Key result
Japanese encephalitis vaccination reduces estimated symptomatic disease and mortality risk ~80% in high-risk travelers.
Why the study?
Weighing the risks versus benefits of Japanese encephalitis vaccination is challenging given the high vaccine cost, low incidence in travellers, and potentially severe consequences, while standard risk matrices struggle to provide personalised risk assessment.
Does Japanese encephalitis vaccination reduce the risk of symptomatic disease and mortality in travellers?
Does Japanese encephalitis vaccination reduce the risk of symptomatic disease and mortality in travellers?
Absolute Event Rate: 1.9% vs 9.5%
A newly developed interactive Bayesian network tool can provide personalized risk-benefit estimates for Japanese encephalitis vaccination in travelers to facilitate shared decision-making.
May support JE vaccination counseling in high-risk travelers; leaves open prospective validation of modeled estimates.
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.
No takes yet. Share an insight, caveat, or question.
Lau et al. (2023) studied Japanese encephalitis. Japanese encephalitis vaccine vs. No vaccination was evaluated on Estimated risk of symptomatic disease per million in high-risk travellers. In high-risk travellers, Japanese encephalitis vaccination was estimated to reduce the risk of symptomatic disease and mortality by approximately 80%, to 1.9 and 0.3 per million, respectively.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: