers visiting every country worldwide, except for rabies-free countries, including Japan, particularly for long-term visitors. However, many travelers do not wish to receive pre-exposure prophylaxis (PrEP) owing to the availability of post-exposure prophylaxis (PEP). Even if PEP is possible, PrEP remains important due to the severity of the disease when it occurs and the safety and availability of rabies immunoglobulin and should continue to be recommended. In 2018, the World Health Organization position paper [5] has been significantly revised to accept a reduction in the number of rabies vaccinations required to complete PrEP from three to two, making it possible to complete PrEP in a shorter period. Thus, more travelers will likely receive PrEP in the future.

The low vaccination coverage of typhoid fever and other travel vaccines among Japanese travelers has been a recurring problem in the past [6,7]. However, manufacturing approval of typhoid vaccine is not issued even now in Japan, and only individually imported typhoid vaccines can be used. Consequently, vaccination coverage among travelers to South Asia, where typhoid prevalence is high, is only approximately 50%. It is necessary to strongly recommend vaccination for people traveling to at-risk areas in the future. Another problem is that the typhoid vaccine is not approved for production in Japan, and there are very few medical facilities where it is available. Some travelers have received a complete set of travel vaccines except for the typhoid vaccine at another clinic and then visit us for the typhoid vaccine alone. As these cases show, the lack of approval for the production of typhoid vaccine in Japan reduces accessibility to the vaccine. We believe that approval for the production of typhoid vaccines in Japan is mandatory.

One of the reasons why travelers hesitate to receive the recommended vaccines is that they are expensive. It is true that highly recommended vaccines, such as hepatitis A, are administered regardless of the price of the vaccine. However, for the rabies vaccine, there was a significant difference in the breakdown of vaccine cost bearers between the vaccinated and non-vaccinated groups. The same trend was observed for the typhoid vaccine, although the difference was not significant (if the number of people enrolled in the study was twice as large as in this study, a significant difference was observed for the typhoid vaccine). Therefore, companies sending their employees abroad, schools sending their students abroad to study, and the Japanese government that encourages its citizens to be active abroad should actively work to subsidize or lower the cost of vaccines. There have been similar reports in the past [8], and our study reinforces the fact that vaccination coverage is associated with cost payers.

Since this was a retrospective study, we should emphasize that we were only able to assess adverse events occurring in the examination room just after the inoculation or unsolicited adverse event after returning home. The lower incidence of adverse events compared to previous reports [9,10,11,12,13,14] may be due to this reason. Nonetheless, no particularly serious adverse events were observed, and the frequency was not high, at approximately a few percentages. However, the vasovagal reflex was the most common event, which may lead to fainting or falling in some cases, suggesting the need to strictly monitor body posture during and after vaccination.

The following are the limiting factors of this study. First, this was a single-center study. We could observe only the trend of a single institution in this study, and it does not apply to the whole of Japan. Second, although we statistically examined the relationship between vaccination rates and cost bearers, there may be confounding factors. For example, the duration of planned travel may be longer when the vaccine is paid for by someone other than the patient. If the travel period is longer, the doctor will more strongly recommend rabies or typhoid vaccination. Third, it is up to the patient to decide whether or not symptoms after vaccination are reported as adverse events, except in the case of adverse events occurring immediately after vaccination. If swelling or pain occurs after vaccination, the patient may not call for help, while a patient who is concerned may call for help with even the slighter symptom.

5 Conclusion

At the travel clinic of Nara Medical University, the only vaccine that is adequately vaccinated for travelers in need is hepatitis A. Efforts should be made to provide rabies and typhoid vaccines more appropriately to travelers who need them. Regarding the rabies vaccine, it is expected that the vaccination rate can be improved by having the cost of the vaccine paid by someone other than the travelers themselves (such as the company sending the employee). Reducing the cost burden is also important for the spread of vaccines. The availability of typhoid vaccines is also a problem, as it has not yet been approved in Japan. Manufacturing approval for typhoid vaccines is necessary for Japan. Finally, in our study, the imported vaccines (Havrix®, Verorab®, Boostrix®, Priorix®, Typhim Vi®, Mencevax®) were used safely and well-tolerated.

tel: +81-744-22-3051 (ext 3525), fax: +81-744-24-9212

Acknowledgments

We would like to thank Ms. Akiko Okada for managing the medical appointments and vaccine inventory.

  1. Funding information: There is no research funding for this study.

  2. Authors contributions: T.O. was an attending physician and prepared the manuscript, performed the statistical analysis, data collection, and data analysis; N.H., N.I., H.F., A.K., Y.I., T.O., and M.T. were attending physicians and performed data collection; K.K. supervised the study.

  3. Conflict of interest: The authors have no conflict of interest to be declared.

  4. Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. However, personal information was deleted from the research data before publication.

  5. Original publication: This manuscript has not been published or submitted anywhere else.

Abbreviations

GNI

gross national income

MCV4

quadrivalent meningococcal conjugate vaccine

PEP

post-exposure prophylaxis

PrEP

pre-exposure prophylaxis

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Received: 2020-12-26
Revised: 2021-04-11
Accepted: 2021-05-05
Published Online: 2021-06-30

© 2021 Taku Ogawa et al., published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  13. Case Report
  14. Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy
  15. Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background
  16. Research Articles
  17. TRIM25 contributes to the malignancy of acute myeloid leukemia and is negatively regulated by microRNA-137
  18. CircRNA circ_0004370 promotes cell proliferation, migration, and invasion and inhibits cell apoptosis of esophageal cancer via miR-1301-3p/COL1A1 axis
  19. LncRNA XIST regulates atherosclerosis progression in ox-LDL-induced HUVECs
  20. Potential role of IFN-γ and IL-5 in sepsis prediction of preterm neonates
  21. Rapid Communication
  22. COVID-19 vaccine: Call for employees in international transportation industries and international travelers as the first priority in global distribution
  23. Case Report
  24. Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature
  25. An infertile female delivered a baby after removal of primary renal carcinoid tumor
  26. Research Articles
  27. Hypertension, BMI, and cardiovascular and cerebrovascular diseases
  28. Case Report
  29. Coexistence of bilateral macular edema and pale optic disc in the patient with Cohen syndrome
  30. Research Articles
  31. Correlation between kinematic sagittal parameters of the cervical lordosis or head posture and disc degeneration in patients with posterior neck pain
  32. Review Articles
  33. Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database
  34. Research Articles
  35. Thermography in the diagnosis of carpal tunnel syndrome
  36. Pemetrexed-based first-line chemotherapy had particularly prominent objective response rate for advanced NSCLC: A network meta-analysis
  37. Comparison of single and double autologous stem cell transplantation in multiple myeloma patients
  38. The influence of smoking in minimally invasive spinal fusion surgery
  39. Impact of body mass index on left atrial dimension in HOCM patients
  40. Expression and clinical significance of CMTM1 in hepatocellular carcinoma
  41. miR-142-5p promotes cervical cancer progression by targeting LMX1A through Wnt/β-catenin pathway
  42. Comparison of multiple flatfoot indicators in 5–8-year-old children
  43. Early MRI imaging and follow-up study in cerebral amyloid angiopathy
  44. Intestinal fatty acid-binding protein as a biomarker for the diagnosis of strangulated intestinal obstruction: A meta-analysis
  45. miR-128-3p inhibits apoptosis and inflammation in LPS-induced sepsis by targeting TGFBR2
  46. Dynamic perfusion CT – A promising tool to diagnose pancreatic ductal adenocarcinoma
  47. Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches
  48. Review Articles
  49. The ambiguous role of mannose-binding lectin (MBL) in human immunity
  50. Case Report
  51. Membranous nephropathy with pulmonary cryptococcosis with improved 1-year follow-up results: A case report
  52. Fertility problems in males carrying an inversion of chromosome 10
  53. Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature
  54. Metastatic renal Ewing’s sarcoma in adult woman: Case report and review of the literature
  55. Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review
  56. Skull hemophilia pseudotumor: A case report
  57. Judicious use of low-dosage corticosteroids for non-severe COVID-19: A case report
  58. Adult-onset citrullinaemia type II with liver cirrhosis: A rare cause of hyperammonaemia
  59. Clinicopathologic features of Good’s syndrome: Two cases and literature review
  60. Fatal immune-related hepatitis with intrahepatic cholestasis and pneumonia associated with camrelizumab: A case report and literature review
  61. Research Articles
  62. Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study
  63. Significance of nucleic acid positive anal swab in COVID-19 patients
  64. circAPLP2 promotes colorectal cancer progression by upregulating HELLS by targeting miR-335-5p
  65. Ratios between circulating myeloid cells and lymphocytes are associated with mortality in severe COVID-19 patients
  66. Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation
  67. Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China
  68. Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
  69. Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
  70. FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
  71. Platelet-rich fibrin: Basics of biological actions and protocol modifications
  72. Accurate diagnosis of prostate cancer using logistic regression
  73. miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
  74. Prognostic significance of TRIM28 expression in patients with breast carcinoma
  75. Integrative bioinformatics analysis of KPNA2 in six major human cancers
  76. Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
  77. A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
  78. Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
  79. Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
  80. Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
  81. COVID-19 severity in relation to sociodemographics and vitamin D use
  82. Clinical analysis of 11 cases of nocardiosis
  83. Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
  84. Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
  85. Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
  86. Relation between IL-8 level and obstructive sleep apnea syndrome
  87. circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
  88. Nomogram prediction model for renal anaemia in IgA nephropathy patients
  89. Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
  90. NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
  91. A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
  92. Clinical and prognostic features of MMP-2 and VEGF in AEG patients
  93. The value of miR-510 in the prognosis and development of colon cancer
  94. Functional implications of PABPC1 in the development of ovarian cancer
  95. Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
  96. Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
  97. Prediction of improvement after anterior cruciate ligament reconstruction
  98. Effluent Osteopontin levels reflect the peritoneal solute transport rate
  99. circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
  100. Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
  101. Association between hair cortisol concentration and metabolic syndrome
  102. Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
  103. Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
  104. Knee alterations in rheumatoid arthritis: Comparison of US and MRI
  105. Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
  106. lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
  107. Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
  108. Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
  109. Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
  110. Travelers’ vaccines and their adverse events in Nara, Japan
  111. Association between Tfh and PGA in children with Henoch–Schönlein purpura
  112. Can exchange transfusion be replaced by double-LED phototherapy?
  113. circ_0005962 functions as an oncogene to aggravate NSCLC progression
  114. Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
  115. Serum intact fibroblast growth factor 23 in healthy paediatric population
  116. Algorithm of rational approach to reconstruction in Fournier’s disease
  117. A meta-analysis of exosome in the treatment of spinal cord injury
  118. Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
  119. Dexmedetomidine may decrease the bupivacaine toxicity to heart
  120. Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
  121. Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
  122. External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
  123. miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
  124. HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
  125. Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
  126. Cell population data in identifying active tuberculosis and community-acquired pneumonia
  127. Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
  128. Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
  129. 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
  130. Association of gene polymorphisms with women urinary incontinence
  131. Influence of COVID-19 pandemic on stress levels of urologic patients
  132. miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
  133. miR-519d downregulates LEP expression to inhibit preeclampsia development
  134. Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
  135. Fluorescent light energy modulates healing in skin grafted mouse model
  136. Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
  137. Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
  138. Severe postoperative hyperbilirubinemia in congenital heart disease
  139. Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
  140. Clinical factors predicting ureteral stent failure in patients with external ureteral compression
  141. Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
  142. Triple-Endobutton and clavicular hook: A propensity score matching analysis
  143. Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
  144. Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
  145. miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
  146. Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
  147. The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
  148. Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
  149. No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
  150. circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
  151. Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
  152. Educational program for orthopedic surgeons’ influences for osteoporosis
  153. Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
  154. GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
  155. lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
  156. Anticoagulation is the answer in treating noncritical COVID-19 patients
  157. Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
  158. Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
  159. VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
  160. Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
  161. Treatment of osteoporosis with teriparatide: The Slovenian experience
  162. New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
  163. Superenhancer–transcription factor regulatory network in malignant tumors
  164. β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
  165. Clinical features of atypical tuberculosis mimicking bacterial pneumonia
  166. Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
  167. Effect of electromagnetic field on abortion: A systematic review and meta-analysis
  168. miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
  169. MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
  170. Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
  171. miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
  172. Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
  173. MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
  174. Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
  175. circATP2A2 promotes osteosarcoma progression by upregulating MYH9
  176. Prognostic role of oxytocin receptor in colon adenocarcinoma
  177. Review Articles
  178. The function of non-coding RNAs in idiopathic pulmonary fibrosis
  179. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
  180. Role of cesarean section in the development of neonatal gut microbiota: A systematic review
  181. Small cell lung cancer transformation during antitumor therapies: A systematic review
  182. Research progress of gut microbiota and frailty syndrome
  183. Recommendations for outpatient activity in COVID-19 pandemic
  184. Rapid Communication
  185. Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
  186. Use of microspheres in embolization for unruptured renal angiomyolipomas
  187. COVID-19 cases with delayed absorption of lung lesion
  188. A triple combination of treatments on moderate COVID-19
  189. Social networks and eating disorders during the Covid-19 pandemic
  190. Letter
  191. COVID-19, WHO guidelines, pedagogy, and respite
  192. Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
  193. COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
  194. What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
  195. Case Report
  196. Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
  197. CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
  198. Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
  199. Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
  200. Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
  201. Pulmonary parenchymal involvement caused by Tropheryma whipplei
  202. Mediastinal mixed germ cell tumor: A case report and literature review
  203. Ovarian female adnexal tumor of probable Wolffian origin – Case report
  204. Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
  205. Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
  206. Primary orbital ganglioneuroblastoma: A case report
  207. Primary aortic intimal sarcoma masquerading as intramural hematoma
  208. Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
  209. Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
  210. Chondroblastoma of mandibular condyle: Case report and literature review
  211. Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
  212. Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
  213. Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
  214. High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
  215. Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
  216. Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
  217. Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
  218. Retraction
  219. Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
  220. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
  221. An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
  222. Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
https://doi.org/10.1515/med-2021-0303
Keywords for this article
typhoid vaccine; rabies vaccine; hepatitis A vaccine; cost payer; unapproved vaccine
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Identification of ZG16B as a prognostic biomarker in breast cancer
  3. Behçet’s disease with latent Mycobacterium tuberculosis infection
  4. Erratum
  5. Erratum to “Suffering from Cerebral Small Vessel Disease with and without Metabolic Syndrome”
  6. Research Articles
  7. GPR37 promotes the malignancy of lung adenocarcinoma via TGF-β/Smad pathway
  8. Expression and role of ABIN1 in sepsis: In vitro and in vivo studies
  9. Additional baricitinib loading dose improves clinical outcome in COVID-19
  10. The co-treatment of rosuvastatin with dapagliflozin synergistically inhibited apoptosis via activating the PI3K/AKt/mTOR signaling pathway in myocardial ischemia/reperfusion injury rats
  11. SLC12A8 plays a key role in bladder cancer progression and EMT
  12. LncRNA ATXN8OS enhances tamoxifen resistance in breast cancer
  13. Case Report
  14. Serratia marcescens as a cause of unfavorable outcome in the twin pregnancy
  15. Spleno-adrenal fusion mimicking an adrenal metastasis of a renal cell carcinoma: A case report and embryological background
  16. Research Articles
  17. TRIM25 contributes to the malignancy of acute myeloid leukemia and is negatively regulated by microRNA-137
  18. CircRNA circ_0004370 promotes cell proliferation, migration, and invasion and inhibits cell apoptosis of esophageal cancer via miR-1301-3p/COL1A1 axis
  19. LncRNA XIST regulates atherosclerosis progression in ox-LDL-induced HUVECs
  20. Potential role of IFN-γ and IL-5 in sepsis prediction of preterm neonates
  21. Rapid Communication
  22. COVID-19 vaccine: Call for employees in international transportation industries and international travelers as the first priority in global distribution
  23. Case Report
  24. Rare squamous cell carcinoma of the kidney with concurrent xanthogranulomatous pyelonephritis: A case report and review of the literature
  25. An infertile female delivered a baby after removal of primary renal carcinoid tumor
  26. Research Articles
  27. Hypertension, BMI, and cardiovascular and cerebrovascular diseases
  28. Case Report
  29. Coexistence of bilateral macular edema and pale optic disc in the patient with Cohen syndrome
  30. Research Articles
  31. Correlation between kinematic sagittal parameters of the cervical lordosis or head posture and disc degeneration in patients with posterior neck pain
  32. Review Articles
  33. Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database
  34. Research Articles
  35. Thermography in the diagnosis of carpal tunnel syndrome
  36. Pemetrexed-based first-line chemotherapy had particularly prominent objective response rate for advanced NSCLC: A network meta-analysis
  37. Comparison of single and double autologous stem cell transplantation in multiple myeloma patients
  38. The influence of smoking in minimally invasive spinal fusion surgery
  39. Impact of body mass index on left atrial dimension in HOCM patients
  40. Expression and clinical significance of CMTM1 in hepatocellular carcinoma
  41. miR-142-5p promotes cervical cancer progression by targeting LMX1A through Wnt/β-catenin pathway
  42. Comparison of multiple flatfoot indicators in 5–8-year-old children
  43. Early MRI imaging and follow-up study in cerebral amyloid angiopathy
  44. Intestinal fatty acid-binding protein as a biomarker for the diagnosis of strangulated intestinal obstruction: A meta-analysis
  45. miR-128-3p inhibits apoptosis and inflammation in LPS-induced sepsis by targeting TGFBR2
  46. Dynamic perfusion CT – A promising tool to diagnose pancreatic ductal adenocarcinoma
  47. Biomechanical evaluation of self-cinching stitch techniques in rotator cuff repair: The single-loop and double-loop knot stitches
  48. Review Articles
  49. The ambiguous role of mannose-binding lectin (MBL) in human immunity
  50. Case Report
  51. Membranous nephropathy with pulmonary cryptococcosis with improved 1-year follow-up results: A case report
  52. Fertility problems in males carrying an inversion of chromosome 10
  53. Acute myeloid leukemia with leukemic pleural effusion and high levels of pleural adenosine deaminase: A case report and review of literature
  54. Metastatic renal Ewing’s sarcoma in adult woman: Case report and review of the literature
  55. Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review
  56. Skull hemophilia pseudotumor: A case report
  57. Judicious use of low-dosage corticosteroids for non-severe COVID-19: A case report
  58. Adult-onset citrullinaemia type II with liver cirrhosis: A rare cause of hyperammonaemia
  59. Clinicopathologic features of Good’s syndrome: Two cases and literature review
  60. Fatal immune-related hepatitis with intrahepatic cholestasis and pneumonia associated with camrelizumab: A case report and literature review
  61. Research Articles
  62. Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study
  63. Significance of nucleic acid positive anal swab in COVID-19 patients
  64. circAPLP2 promotes colorectal cancer progression by upregulating HELLS by targeting miR-335-5p
  65. Ratios between circulating myeloid cells and lymphocytes are associated with mortality in severe COVID-19 patients
  66. Risk factors of left atrial appendage thrombus in patients with non-valvular atrial fibrillation
  67. Clinical features of hypertensive patients with COVID-19 compared with a normotensive group: Single-center experience in China
  68. Surgical myocardial revascularization outcomes in Kawasaki disease: systematic review and meta-analysis
  69. Decreased chromobox homologue 7 expression is associated with epithelial–mesenchymal transition and poor prognosis in cervical cancer
  70. FGF16 regulated by miR-520b enhances the cell proliferation of lung cancer
  71. Platelet-rich fibrin: Basics of biological actions and protocol modifications
  72. Accurate diagnosis of prostate cancer using logistic regression
  73. miR-377 inhibition enhances the survival of trophoblast cells via upregulation of FNDC5 in gestational diabetes mellitus
  74. Prognostic significance of TRIM28 expression in patients with breast carcinoma
  75. Integrative bioinformatics analysis of KPNA2 in six major human cancers
  76. Exosomal-mediated transfer of OIP5-AS1 enhanced cell chemoresistance to trastuzumab in breast cancer via up-regulating HMGB3 by sponging miR-381-3p
  77. A four-lncRNA signature for predicting prognosis of recurrence patients with gastric cancer
  78. Knockdown of circ_0003204 alleviates oxidative low-density lipoprotein-induced human umbilical vein endothelial cells injury: Circulating RNAs could explain atherosclerosis disease progression
  79. Propofol postpones colorectal cancer development through circ_0026344/miR-645/Akt/mTOR signal pathway
  80. Knockdown of lncRNA TapSAKI alleviates LPS-induced injury in HK-2 cells through the miR-205/IRF3 pathway
  81. COVID-19 severity in relation to sociodemographics and vitamin D use
  82. Clinical analysis of 11 cases of nocardiosis
  83. Cis-regulatory elements in conserved non-coding sequences of nuclear receptor genes indicate for crosstalk between endocrine systems
  84. Four long noncoding RNAs act as biomarkers in lung adenocarcinoma
  85. Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens
  86. Relation between IL-8 level and obstructive sleep apnea syndrome
  87. circAGFG1 sponges miR-28-5p to promote non-small-cell lung cancer progression through modulating HIF-1α level
  88. Nomogram prediction model for renal anaemia in IgA nephropathy patients
  89. Effect of antibiotic use on the efficacy of nivolumab in the treatment of advanced/metastatic non-small cell lung cancer: A meta-analysis
  90. NDRG2 inhibition facilitates angiogenesis of hepatocellular carcinoma
  91. A nomogram for predicting metabolic steatohepatitis: The combination of NAMPT, RALGDS, GADD45B, FOSL2, RTP3, and RASD1
  92. Clinical and prognostic features of MMP-2 and VEGF in AEG patients
  93. The value of miR-510 in the prognosis and development of colon cancer
  94. Functional implications of PABPC1 in the development of ovarian cancer
  95. Prognostic value of preoperative inflammation-based predictors in patients with bladder carcinoma after radical cystectomy
  96. Sublingual immunotherapy increases Treg/Th17 ratio in allergic rhinitis
  97. Prediction of improvement after anterior cruciate ligament reconstruction
  98. Effluent Osteopontin levels reflect the peritoneal solute transport rate
  99. circ_0038467 promotes PM2.5-induced bronchial epithelial cell dysfunction
  100. Significance of miR-141 and miR-340 in cervical squamous cell carcinoma
  101. Association between hair cortisol concentration and metabolic syndrome
  102. Microvessel density as a prognostic indicator of prostate cancer: A systematic review and meta-analysis
  103. Characteristics of BCR–ABL gene variants in patients of chronic myeloid leukemia
  104. Knee alterations in rheumatoid arthritis: Comparison of US and MRI
  105. Long non-coding RNA TUG1 aggravates cerebral ischemia and reperfusion injury by sponging miR-493-3p/miR-410-3p
  106. lncRNA MALAT1 regulated ATAD2 to facilitate retinoblastoma progression via miR-655-3p
  107. Development and validation of a nomogram for predicting severity in patients with hemorrhagic fever with renal syndrome: A retrospective study
  108. Analysis of COVID-19 outbreak origin in China in 2019 using differentiation method for unusual epidemiological events
  109. Laparoscopic versus open major liver resection for hepatocellular carcinoma: A case-matched analysis of short- and long-term outcomes
  110. Travelers’ vaccines and their adverse events in Nara, Japan
  111. Association between Tfh and PGA in children with Henoch–Schönlein purpura
  112. Can exchange transfusion be replaced by double-LED phototherapy?
  113. circ_0005962 functions as an oncogene to aggravate NSCLC progression
  114. Circular RNA VANGL1 knockdown suppressed viability, promoted apoptosis, and increased doxorubicin sensitivity through targeting miR-145-5p to regulate SOX4 in bladder cancer cells
  115. Serum intact fibroblast growth factor 23 in healthy paediatric population
  116. Algorithm of rational approach to reconstruction in Fournier’s disease
  117. A meta-analysis of exosome in the treatment of spinal cord injury
  118. Src-1 and SP2 promote the proliferation and epithelial–mesenchymal transition of nasopharyngeal carcinoma
  119. Dexmedetomidine may decrease the bupivacaine toxicity to heart
  120. Hypoxia stimulates the migration and invasion of osteosarcoma via up-regulating the NUSAP1 expression
  121. Long noncoding RNA XIST knockdown relieves the injury of microglia cells after spinal cord injury by sponging miR-219-5p
  122. External fixation via the anterior inferior iliac spine for proximal femoral fractures in young patients
  123. miR-128-3p reduced acute lung injury induced by sepsis via targeting PEL12
  124. HAGLR promotes neuron differentiation through the miR-130a-3p-MeCP2 axis
  125. Phosphoglycerate mutase 2 is elevated in serum of patients with heart failure and correlates with the disease severity and patient’s prognosis
  126. Cell population data in identifying active tuberculosis and community-acquired pneumonia
  127. Prognostic value of microRNA-4521 in non-small cell lung cancer and its regulatory effect on tumor progression
  128. Mean platelet volume and red blood cell distribution width is associated with prognosis in premature neonates with sepsis
  129. 3D-printed porous scaffold promotes osteogenic differentiation of hADMSCs
  130. Association of gene polymorphisms with women urinary incontinence
  131. Influence of COVID-19 pandemic on stress levels of urologic patients
  132. miR-496 inhibits proliferation via LYN and AKT pathway in gastric cancer
  133. miR-519d downregulates LEP expression to inhibit preeclampsia development
  134. Comparison of single- and triple-port VATS for lung cancer: A meta-analysis
  135. Fluorescent light energy modulates healing in skin grafted mouse model
  136. Silencing CDK6-AS1 inhibits LPS-induced inflammatory damage in HK-2 cells
  137. Predictive effect of DCE-MRI and DWI in brain metastases from NSCLC
  138. Severe postoperative hyperbilirubinemia in congenital heart disease
  139. Baicalin improves podocyte injury in rats with diabetic nephropathy by inhibiting PI3K/Akt/mTOR signaling pathway
  140. Clinical factors predicting ureteral stent failure in patients with external ureteral compression
  141. Novel H2S donor proglumide-ADT-OH protects HUVECs from ox-LDL-induced injury through NF-κB and JAK/SATA pathway
  142. Triple-Endobutton and clavicular hook: A propensity score matching analysis
  143. Long noncoding RNA MIAT inhibits the progression of diabetic nephropathy and the activation of NF-κB pathway in high glucose-treated renal tubular epithelial cells by the miR-182-5p/GPRC5A axis
  144. Serum exosomal miR-122-5p, GAS, and PGR in the non-invasive diagnosis of CAG
  145. miR-513b-5p inhibits the proliferation and promotes apoptosis of retinoblastoma cells by targeting TRIB1
  146. Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p
  147. The diagnostic and prognostic value of miR-92a in gastric cancer: A systematic review and meta-analysis
  148. Prognostic value of α2δ1 in hypopharyngeal carcinoma: A retrospective study
  149. No significant benefit of moderate-dose vitamin C on severe COVID-19 cases
  150. circ_0000467 promotes the proliferation, metastasis, and angiogenesis in colorectal cancer cells through regulating KLF12 expression by sponging miR-4766-5p
  151. Downregulation of RAB7 and Caveolin-1 increases MMP-2 activity in renal tubular epithelial cells under hypoxic conditions
  152. Educational program for orthopedic surgeons’ influences for osteoporosis
  153. Expression and function analysis of CRABP2 and FABP5, and their ratio in esophageal squamous cell carcinoma
  154. GJA1 promotes hepatocellular carcinoma progression by mediating TGF-β-induced activation and the epithelial–mesenchymal transition of hepatic stellate cells
  155. lncRNA-ZFAS1 promotes the progression of endometrial carcinoma by targeting miR-34b to regulate VEGFA expression
  156. Anticoagulation is the answer in treating noncritical COVID-19 patients
  157. Effect of late-onset hemorrhagic cystitis on PFS after haplo-PBSCT
  158. Comparison of Dako HercepTest and Ventana PATHWAY anti-HER2 (4B5) tests and their correlation with silver in situ hybridization in lung adenocarcinoma
  159. VSTM1 regulates monocyte/macrophage function via the NF-κB signaling pathway
  160. Comparison of vaginal birth outcomes in midwifery-led versus physician-led setting: A propensity score-matched analysis
  161. Treatment of osteoporosis with teriparatide: The Slovenian experience
  162. New targets of morphine postconditioning protection of the myocardium in ischemia/reperfusion injury: Involvement of HSP90/Akt and C5a/NF-κB
  163. Superenhancer–transcription factor regulatory network in malignant tumors
  164. β-Cell function is associated with osteosarcopenia in middle-aged and older nonobese patients with type 2 diabetes: A cross-sectional study
  165. Clinical features of atypical tuberculosis mimicking bacterial pneumonia
  166. Proteoglycan-depleted regions of annular injury promote nerve ingrowth in a rabbit disc degeneration model
  167. Effect of electromagnetic field on abortion: A systematic review and meta-analysis
  168. miR-150-5p affects AS plaque with ASMC proliferation and migration by STAT1
  169. MALAT1 promotes malignant pleural mesothelioma by sponging miR-141-3p
  170. Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model
  171. miR-654-5p promotes gastric cancer progression via the GPRIN1/NF-κB pathway
  172. Identification of LIG1 and LIG3 as prognostic biomarkers in breast cancer
  173. MitoQ inhibits hepatic stellate cell activation and liver fibrosis by enhancing PINK1/parkin-mediated mitophagy
  174. Dissecting role of founder mutation p.V727M in GNE in Indian HIBM cohort
  175. circATP2A2 promotes osteosarcoma progression by upregulating MYH9
  176. Prognostic role of oxytocin receptor in colon adenocarcinoma
  177. Review Articles
  178. The function of non-coding RNAs in idiopathic pulmonary fibrosis
  179. Efficacy and safety of therapeutic plasma exchange in stiff person syndrome
  180. Role of cesarean section in the development of neonatal gut microbiota: A systematic review
  181. Small cell lung cancer transformation during antitumor therapies: A systematic review
  182. Research progress of gut microbiota and frailty syndrome
  183. Recommendations for outpatient activity in COVID-19 pandemic
  184. Rapid Communication
  185. Disparity in clinical characteristics between 2019 novel coronavirus pneumonia and leptospirosis
  186. Use of microspheres in embolization for unruptured renal angiomyolipomas
  187. COVID-19 cases with delayed absorption of lung lesion
  188. A triple combination of treatments on moderate COVID-19
  189. Social networks and eating disorders during the Covid-19 pandemic
  190. Letter
  191. COVID-19, WHO guidelines, pedagogy, and respite
  192. Inflammatory factors in alveolar lavage fluid from severe COVID-19 pneumonia: PCT and IL-6 in epithelial lining fluid
  193. COVID-19: Lessons from Norway tragedy must be considered in vaccine rollout planning in least developed/developing countries
  194. What is the role of plasma cell in the lamina propria of terminal ileum in Good’s syndrome patient?
  195. Case Report
  196. Rivaroxaban triggered multifocal intratumoral hemorrhage of the cabozantinib-treated diffuse brain metastases: A case report and review of literature
  197. CTU findings of duplex kidney in kidney: A rare duplicated renal malformation
  198. Synchronous primary malignancy of colon cancer and mantle cell lymphoma: A case report
  199. Sonazoid-enhanced ultrasonography and pathologic characters of CD68 positive cell in primary hepatic perivascular epithelioid cell tumors: A case report and literature review
  200. Persistent SARS-CoV-2-positive over 4 months in a COVID-19 patient with CHB
  201. Pulmonary parenchymal involvement caused by Tropheryma whipplei
  202. Mediastinal mixed germ cell tumor: A case report and literature review
  203. Ovarian female adnexal tumor of probable Wolffian origin – Case report
  204. Rare paratesticular aggressive angiomyxoma mimicking an epididymal tumor in an 82-year-old man: Case report
  205. Perimenopausal giant hydatidiform mole complicated with preeclampsia and hyperthyroidism: A case report and literature review
  206. Primary orbital ganglioneuroblastoma: A case report
  207. Primary aortic intimal sarcoma masquerading as intramural hematoma
  208. Sustained false-positive results for hepatitis A virus immunoglobulin M: A case report and literature review
  209. Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature
  210. Chondroblastoma of mandibular condyle: Case report and literature review
  211. Trauma-induced complete pacemaker lead fracture 8 months prior to hospitalization: A case report
  212. Primary intradural extramedullary extraosseous Ewing’s sarcoma/peripheral primitive neuroectodermal tumor (PIEES/PNET) of the thoracolumbar spine: A case report and literature review
  213. Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report
  214. High quality of 58-month life in lung cancer patient with brain metastases sequentially treated with gefitinib and osimertinib
  215. Rapid response of locally advanced oral squamous cell carcinoma to apatinib: A case report
  216. Retrieval of intrarenal coiled and ruptured guidewire by retrograde intrarenal surgery: A case report and literature review
  217. Usage of intermingled skin allografts and autografts in a senior patient with major burn injury
  218. Retraction
  219. Retraction on “Dihydromyricetin attenuates inflammation through TLR4/NF-kappa B pathway”
  220. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part I
  221. An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers
  222. Breast cancer recurrence prediction with ensemble methods and cost-sensitive learning
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