Cost-effectiveness of Japanese encephalitis (JE) immunization in Bali, Indonesia

Liu, Wei; Clemens, John D.; Kari, Komang; Zhang, Xu

doi:10.1016/j.vaccine.2008.06.050

Cited by 35 publications

(28 citation statements)

References 9 publications

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“…Among the 15 Nepali families who were able to give a breakdown of admission costs, medication was the main expense, representing over half the acute admission cost. Similarly, medication was identified to be the predominant acute medical cost associated with JE illness in Indonesia [25].…”

Section: Discussionmentioning

confidence: 99%

“…A few studies have evaluated the economic cost of JE. Studies have estimated costs associated with JE through information from hospital administrators or neurologists, as well as by extrapolation of costs from other infectious conditions [25]–[27]. One study in Cambodia also ascertained ‘out of pocket’ costs to the family, by interviewing carers of children with JE up to 90 days after discharge from hospital [28].…”

Section: Introductionmentioning

confidence: 99%

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The Functional, Social and Economic Impact of Acute Encephalitis Syndrome in Nepal – a Longitudinal Follow-Up Study

et al. 2013

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BackgroundOver 133,000 children present to hospitals with Acute Encephalitis Syndrome (AES) annually in Asia. Japanese encephalitis (JE) accounts for approximately one-quarter of cases; in most cases no pathogen is identified and management is supportive. Although JE is known to result in neurological impairment, few studies have examined the wider impact of JE and AES on patients and their families.Methodology/Principal FindingsChildren (aged 1 month–14 years) with AES were assessed 5–12 months after discharge from two Nepali hospitals. Assessment included clinical examination, the Liverpool Outcome Score (LOS) - a validated assessment of function following encephalitis, questionnaires about the child's social participation since discharge, and out-of-pocket costs to the family. Children were classified as JE or ‘other AES’ based on anti-JE virus antibody titres during acute illness. Contact was made with the families of 76% (73/96) of AES children. Six children had died and one declined participation. 48% (32/66) reported functional impairment at follow-up, most frequently affecting behaviour, language or limb use. Impairment was more frequent in JE compared to ‘other AES’ cases (68% [13/19] versus 40% [19/47]; p = 0.06). 49% (26/53) had improvement in LOS between discharge and follow-up. The median out-of-pocket cost to families, including medical bills, medication and lost earnings was US$ 1151 (10 times their median monthly income) for children with severe/moderate impairment and $524 (4.6 times their income) for those with mild/no impairment (P = 0.007). Acute admission accounted for 74% of costs. Social participation was limited in 21% of children (n = 14).Conclusions/SignificanceProlonged functional impairment was common following AES. Economic impact to families was substantial. Encouragingly, almost half the children improved after discharge and most reported sustained social participation. This study highlights a need for long-term medical support following AES. Rationalisation of initial expensive hospital treatments may be warranted, especially since only supportive treatment is available.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Functional, Social and Economic Impact of Acute Encephalitis Syndrome in Nepal – a Longitudinal Follow-Up Study

et al. 2013

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“…GD1a does not appear to interact with triacyl molecules (Liang et al, 2007b). Since bacterial porins, which have been shown to be TLR2 ligands (Massari et al, 2002; Liu et al, 2008), are also oligomeric pore forming proteins that bind to the same dimer, there is a possibility that GD1a may also affect or enhance their signaling, but there is no experimental evidence supporting this hypothesis (Massari et al, 2006). …”

Section: Tlr2 Receptor Complexes and Accessory Moleculesmentioning

confidence: 99%

The Role of TLR2 in Infection and Immunity

Nascimento¹,

Massi²,

Wetzler³

2012

Front. Immun.

558

520

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Toll-like receptors (TLRs) are recognition molecules for multiple pathogens, including bacteria, viruses, fungi, and parasites. TLR2 forms heterodimers with TLR1 and TLR6, which is the initial step in a cascade of events leading to significant innate immune responses, development of adaptive immunity to pathogens and protection from immune sequelae related to infection with these pathogens. This review will discuss the current status of TLR2 mediated immune responses by recognition of pathogen-associated molecular patterns (PAMPS) on these organisms. We will emphasize both canonical and non-canonical responses to TLR2 ligands with emphasis on whether the inflammation induced by these responses contributes to the disease state or to protection from diseases.

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“…5,8,13,14 India has introduced a cost effective live-attenuated JE vaccine (SA 14-14-2) in a area hyperendemic for this disease area in 2006 after the JE epidemic in 2005. 8,15 More than 44 million children were immunized during [2006][2007][2008]. By 2010, 102 million children are targeted to be immunized in 111 districts endemic for JE in 11 states in India.…”

Section: Introductionmentioning

confidence: 99%

Hospital-Based Surveillance for Japanese Encephalitis at Four Sites in Bangladesh, 2003–2005

Hossain

Gurley

Montgomery³

et al. 2010

The American Journal of Tropical Medicine and Hygiene

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Abstract. We investigated the epidemiology and etiology of encephalitis at four tertiary hospitals in Bangladesh during [2003][2004][2005]. Patients who met a clinical case definition for acute encephalitis and had cerebrospinal fluid (CSF) pleocytosis were eligible for enrollment; a standardized sampling pattern was used to enroll eligible patients. Recent Japanese encephalitis virus (JEV) infection was defined by presence of IgM antibodies against JEV in CSF or serum. Twenty (4%) of 492 cases had laboratory evidence of recent JEV infection; two died. All JE cases occurred during May-December, and cases were identified among all age groups. All cases resided in rural areas. Fifteen patients were re-assessed 4-6 weeks after hospitalization; 5 (33%) patients had physical disabilities and 7 (47%) reported cognitive difficulties. Infection with JEV is clearly an etiology of encephalitis in Bangladesh. Population-based studies to quantify burden of disease could assess options for targeted immunization programs.

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Cost-effectiveness of Japanese encephalitis (JE) immunization in Bali, Indonesia

Cited by 35 publications

References 9 publications

The Functional, Social and Economic Impact of Acute Encephalitis Syndrome in Nepal – a Longitudinal Follow-Up Study

The Functional, Social and Economic Impact of Acute Encephalitis Syndrome in Nepal – a Longitudinal Follow-Up Study

The Role of TLR2 in Infection and Immunity

Hospital-Based Surveillance for Japanese Encephalitis at Four Sites in Bangladesh, 2003–2005

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