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

Abstract

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.

Age-dependent Powassan Virus Lethality is Directed by Glial Cell Activation and Divergent Neuroinflammatory Cytokine Responses in a Murine Model

“…Although human POWV cases are limited, available data indicates that lethal POWV infections occur in individuals >60 years of age (2,7,14,17) . This is consistent with the age-dependent lethality of TBEV infections (38,39) and the severity of mosquito-borne West Nile virus (WNV) and Japanese Encephalitis virus (JEV) infections (73,(87)(88)(89) . Models of POWV infection were previously studied in peripherally inoculated 5-14 week old mice using murine brain neuroadapted LB and SP strains (2,12,24,25,27,29,34) .…”

Molecular Mechanisms in the Genesis of Seizures and Epilepsy Associated With Viral Infection

“…The seizures are generalized or focal with secondary generalization, single or multiple, and may present as status epilepticus. Late-onset epilepsy is less common in JEV ( Singhi, 2011 ; Chen et al, 2021 ). Concerning congenital ZIKV syndrome, recent reports show that epileptic seizures are among the main neurological outcomes of this syndrome ( Table 1 ).…”

Attenuated Chimeric GI/GIII Vaccine Candidate against Japanese Encephalitis Virus

“…Approximately 68,000 people worldwide are infected annually by JEV, but most remain asymptomatic [ 5 ]. However, among patients manifesting symptoms, approximately 30% die, and 30–50% of survivors continue to have neurological complications [ 6 ]. The virus incubation for the infection is between 7 and 14 days [ 6 , 7 ].…”

“…However, among patients manifesting symptoms, approximately 30% die, and 30–50% of survivors continue to have neurological complications [ 6 ]. The virus incubation for the infection is between 7 and 14 days [ 6 , 7 ]. Unlike in adults, who are asymptomatic upon infection, in children and the elderly, Japanese encephalitis (JE) causes high fever, headache, perceptual abnormalities, disturbance of consciousness, coma, and death.…”