Japanese encephalitis vaccine for travelers: risk-benefit reconsidered

Connor, Bradley A.; Hamer, Davidson H.; Kozarsky, Phyllis E.; Jong, Elaine C.; Halstead, Scott B.; Keystone, Jay S.; Mileno, Maria D.; Dawood, Richard; Rogers, Bonnie; Bunn, William B.

doi:10.1093/jtm/taz037

Cited by 15 publications

(7 citation statements)

References 8 publications

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“…JE can be challenging to diagnose as virus or viral nucleic acid is usually not detected in readily available clinical specimens at the time of illness, and it is possible that JE is under diagnosed in returning travellers. For example, the Geosentinel survey has identified a number of cases of meningoencephalitis without a cause determined, 19 including 48 cases returning from JE endemic areas between 2009 and 2018 3 …”

Section: Discussionmentioning

confidence: 99%

“…Any risk assessment for JE vaccination must, therefore, carefully consider the proposed itinerary and season of travel, as well as any predisposing conditions that might increase the risk of developing JE following infection with the virus, such as immunocompromise, extremes of age, pregnancy and conditions compromising the blood brain barrier, as well as the prospect of repeated visits 3 , 34 . Our third patient’s arteriovenous malformation may have predisposed to JE through compromise to the blood–brain barrier.…”

Section: Discussionmentioning

confidence: 99%

“…Most of South and Southeast Asia is endemic for JE, though local disease incidence can be highly variable. In endemic areas, where exposure usually occurs in childhood, only 0.1–0.3% of infections result in disease, 1 but in people exposed at an older age, the rate of symptomatic disease may be higher, up to 4% of infections 2 , 3 . The adult population in JE endemic areas is usually immune to JE through asymptomatic exposure to the virus (or vaccination) in childhood, 4 whereas non-JE immune adults, such as travellers, are susceptible to the disease upon first exposure to JEV, irrespective of age.…”

Section: Introductionmentioning

confidence: 99%

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‘More than devastating’—patient experiences and neurological sequelae of Japanese encephalitis§

Turtle

Easton

Defres

et al. 2019

Journal of Travel Medicine

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Background Japanese encephalitis (JE), caused by the mosquito-borne JE virus, is a vaccine-preventable disease endemic to much of Asia. Travellers from non-endemic areas are susceptible if they travel to a JE endemic area. Although the risk to travellers of JE is low, the consequences may be severe. Methods Here, we describe three cases of JE in British travellers occurring in 2014–15. In addition, we report, through interviews with survivors and their families, personal experiences of life after JE. Results Three cases of JE were diagnosed in British travellers in 2014/15. One was acquired in Thailand, one in China and one in either Thailand, Laos or Cambodia. All three patients suffered severe, life-threatening illnesses, all were admitted to intensive care units and required medical evacuation back to the UK. One patient suffered a cardiac arrest during the acute stage but made a good recovery. The other two patients remain significantly paralysed and ventilator dependent. All three cases had clear indications for vaccination, and all have been left with life-changing neurological sequelae. Conclusions Travel health providers should be aware of the severity of JE, as well as the risk, allowing travellers to make fully informed decisions on JE vaccination.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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‘More than devastating’—patient experiences and neurological sequelae of Japanese encephalitis§

Turtle

Easton

Defres

et al. 2019

Journal of Travel Medicine

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“…In addition, Lee et al have reviewed the applicability and usage of inactivated Vero-cell-derived vaccines, live attenuated vaccines, and live recombinant vaccines [ 158 ]. Connor et al have reviewed the US Advisory Committee on Immunization Practices (ACIP) policy for travellers, which has recommended JEV vaccination for those who frequently travel to JEV-endemic countries or decide to stay there for an extended period of time [ 159 ]. These types of policies may help to reduce the risk of infection in healthy people and should be adopted by other countries that are geographically close to JEV-endemic countries but are not themselves affected by JEV.…”

Section: Recent Insights and Developments: Vaccines Therapeutics And ...mentioning

confidence: 99%

Molecular pathogenesis of Japanese encephalitis and possible therapeutic strategies

et al. 2022

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Japanese encephalitis virus (JEV), a single-stranded, enveloped RNA virus, is a health concern across Asian countries, associated with severe neurological disorders, especially in children. Primarily, pigs, bats, and birds are the natural hosts for JEV, but humans are infected incidentally. JEV requires a few host proteins for its entry and replication inside the mammalian host cell. The endoplasmic reticulum (ER) plays a significant role in JEV genome replication and assembly. During this process, the ER undergoes stress due to its remodelling and accumulation of viral particles and unfolded proteins, leading to an unfolded protein response (UPR). Here, we review the overall strategy used by JEV to infect the host cell and various cytopathic effects caused by JEV infection. We also highlight the role of JEV structural proteins (SPs) and non-structural proteins (NSPs) at various stages of the JEV life cycle that are involved in up- and downregulation of different host proteins and are potentially relevant for developing efficient therapeutic drugs. Graphical abstract

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“…The case fatality rate of symptomatic cases is up to 30% among the symptomatic cases of JEV. Of those who survive, 30% to 50% of the surviving patients had long-term neurological, psychological, and cognitive impairment, including polio-like weakness and life-long seizure disorders [ 37 , 38 ].…”

Section: Introductionmentioning

confidence: 99%

Novel Antiviral Efficacy of Hedyotis diffusa and Artemisia capillaris Extracts against Dengue Virus, Japanese Encephalitis Virus, and Zika Virus Infection and Immunoregulatory Cytokine Signatures

Mao

Minakawa

Moi

2022

Plants

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Currently, there are no specific therapeutics for flavivirus infections, including dengue virus (DENV) and Zika virus (ZIKV). In this study, we evaluated extracts from the plants Hedyotis diffusa (HD) and Artemisia capillaris (AC) to determine the antiviral activity against DENV, ZIKV, and Japanese encephalitis virus (JEV). HD and AC demonstrated inhibitory activity against JEV, ZIKV, and DENV replication and reduced viral RNA levels in a dose–responsive manner, with non-cytotoxic concentration ranging from 0.1 to 10 mg/mL. HD and AC had low cytotoxicity to Vero cells, with CC50 values of 33.7 ± 1.6 and 30.3 ± 1.7 mg/mL (mean ± SD), respectively. The anti-flavivirus activity of HD and AC was also consistent in human cell lines, including human glioblastoma (T98G), human chronic myeloid leukemia (K562), and human embryonic kidney (HEK-293T) cells. Viral-infected, HD-treated cells demonstrated downregulation of cytokines including CCR1, CCL26, CCL15, CCL5, IL21, and IL17C. In contrast, CCR1, CCL26, and AIMP1 were elevated following AC treatment in viral-infected cells. Overall, HD and AC plant extracts demonstrated flavivirus replication inhibitory activity, and together with immunoregulatory cytokine signatures, these results suggest that HD and AC possess bioactive compounds that may further be refined as promising candidates for clinical applications.

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Japanese encephalitis vaccine for travelers: risk-benefit reconsidered

Cited by 15 publications

References 8 publications

‘More than devastating’—patient experiences and neurological sequelae of Japanese encephalitis§

‘More than devastating’—patient experiences and neurological sequelae of Japanese encephalitis§

Molecular pathogenesis of Japanese encephalitis and possible therapeutic strategies

Novel Antiviral Efficacy of Hedyotis diffusa and Artemisia capillaris Extracts against Dengue Virus, Japanese Encephalitis Virus, and Zika Virus Infection and Immunoregulatory Cytokine Signatures

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