1
|
Charoensakulchai S, Singhasenee P, Matsee W, Caumes E, Pisutsan P. Rationale for Japanese encephalitis vaccination in short-term travellers to endemic areas. J Travel Med 2024; 31:taae003. [PMID: 38195999 DOI: 10.1093/jtm/taae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024]
Abstract
Although the Japanese encephalitis (JE) vaccine is typically strongly recommended for long-term high-risk travellers, some cases of JE infections have been reported amongst short-term travellers with seemingly low risk. This article underscores the advantages and reasoning behind JE vaccination for this particular group of travellers.
Collapse
Affiliation(s)
- Sakarn Charoensakulchai
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Pattaratida Singhasenee
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Wasin Matsee
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Travel Medicine Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Eric Caumes
- Department of Infectious Diseases, Hospital Hotel Dieu, 1 place du Parvis Notre Dame, Paris 75004, France
| | - Phimphan Pisutsan
- Thai Travel Clinic, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Travel Medicine Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| |
Collapse
|
2
|
Hills SL, Walter EB, Atmar RL, Fischer M. Japanese Encephalitis Vaccine: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2019; 68:1-33. [PMID: 31518342 PMCID: PMC6659993 DOI: 10.15585/mmwr.rr6802a1] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This report updates the 2010 recommendations from the CDC Advisory Committee on Immunization Practices (ACIP) regarding prevention of Japanese encephalitis (JE) among U.S. travelers and laboratory workers (Fischer M, Lindsey N, Staples JE, Hills S. Japanese encephalitis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010;59[No. RR-1]). The report summarizes the epidemiology of JE, describes the JE vaccine that is licensed and available in the United States, and provides recommendations for its use among travelers and laboratory workers.JE virus, a mosquitoborne flavivirus, is the most common vaccine-preventable cause of encephalitis in Asia. JE occurs throughout most of Asia and parts of the western Pacific. Approximately 20%-30% of patients die, and 30%-50% of survivors have neurologic, cognitive, or behavioral sequelae. No antiviral treatment is available.Inactivated Vero cell culture-derived JE vaccine (Ixiaro [JE-VC]) is the only JE vaccine that is licensed and available in the United States. In 2009, the U.S. Food and Drug Administration (FDA) licensed JE-VC for use in persons aged ≥17 years; in 2013, licensure was extended to include children aged ≥2 months.Most travelers to countries where the disease is endemic are at very low risk for JE. However, some travelers are at increased risk for infection on the basis of their travel plans. Factors that increase the risk for JE virus exposure include 1) traveling for a longer period; 2) travel during the JE virus transmission season; 3) spending time in rural areas; 4) participating in extensive outdoor activities; and 5) staying in accommodations without air conditioning, screens, or bed nets. All travelers to countries where JE is endemic should be advised to take precautions to avoid mosquito bites to reduce the risk for JE and other vectorborne diseases. For some persons who might be at increased risk for JE, the vaccine can further reduce the risk for infection. The decision about whether to vaccinate should be individualized and consider the 1) risks related to the specific travel itinerary, 2) likelihood of future travel to countries where JE is endemic, 3) high morbidity and mortality of JE, 4) availability of an effective vaccine, 5) possibility (but low probability) of serious adverse events after vaccination, and 6) the traveler's personal perception and tolerance of risk.JE vaccine is recommended for persons moving to a JE-endemic country to take up residence, longer-term (e.g., ≥1 month) travelers to JE-endemic areas, and frequent travelers to JE-endemic areas. JE vaccine also should be considered for shorter-term (e.g., <1 month) travelers with an increased risk for JE on the basis of planned travel duration, season, location, activities, and accommodations and for travelers to JE-endemic areas who are uncertain about their specific travel duration, destinations, or activities. JE vaccine is not recommended for travelers with very low-risk itineraries, such as shorter-term travel limited to urban areas or outside of a well-defined JE virus transmission season.
Collapse
|
3
|
Abstract
PURPOSE OF REVIEW We examine the present global burden of Japanese encephalitis (JE) in endemic populations, summarize published cases in travelers since 2009, examine current guidelines for vaccination for international travelers, and consider challenges in prevention of this vector-borne disease. RECENT FINDINGS We identified 11 JE cases in travelers that were published in peer-reviewed literature since 2009. JE incidence in endemic countries appears to be declining but the number of JE cases reported to the World Health Organization (WHO) varied from estimates derived from other published reports based on serosurveys or sentinel surveillance. Current JE vaccines appear to be safe and are not associated with delayed hypersensitivity in contrast to the older mouse brain vaccine. Given differences between WHO-reported cases and local surveillance data, future research on true incidence is needed. Regular assessment will inform JE risk in travelers. National and international guidelines on JE vaccination varied; we suggest areas for improvement.
Collapse
|
4
|
Erra EO, Kantele A. The Vero cell-derived, inactivated, SA14-14-2 strain-based vaccine (Ixiaro) for prevention of Japanese encephalitis. Expert Rev Vaccines 2015; 14:1167-79. [PMID: 26162529 DOI: 10.1586/14760584.2015.1061939] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With an estimated 68,000 cases each year, Japanese encephalitis (JE) is the leading cause of viral encephalitis in Asia. Vaccination against the disease is recommended for endemic populations and also for travelers at risk. Recently, a Vero cell-derived, inactivated, SA14-14-2 strain-based JE vaccine (JE-VC) became available for travelers from non-endemic regions, replacing the traditional mouse brain-derived vaccines. First licensed in 2009, JE-VC is currently available in Europe, the USA, Canada, Australia and several other countries. In 2013, the vaccine was approved by the European Medicines Agency and the US Food and Drug Administration for use in children. This review summarizes current data on the immunogenicity, safety and clinical use of JE-VC.
Collapse
Affiliation(s)
- Elina O Erra
- Haartman Institute, University of Helsinki, Helsinki, Finland
| | | |
Collapse
|
5
|
Hills SL, Stoltey J, Martínez D, Kim PY, Sheriff H, Zangeneh A, Eilerman SR, Fischer M. A case series of three US adults with Japanese encephalitis, 2010-2012. J Travel Med 2014; 21:310-3. [PMID: 24861145 PMCID: PMC4594826 DOI: 10.1111/jtm.12127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 02/10/2014] [Accepted: 02/19/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Japanese encephalitis (JE) virus is the leading cause of vaccine-preventable encephalitis in Asia. Although the risk for acquiring JE for most travelers to Asia is low, it varies based on the destination, season, trip duration, and activities. METHODS We present case reports of three US adults who were infected with JE virus while traveling or residing in Asia. RESULTS Among the three JE patients, the first made a 10-day trip to mainland China and participated in outdoor activities in a rural area, the second had been resident in Taiwan for 4 months, and the third, fatal case was an expatriate living in South Korea. CONCLUSIONS JE should be considered in the differential diagnosis for any patient with an acute neurologic infection, who has recently been in a JE-endemic country. Health-care providers should assess the itineraries of travelers to JE-endemic countries, provide guidance on personal protective measures to prevent vector-borne diseases, and consider recommending JE vaccine for travelers at increased risk for JE virus infection.
Collapse
Affiliation(s)
- Susan L Hills
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Takeshita N, Lim CK, Mizuno Y, Shimbo T, Kotaki A, Ujiie M, Hayakawa K, Kato Y, Kanagawa S, Kaku M, Takasaki T. Immunogenicity of single-dose Vero cell-derived Japanese encephalitis vaccine in Japanese adults. J Infect Chemother 2014; 20:238-42. [PMID: 24485326 DOI: 10.1016/j.jiac.2013.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/25/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
In Japan, intensive immunization against Japanese encephalitis (JE) was performed from 1967 to 1976, and regular JE immunization was performed thereafter. However, for Japanese adults facing JE risk, dates of vaccination with new inactivated Vero cell-derived JE vaccine are unavailable. This study investigated how a single dose of Vero cell-derived JE vaccine affects Japanese adults. Neutralizing antibodies were measured pre- and post-JE vaccination in 79 participants (age 40.7 ± 9.4 years), enrolled between October 2009 and March 2011, whose JE-vaccination data were gathered from vaccination records and history taking. Before vaccination, the participants' seroprotection rate (SPR) was 51.9%, whereas SPR after vaccination was 93.7%. The seroconversion rate (SCR), which measures seronegative cases that turn seropositive after vaccination, was 86.8%. The geometric mean titer (GMT) was 14.7 before vaccination and 70.1 after vaccination. Age was a significant difference between seroprotected (42.8 years) and non-seroprotected (38.7 years) groups before vaccination. Then the difference of age, SCR, pre-vaccination GMT, post-vaccination GMT and sex ratio were also significant in participants aged 25-39 years and ≥40 years, who represent generations born when Japan's JE-vaccination policy changed. SCR was 100% in participants aged 25-39 years with a vaccination recorded 55.6% in participants aged 25-39 without a vaccination record, and 96.0% in participants aged ≥40 years. Thus, more participants aged 25-39 years were seroprotected before vaccination, but SCR was higher in those aged ≥40 years. Most Japanese adults can be protected after one-dose vaccination, but this may be insufficient for people aged 25-39 years without recorded JE vaccination.
Collapse
Affiliation(s)
- Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
| | - Chang-Kweng Lim
- Department of Virology 1, National Institute of Infectious Diseases, Tokyo, Japan.
| | - Yasutaka Mizuno
- Department of Infection Control and Prevention, Tokyo Medical University, Japan.
| | - Takuro Shimbo
- Department of Clinical Research and Informatics, International Clinical Research Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
| | - Akira Kotaki
- Department of Virology 1, National Institute of Infectious Diseases, Tokyo, Japan.
| | - Mugen Ujiie
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
| | - Yasuyuki Kato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
| | - Shuzo Kanagawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
| | - Mitsuo Kaku
- Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Tomohiko Takasaki
- Department of Virology 1, National Institute of Infectious Diseases, Tokyo, Japan.
| |
Collapse
|
7
|
Japanese encephalitis in a French traveler to Nepal. J Neurovirol 2014; 20:99-102. [PMID: 24408307 DOI: 10.1007/s13365-013-0226-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/28/2013] [Accepted: 12/05/2013] [Indexed: 10/25/2022]
Abstract
Japanese encephalitis is frequent in Asia, with a severe prognosis, but rare in travelers. Culex mosquitoes transmit Japanese encephalitis virus. Risk factors are destination, duration of stay, summer and fall seasons, outdoor activities, and type of accommodation. We report the case of a French traveler to Nepal with neutralization-based serological confirmed Japanese encephalitis. He presented classical clinical (viral syndrome before an encephalitis status with behavioral disorder, global hypotonia, mutism, movement disorders, seizure, and coma), radiological (lesions of thalami, cortico-spinal tracts, and brainstem) and biological features (lymphocytic meningitis). Nowadays, the presence of Japanese encephalitis virus in Nepal, including mountain areas, is established but Japanese encephalitis remains rare in travelers returning from this area and neurologist physicians need to become familiar with this. We recommend vaccination for travelers spending a long period of time in Nepal and having at-risk outdoor activities.
Collapse
|
8
|
Doti P, Castro P, Martínez MJ, Zboromyrska Y, Aldasoro E, Inciarte A, Requena-Méndez A, Requena A, Milisenda J, Fernández S, Nicolás JM, Muñoz J. A case of Japanese encephalitis in a 20 year-old Spanish sportsman, February 2013. ACTA ACUST UNITED AC 2013; 18:20573. [PMID: 24008230 DOI: 10.2807/1560-7917.es2013.18.35.20573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a severe case of imported Japanese encephalitis (JE) in a healthy young Spanish traveller who developed symptoms after spending three weeks in a touristic area of Thailand. The patient was diagnosed in Thailand and subsequently transferred to Barcelona, Spain, where the Thai laboratory results were confirmed based on IgM serology. Although JE is a rare disease in travellers, this case illustrates the need for seeking travel medical advice before visiting tropical countries.
Collapse
Affiliation(s)
- P Doti
- Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Duffy MR, Reed C, Edelson PJ, Blumensaadt S, Crocker K, Griggs A, Biggerstaff BJ, Delorey MJ, Hayes EB, Fischer M. A survey of US travelers to Asia to assess compliance with recommendations for the use of Japanese encephalitis vaccine. J Travel Med 2013; 20:165-70. [PMID: 23577862 PMCID: PMC5659122 DOI: 10.1111/jtm.12020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 11/02/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Japanese encephalitis (JE) vaccine is recommended for travelers to Asia whose itineraries increase their risk of exposure to JE virus. The numbers of travelers with such itineraries and the proportion of those who receive JE vaccine are unknown. We performed a survey to estimate the proportion of US travelers to Asia who receive JE vaccine according to the Advisory Committee on Immunization Practices (ACIP) recommendations. METHODS We surveyed US residents ≥ 18 years old departing on 38 flights to Asia selected through a stratified random sample of all direct flights to JE-endemic countries from three US airports. We asked participants about planned itineraries and activities, sources of travel health information, JE vaccination status, and potential barriers to vaccination. Participants planning to spend ≥ 30 days in Asia or at least half of their time in rural areas were defined as "higher JE risk" travelers for whom vaccination should have been considered. RESULTS Of 2,341 eligible travelers contacted, 1,691(72%) completed the survey. Among these 1,691 participants, 415 (25%) described itineraries for which JE vaccination should have been considered. Of these 415 higher JE risk travelers, only 47 (11%) reported receiving ≥ 1 dose of JE vaccine. Of the 164 unvaccinated higher JE risk travelers who visited a health care provider before their trip, 113 (69%) indicated that they had never heard of JE vaccine or their health care provider had not offered or recommended JE vaccine. CONCLUSIONS A quarter of surveyed US travelers to Asia reported planned itineraries for which JE vaccination should have been considered. However, few of these at-risk travelers received JE vaccine.
Collapse
Affiliation(s)
- Mark R Duffy
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO 80521, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Langevin S, Libman M, Drebot MA, Laverdière M. A case of Japanese encephalitis virus infection acquired during a trip in Thailand. J Travel Med 2012; 19:127-9. [PMID: 22414040 DOI: 10.1111/j.1708-8305.2011.00582.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A case of Japanese encephalitis virus (JEV) infection is reported in a young traveler returning from Thailand. Clinical suspicion of JEV in travelers returning from endemic areas with neurologic symptoms is warranted. Confirmation of the diagnosis is complex and requires specialized laboratory services. Individualized advice on the costs and benefits of vaccination is recommended.
Collapse
Affiliation(s)
- Stephanie Langevin
- Department of Microbiology-Infectious Diseases, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | | | | | | |
Collapse
|