Hospital-based surveillance for Japanese encephalitis in Bangladesh, 2007–2016: Implications for introduction of immunization

Paul, Kishor Kumar; Sazzad, Hossain M.S.; Rahman, Mohammad Mizanur; Sultana, Sharmin; Hossain, M. Jahangir; Ledermann, Jeremy P.; Burns, Paul; Friedman, Michael S.; Flora, Meerjady Sabrina; Fischer, Marc; Hills, Susan L.; Luby, Stephen P.; Gurley, Emily S.

doi:10.1016/j.ijid.2020.07.026

Cited by 22 publications

(24 citation statements)

References 24 publications

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“…In areas with childhood JE vaccination, although the overall incidence of JE has decreased, a greater proportion of adults affected by JE has been reported, predominantly in temperate Asian countries (e.g., Japan, China, South Korea) [14][15][16][17][18][19][20][21][22]. The phenomenon of increasing adult population with JE has also been reported from South Asia where the routine vaccination program for JE was not available [23,24]. The epidemiology of childhood JE has been extensively studied [3][4][5][6][7][8][9][10][11][12]; however, the original epidemiology research with an assessment of infection in adults remains limited [14][15][16][17][18][20][21][22]25].…”

Section: Introductionmentioning

confidence: 99%

Long-term neurological and healthcare burden of adults with Japanese encephalitis: A nationwide study 2000-2015

Chen

Hsieh

et al. 2021

PLoS Negl Trop Dis

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Objective To assess the healthcare utilization, economic burden, and long-term neurological complications and mortality of an adult population with Japanese encephalitis (JE). Methods This study utilized two nationwide datasets in Taiwan: the Notifiable Disease Dataset of confirmed cases from the Centers for Disease Control to identify JE patients, and the National Health Insurance Research Database to obtain patients’ healthcare utilization. Survival analyses were performed to identify prognostic factors associated with the all-cause mortality of patients. Results This study included 352 adult cases with JE (aged≥20 years). The mean age of JE patients was 45 years. Stroke (event rate: 3.49/100 person-years) was the most common neurological complication, followed by epilepsy/convulsions (3.13/100 person-years), encephalopathy/delirium (2.20/100 person-years), and parkinsonism (1.97/100 person-years). Among the 336 hospitalized patients at JE diagnosis, 58.33% required intensive care. Among 79 patients who died following JE diagnosis, 48.84% of death events occurred within the year of diagnosis. The medical costs increased considerably at JE diagnosis and subsequent-year costs remained significantly higher than the costs before diagnosis (p<0.05). Having a four-dose JE vaccination (i.e., born after 1976) versus no JE vaccination history (i.e., born before 1963) was significantly associated with lower all-cause mortality (hazard ratio: 0.221 [95% confidence interval: 0.067, 0.725]). Comorbid diabetes and incident epilepsy/convulsion events significantly increased the mortality risk by 2.47- and 1.85-fold, respectively (p<0.05). Conclusion A considerable medical burden associated with JE was observed in affected adults, even in the years following JE diagnosis. Vaccination should be considered to prevent this sporadic, but lethal, viral infection.

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Section: Introductionmentioning

confidence: 99%

Long-term neurological and healthcare burden of adults with Japanese encephalitis: A nationwide study 2000-2015

Chen

Hsieh

et al. 2021

PLoS Negl Trop Dis

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“…Thirdly, at least 20-30% of cases do not have detectable levels of IgM antibodies in CSF on admission and therefore are misclassified as negative for JE [10]. Although previous studies [11][12][13][14][15] have discussed the burden of JE, complete analysis on both economic and disease burden is limited. In addition, measurement of DALYs for a certain region based on local empirical data remain rare.…”

Section: Introductionmentioning

confidence: 99%

Economic and disease burden of Japanese encephalitis in Zhejiang Province, 2013–2018

Deng

Yan

et al. 2021

PLoS Negl Trop Dis

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Background Japanese encephalitis (JE) is a mosquito-borne disease and associated with high mortality and disability rate among symptomatic cases. In the absence of local data, this study estimated the economic burden and the disability-adjusted life years (DALYs) due to JE in Zhejiang Province, China during 2013–2018, to increase disease awareness and provide evidence for effective health policy. Methodology/Principle findings We merged multiple data sources, including National Notifiable Disease Registry System (NNDRS), patient interviews and medical records from corresponding hospitals for JE cases which occurred during 2013–2018 in Zhejiang Province. Direct costs were extracted from hospitals’ billing systems and patient interviews. Indirect costs and disease burden were calculated based on questionnaire survey from patient interviews and follow-up assessment by general practitioners. Given under-reporting, an expansion factor (EF) was applied to extrapolate the JE burden to the provincial level. The total economic burden of JE during 2013–2018 was estimated at US $12.01 million with an EF = 3. Of this, $8.32 million was due to direct economic cost and $3.69 million to indirect cost. The disease burden of JE was 42.75 DALYs per million population (28.44 YLD, 14.28 YLL) according to the 1990 Global Burden of Disease (GBD 1990) methodology and 80.01 DALYs (53.67YLD, 26.34YLL) according to the GBD 2010 methodology. Sensitivity analysis demonstrated that the overall economic burden varied from US$ 1.73–36.42 million. The greatest variation was due to the prognosis of illness (-85.57%-203.17%), followed by occupation (-34.07%-134.12%) and age (-72.97%-47.69%). Conclusions/Significance JE imposes a heavy burden for families and society in Zhejiang Province. This study provides comprehensive empirical estimates of JE burden to increase awareness and strengthen knowledge of the public. These data may support provincial level public health decision making for prevention and control of JE. Ongoing surveillance for acute meningitis and encephalitis syndrome (AEMS) in sentinel hospitals, is needed to further refine estimates of JE burden.

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“…[ 29 ] The need to develop and improve the standard of JE surveillance is therefore well recognized. [ 30 31 ] It is uncertain if the ongoing rise in the occurrence of AES/JE is primarily related to poor vaccination coverage, vaccine ineffectiveness, emergence of a new strain or maybe a combination of those factors. It calls for robust epidemiological investigations of JE outbreaks,[ 32 ] in addition to largescale postvaccination sero-surveillance studies to resolve some of these issues.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of introduction of JEV vaccination into routine immunization program in a tribal district of Odisha

Kshatri¹,

Pattnaik²,

Badaik³

et al. 2022

Journal of Family Medicine and Primary Care

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Background: A severe outbreak of Japanese encephalitis (JE) and acute encephalitis syndrome (AES) with high case fatality among tribal children was reported from Malkangiri district of Odisha, during September to November 2016 affecting 336 children with 103 deaths. Following the outbreak, a mass vaccination campaign was introduced in Malkangiri district in2017. In 2018, the JE vaccine was introduced into the routine immunization program as per National Immunization Schedule. Our study surveys the JE vaccination coverage among children of Malkangiri and the incidence of JE cases for a period of three years. Methodology: The current study was conducted by establishing prospective and retrospective AES surveillance system and household vaccine coverage surveys in Malkangiri district. In the target population, the vaccination coverage survey was undertaken and also additional immunization coverage data from sub-centers was collected. Results: After 2016 JE outbreak, a mass vaccination campaign was carried out in children up to 15 years of age, where 96% of children were covered in the district in 2017 and only four AES cases were detected. Under routine immunization program, the vaccine coverage for the year 2018 was 68% for JE-1 dose and 37% for JE-2 dose. There were 8 AES cases detected in 2018 out of which four children died. Vaccination coverage for 2019 was 97% for JE-1 dose and 84% for JE-2 dose. The AES cases detected in 2019 was nil. Conclusion: Vaccination against JEV and AES surveillance systems has an important role in prevention and control of AES outbreaks.

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Hospital-based surveillance for Japanese encephalitis in Bangladesh, 2007–2016: Implications for introduction of immunization

Cited by 22 publications

References 24 publications

Long-term neurological and healthcare burden of adults with Japanese encephalitis: A nationwide study 2000-2015

Long-term neurological and healthcare burden of adults with Japanese encephalitis: A nationwide study 2000-2015

Economic and disease burden of Japanese encephalitis in Zhejiang Province, 2013–2018

Effectiveness of introduction of JEV vaccination into routine immunization program in a tribal district of Odisha

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