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Lau CL, Mills DJ, Mayfield H, Gyawali N, Johnson BJ, Lu H, Allel K, Britton PN, Ling W, Moghaddam T, Furuya-Kanamori L. A decision support tool for risk-benefit analysis of Japanese encephalitis vaccine in travellers. J Travel Med 2023; 30:taad113. [PMID: 37602668 DOI: 10.1093/jtm/taad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND During pre-travel consultations, clinicians and travellers face the challenge of weighing the risks verus benefits of Japanese encephalitis (JE) vaccination due to the high cost of the vaccine, low incidence in travellers (~1 in 1 million), but potentially severe consequences (~30% case-fatality rate). Personalised JE risk assessment based on the travellers' demographics and travel itinerary is challenging using standard risk matrices. We developed an interactive digital tool to estimate risks of JE infection and severe health outcomes under different scenarios to facilitate shared decision-making between clinicians and travellers. METHODS A Bayesian network (conditional probability) model risk-benefit analysis of JE vaccine in travellers was developed. The model considers travellers' characteristics (age, sex, co-morbidities), itinerary (destination, departure date, duration, setting of planned activities) and vaccination status to estimate the risks of JE infection, the development of symptomatic disease (meningitis, encephalitis), clinical outcomes (hospital admission, chronic neurological complications, death) and adverse events following immunization. RESULTS In low-risk travellers (e.g. to urban areas for <1 month), the risk of developing JE and dying is low (<1 per million) irrespective of the destination; thus, the potential impact of JE vaccination in reducing the risk of clinical outcomes is limited. In high-risk travellers (e.g. to rural areas in high JE incidence destinations for >2 months), the risk of developing symptomatic disease and mortality is estimated at 9.5 and 1.4 per million, respectively. JE vaccination in this group would significantly reduce the risk of symptomatic disease and mortality (by ~80%) to 1.9 and 0.3 per million, respectively. CONCLUSION The JE tool may assist decision-making by travellers and clinicians and could increase JE vaccine uptake. The tool will be updated as additional evidence becomes available. Future work needs to evaluate the usability of the tool. The interactive, scenario-based, personalised JE vaccine risk-benefit tool is freely available on www.VaxiCal.com.
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Affiliation(s)
- Colleen L Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD, Australia
| | - Deborah J Mills
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD, Australia
| | - Helen Mayfield
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Narayan Gyawali
- Mosquito Control Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Brian J Johnson
- Mosquito Control Laboratory, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Hongen Lu
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Kasim Allel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, Children's Hospital Westmead, Westmead, NSW, Australia
- Child and Adolescent Health and Sydney ID, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Weiping Ling
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Tina Moghaddam
- School of Information Technology and Electrical Engineering, Faculty of Science, The University of Queensland, St Lucia, QLD, Australia
| | - Luis Furuya-Kanamori
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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