Hiroshi Nishiura

Kyoto University | Kyodai · School of Public Health

Although the Japanese government removed mask-wearing requirements in 2023, relatively high rates of mask wearing have continued in Japan. We aimed to assess psychological reasons and the strength of habitual mask wearing in Japan. An Internet-based cross-sectional survey was conducted with non-random participant recruitment. We explored the freque...

Background Many countries, including high-income nations, struggled to control epidemic waves caused by the Omicron variant (B.1.1.529), which had an antigenically distinct evolution. Evaluating the direct and indirect effects of vaccination during the Omicron waves is essential to assess virus control policies. The present study assessed the popul...

Japan implemented its nationwide vaccination program against COVID-19 in 2021, immunizing more than one million people (approximately 1%) a day. However, the direct and indirect impacts of the program at the population level have yet to be fully evaluated. To assess the vaccine effectiveness during the Delta variant (B.1.617.2) epidemic in 2021, we...

Introduction Heatstroke mortality is highest among older adults aged 65 years and older, and the risk is even doubled among those aged 75 years and older. The incidence of heatstroke is expected to increase in the future with elevated temperatures owing to climate change. In the context of a super-aged society, we examined possible adaptation measu...

Background The COVID-19 pandemic had a low impact on Japan in 2020, but the size of the epidemic increased considerably there in 2021. This study made a statistical analysis of life expectancy changes up to the end of 2021 in Japan. Objective We aimed to estimate changes in life expectancy from 2019 to 2021 associated with the COVID-19 pandemic. T...

Background Mobility data are crucial for understanding the dynamics of coronavirus disease 2019 (COVID-19), but the consistency of the usefulness of these data over time has been questioned. The present study aimed to reveal the relationship between the transmissibility of COVID-19 in Tokyo, Osaka, and Aichi prefectures and the daily night-time pop...

Japanese government initially enforced restrictions on outpatient attendances among febrile individuals suspected of having COVID-19, asking everyone to remain at home for at least 4 days from the onset of fever. This restriction was cancelled on 8 May 2020, and a new antiviral, remdesivir, was approved from 7 May 2020. To investigate how this poli...

The present study aimed to estimate the infection fatality risk (IFR) and ascertainment bias of SARS-CoV-2 for six epidemic waves in Japan from February 2020 to January 2022. We used two types of datasets: (i) surveillance-based datasets containing the cumulative numbers of confirmed cases and deaths in each epidemic wave and (ii) seroepidemiologic...

Many countries struggled with suppressing the incidence with Omicron variant (B.1.1.529). As the epidemic size of COVID-19 in 2022 became bigger than earlier years in Japan, the present study aimed to estimate life expectancy at birth at the end of 2022, using provisional death datasets in Aichi and Fukui prefectures. We collected monthly death cou...

A study on life expectancy changes up to the end of 2021 in Japan, where the size of the COVID-19 epidemic was relatively small until 2021. The upward trend in life expectancy trend halted in 2021, though the life expectancy changes from 2019–20 and 2020–21 were small. This may be attributable to the small epidemiological impact of COVID-19 during...

The transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to be overdispersed, meaning that only a fraction of infected cases contributes to super-spreading. While cluster interventions are an effective measure for controlling pandemics due to the viruses’ overdispersed nature, a quantitative assessment of the risk o...

Mobility restrictions were widely practiced to reduce contact with others and prevent the spatial spread of COVID-19 infection. Using inter-prefectural mobility and epidemiological data, a statistical model was devised to predict the number of imported cases in each Japanese prefecture. The number of imported cases crossing prefectural borders in 2...

Abstract Background It has been descriptively argued that the case fatality risk (CFR) of coronavirus disease (COVID-19) is elevated when medical services are overwhelmed. The relationship between CFR and pressure on health-care services should thus be epidemiologically explored to account for potential epidemiological biases. The purpose of the pr...

The purpose of the present study was to develop a transmission model of COVID-19 cases with and without a contact history to understand the meaning of the proportion of infected individuals with a contact history over time. We extracted epidemiological information regarding the proportion of coronavirus disease 2019 (COVID-19) cases with a contact...

Coronavirus disease 2019 (COVID-19) booster vaccination has been implemented globally in the midst of surges in infection due to the Delta and Omicron variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of the present study was to present a framework to estimate the proportion of the population that is immune to...

With continuing emergence of new SARS-CoV-2 variants, understanding the proportion of the population protected against infection is crucial for public health risk assessment and decision-making and so that the general public can take preventive measures. We aimed to estimate the protection against symptomatic illness caused by SARS-CoV-2 Omicron va...

Coronavirus disease 2019 (COVID-19) has been described as having an overdispersed offspring distribution, i.e. high variation in the number of secondary transmissions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) per single primary COVID-19 case. Accordingly, countermeasures focused on high-risk settings and contact tracing could...

Background In Japan, vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was initiated on 17 February 2021, mainly using messenger RNA vaccines and prioritizing health care professionals. Whereas nationwide vaccination alleviated the coronavirus disease 2019 (COVID-19)-related burden, the population impact has yet to be...

Severe acute respiratory coronavirus 2 (SARS-CoV-2) infections have been associated with substantial presymptomatic transmission, which occurs when the generation interval—the time between infection of an individual with a pathogen and transmission of the pathogen to another individual—is shorter than the incubation period—the time between infectio...

Background In 2020, the Japanese government implemented first of two Go To Travel campaigns to promote the tourism sector as well as eating and drinking establishments, especially in remote areas. The present study aimed to explore the relationship between enhanced travel and geographic propagation of COVID-19 across Japan, focusing on the second c...

The basic reproduction number, $ R_0 $, plays a central role in measuring the transmissibility of an infectious disease, and it thus acts as the fundamental index for planning control strategies. In the present study, we apply a branching process model to meticulously observed contact tracing data from Wakayama Prefecture, Japan, obtained in early...

Objective Elucidating the infection dynamics that lead to severe respiratory syncytial virus pneumonia and hospitalization among young children is critical. We explored the role of infection parity as well as age in months for respiratory syncytial virus-associated hospitalization among young children in Japan. Methods We used a sequential transmi...

The concept of doubling time has been increasingly used since the onset of the coronavirus disease 2019 (COVID-19) pandemic, but its characteristics are not well understood, especially as applied to infectious disease epidemiology. The present study aims to be a practical guide to monitoring the doubling time of infectious diseases. Via simulation...

COVID-19 vaccine effectiveness against death in Japan remains unknown. Furthermore, although evidence indicates that healthcare capacity influences case-fatality risk (CFR), it remains unknown whether this relationship is mediated by age. With a modeling study, we analyzed daily COVID-19 cases and deaths during January–August 2021 by using Tokyo su...

Background The number of coronavirus disease 2019 (COVID-19) cases was expected to increase during the Tokyo Olympic Games because of the increased physical contact within and between the domestic population and international participants of the Games. The rapid rise of the Delta variant (B.1.617) in Japan meant that hosting the Olympic Games witho...

Monkeypox is a rare viral infection, endemic in many central and western African countries. The last international outbreak of monkeypox reported outside Africa occurred back in 2003. However, monkeypox has reemerged at a global scale with numerous confirmed cases across the globe in 2022. The rapid spread of cases through different countries has r...

The Omicron variant spreads fastest as ever among the severe acute respiratory syndrome coronaviruses 2 (SARS-CoV-2) we had so far. The BA.1 and BA.2 sublineages of Omicron are circulating worldwide and it is urgent to evaluate the transmission advantages of these sublineages. Using a mathematical model describing trajectories of variant frequencie...

Background Osaka, the third largest prefecture in Japan, experienced a rapid replacement of preexisting strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by variant alpha during March-April 2021. Assessing the burden of variant alpha on health centers and medical institutions is vital to anticipating the surge of patients. The...

Quantitative assessments of when infectious disease outbreaks end are crucial, as resources targeted towards outbreak responses typically remain in place until outbreaks are declared over. Recent improvements and innovations in mathematical approaches for determining when outbreaks end provide public health authorities with more confidence when mak...

Objectives COVID-19 vaccination in Japan started on February 17, 2021. Because the timing of vaccination and the risk of severe COVID-19 greatly varied with age, the present study aimed to monitor the age-specific fractions of the population who were immune to SARS-CoV-2 infection following vaccination. Methods Natural infection remained extremely...

Objectives: In industrialized countries that have experienced major extensive epidemics of Omicron (B.1.1.529), substantial fraction of the population was exposed including children. Methods: Statistical association between the detection of at least one hepatitis case among children and the cumulative number of Omicron cases (B.1.1.529) was examine...

Japan successfully implemented a mass vaccination program for coronavirus disease 2019 (COVID-19), immunizing more than 1 million persons a day by July 2021. Given the COVID-19 vaccination capacity limitations, an urgent question was raised regarding whether it would be better to (ⅰ) complete double-dose COVID-19 vaccination among healthcare person...

In response to the coronavirus disease 2019 (COVID-19) pandemic, Japan conducted mass vaccination. Seventy-two million doses of vaccine (i.e., for 36 million people if a double dose is planned per person) were obtained, with initial vaccination of the older population (≡ 65 years). Because of the limited number of vaccines, the government discussed...

Following the emergence and worldwide spread of coronavirus disease 2019 (COVID-19), each country has attempted to control the disease in different ways. The first patient with COVID-19 in Japan was diagnosed on 15 January 2020, and until 31 October 2020, the epidemic was characterized by two large waves. To prevent the first wave, the Japanese gov...

The Omicron variant is the most transmissible variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) we had so far. The BA.1 and BA.2 sublineages of Omicron are circulating in Europe and it is urgent to evaluate the transmissibility of these sub-lineages. Using a mathematical model describing trajectories of variant frequencies...

R(t), the actual average number of secondary cases per primary case at calendar time t, is epidemiologically useful in assessing transmission dynamics in a population with varying susceptibility levels. However, a technical limitation of existing methods of estimating R(t) is the reliance on the daily number of cases with illness onset and the dist...

In Japan, a prioritized COVID-19 vaccination program using Pfizer/BioNTech messenger RNA (mRNA) vaccine among healthcare workers commenced on February 17, 2021. As vaccination coverage increases, clusters in healthcare and elderly care facilities including hospitals and nursing homes are expected to be reduced. The present study aimed to explicitly...

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has rapidly spread across the globe. The variant of concern (VOC) 202012/01 (B.1.1.7, also known as the alpha variant) bearing the N501Y mutation emerged in late 2020. VOC 202012/01 was more transmissible than existing SARS-CoV-2 variants an...

COVID-19 vaccination commenced globally in December 2020. Japan launched its vaccination rollout on February 17, 2021 and commenced booster vaccination campaign on December 1, 2021. It has been crucial to grasp the immune landscape in the country in order to aid in decision-making and evaluation of vaccination campaigns as well as understating the...

The Omicron variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become widespread across the world in a flashing manner. As of December 7, 2021, a total of 758 Omicron cases were confirmed in Denmark. Using the nucleotide sequences of the Delta and Omicron variants registered from Denmark in the GISAID database, we found...

The world identified the rapidly increasing incidence of the causative variant of SARS-CoV-2 Pangolin B [...]

Helicobacter pylori eradication therapy was included with insurance coverage from 1999 onwards in Japan, with the incidence of peptic ulcer expected to decrease as a consequence. This study investigated the temporal dynamics of peptic ulcer in Japan and identified underlying contributory factors using mathematical models. We investigated the seropr...

Background Following an outbreak of coronavirus disease 2019 (COVID-19) on the cruise ship Diamond Princess, passengers and crew were followed up to determine prognosis. We examined the epidemiological determinants of COVID-19 natural history using these follow-up data. Methods We analysed infection status, diagnosis, clinical symptoms and prognos...

The Tokyo 2020 Olympic and Paralympic Games represent the most diverse international mass gathering event held since the start of the coronavirus disease 2019 (COVID-19) pandemic. Postponed to summer 2021, the rescheduled Games were set to be held amidst what would become the highest-ever levels of COVID-19 transmission in the host city of Tokyo. A...

Background A hepatitis A epidemic occurred among men who have sex with men (MSM) in Japan in 2017–2018. In this study, we employ a parsimonious mathematical model to epidemiologically investigate the dynamics of infection, aiming to evaluate the effectiveness of campaign-based interventions among MSM to raise awareness of the situation. Methods A...

Objectives: The effective reproduction number (Rt) is critical for assessing the effectiveness of countermeasures during the coronavirus disease 2019 (COVID-19) pandemic. Conventional methods using reported incidence are unable to provide Rt timely due to the delay from infection to reporting. Here, we aim to develop a framework to predict the Rt...

Travelers play a role in triggering epidemics of imported dengue fever because they can carry the virus to other countries during the incubation period. If a traveler carrying dengue virus visits open green space and is bitten by mosquitoes, a local outbreak can ensue. In the present study, we aimed to understand the movement patterns of internatio...

To deal with the risk of emerging diseases with many unknowns, close and timely collaboration and communication between science experts and policymakers are crucial to developing and implementing an effective science-based intervention strategy. The Expert Meeting, an ad hoc medical advisory body, was established in February 2020 to advise Japan's...

Severe acute respiratory coronavirus 2 (SARS-CoV-2) infections have been associated with substantial presymptomatic transmission, which occurs when the generation interval--the time between infection of an individual with a pathogen and transmission of the pathogen to another individual--is shorter than the incubation period--the time between infec...

Background Individuals with asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection can propagate the virus unknowingly and thus have been a focus of public health attentions since the early stages of the pandemic. Understanding viral transmissibility among asymptomatic individuals is critical for successful control of c...

Norovirus continues to evolve, adjusting its pathogenesis and transmissibility. In the present study, we systematically collected datasets on Norovirus outbreaks in Japan from 2005 to 2019 and analyzed time-dependent changes in the asymptomatic ratio, the probability of virus detection, and the probability of infection given exposure. Reports of 1,...

Using numbers of SARS-CoV-2 variants detected in Japan as at 13 June 2021, relative instantaneous reproduction numbers (R RI ) of the R.1, Alpha, and Delta variants with respect to other strains circulating in Japan were estimated at 1.25, 1.44, and 1.95. Depending on the assumed serial interval distributions, R RI varies from 1.20–1.32 for R.1, 1....

Using nucleotide sequences of SARS-CoV-2 strains collected in Japan, the relative instantaneous reproduction numbers of the R.1, Alpha, and Delta variants with respect to other strains circulation in Japan were estimated at 1.256, 1.449, and 1.776, respectively. The numbers can range 1.198–1.335 for R.1, 1.342–1.596 for Alpha, and 1.557–2.00 for De...

Following the first report of the coronavirus disease 2019 (COVID-19) in Sapporo city, Hokkaido Prefecture, Japan, on 14 February 2020, a surge of cases was observed in Hokkaido during February and March. As of 6 March, 90 cases were diagnosed in Hokkaido. Unfortunately, many infected persons may not have been recognized due to having mild or no sy...

A classical swine fever (CSF) epidemic has been ongoing in Japan since September 2018. The outbreak started in Gifu Prefecture and involved 21 prefectures by the end of October 2020, posing a serious threat to pork industries. The present study was conducted to capture the spatiotemporal dynamics of CSF in Japan and assess the geographic range of t...

Benchmark dose (BMD) method have been used in the toxicological assessment of chemical substances so that the point of departure can be derived, as an alternative to the use of no observable adverse effect level (NOAEL), and the method is often applied to the incidence data of histopathological findings in the toxicity studies. In the present study...

Background: As the COVID-19 pandemic spread, the Japanese government declared a state of emergency on April 7, 2020 for seven prefectures, and on April 16, 2020 for all prefectures. The Japanese Prime Minister and governors requested people to adopt self-restraint behaviors, including working from home and refraining from visiting nightlife spots....

An initial set of interventions, including the closure of host and hostess clubs and voluntary limitation of non-household contact, probably greatly contributed to reducing the disease incidence of coronavirus disease (COVID-19) in Japan, but this approach must eventually be replaced by a more sustainable strategy. To characterize such a possible e...

Estimation of the effective reproduction number, R(t), of coronavirus disease (COVID-19) in real-time is a continuing challenge. R(t) reflects the epidemic dynamics based on readily available illness onset data, and is useful for the planning and implementation of public health and social measures. In the present study, we proposed a method for com...

The overall coronavirus disease secondary attack rate (SAR) in family members was 19.0% in 10 prefectures of Japan during February 22-May 31, 2020. The SAR was lower for primary cases diagnosed early, within 2 days after symptom onset. The SAR of asymptomatic primary cases was 11.8%.

Objectives: End-of-outbreak declarations are an important component of outbreak response as they indicate that public health and social interventions may be relaxed or lapsed. The present study aimed to assess end-of-outbreak probabilities for clusters of coronavirus disease 2019 (COVID-19) cases detected during the first wave of the COVID-19 pand...

The incubation period, or the time from infection to symptom onset, of COVID-19 has usually been estimated by using data collected through interviews with cases and their contacts. However, this estimation is influenced by uncertainty in the cases’ recall of exposure time. We propose a novel method that uses viral load data collected over time sinc...

Objective On 7 April 2020, the Japanese government declared a state of emergency in response to the novel coronavirus outbreak. To estimate the impact of the declaration on regional cities with low numbers of COVID-19 cases, large-scale surveillance to capture the current epidemiological situation of COVID-19 was urgently conducted in this study....

Background The relative importance of asymptomatic individuals who would never develop illness, compared to those who eventually develop symptoms, has yet to be fully clarified. Methods The very first cluster data in Tokyo and Kanagawa (n = 36) were analyzed. Movement of all close contact was restricted for 14 days and they underwent laboratory te...

The Japanese government initiated the Go To Travel campaign on 22 July 2020, offering deep discounts on hotel charges and issuing coupons to be used for any consumption at travel destinations in Japan. In the present study, we aimed to describe the possible epidemiological impact of the tourism campaign on increasing travel-associated cases of coro...

Objective: Even with relatively high vaccination coverage, Japan experienced rubella epidemics in 2012-2014 and 2018-2019, which were fueled by untraced imported cases. We aimed to develop a risk map for rubella epidemics in Japan by geographic location via analysis of seroepidemiological data and accounting for the abundance of foreign visitors....

Forecasting future epidemics helps inform policy decisions regarding interventions. During the early coronavirus disease 2019 epidemic period in January–February 2020, limited information was available, and it was too challenging to build detailed mechanistic models reflecting population behavior. This study compared the performance of phenomenolog...

Background: A measles outbreak involving 60 cases occurred in Yamagata, Japan in 2017. Using two different mathematical models for different datasets, we aimed to estimate measles transmissibility over time and explore any heterogeneous transmission patterns. Methods: The first model relied on the temporal distribution for date of illness onset for...

Background Seroepidemiological surveillance data has been demonstrated to be useful for estimating the cumulative incidence of influenza, and measures the difference between pre- and post-epidemic seropositive fractions. Despite this, such studies relied on a chosen cut-off value for seropositivity. The aim of the present study is to develop a meth...