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Article ; Online: Expanding japanese encephalitis vaccination to selected endemic indonesia provinces: A cost-effectiveness analysis.

Kosen, Soewarta / Khoe, Levina Chandra / Indriasih, Endang / Tarigan, Ingan / Iriawan, Retno Widyastuti / Agustiya, Rozana Ika / Letson, G William / Vodicka, Elisabeth

Vaccine: X

2022 Volume 11, Page(s) 100179

Abstract: Introduction: A Markov model was used to evaluate the potential health and economic impact of introducing JE vaccine nationally and in selected endemic areas of Indonesia compared to no vaccination from government and societal perspectives over a child' ... ...

Abstract	Introduction: A Markov model was used to evaluate the potential health and economic impact of introducing JE vaccine nationally and in selected endemic areas of Indonesia compared to no vaccination from government and societal perspectives over a child's lifetime horizon. Methods: Costs were obtained from hospitalized JE suspected patient billing data from 2014 to 2019 in seven provinces. Local data burden data were derived from the literature. Analysis considered several scenarios, including national and sub-regional introduction in seven provinces via a one-time vaccination campaign in all children 1-15 years old followed by routine immunization among infants (RI), or RI alone without vaccination campaign. Results and discussions: Across scenarios, JE vaccination was projected to range from cost-saving to cost-effective compared to no vaccination at a willingness-to-pay threshold of 0.5x gross domestic product per capita. Including a one-time campaign would avert nearly three times as many JE cases and deaths compared to RI alone while still providing good value for money.
Language	English
Publishing date	2022-06-13
Publishing country	England
Document type	Journal Article
ISSN	2590-1362
ISSN (online)	2590-1362
DOI	10.1016/j.jvacx.2022.100179
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Article ; Online: Dengue surveillance in preparation for field vaccine trials.

Letson, G William

Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology

2009 Volume 46 Suppl 2, Page(s) S10–2

Abstract: Preparations for dengue vaccine trials as well as vaccine introduction strategies require laboratory-based surveillance on an international and coordinated level. The Pediatric Dengue Vaccine Initiative (PDVI) has developed an international consortium of ...

Abstract	Preparations for dengue vaccine trials as well as vaccine introduction strategies require laboratory-based surveillance on an international and coordinated level. The Pediatric Dengue Vaccine Initiative (PDVI) has developed an international consortium of field sites in Latin America and Asia. These sites conduct community- based and enhanced passive laboratory-based surveillance of dengue fever. Through this consortium, PDVI is facilitating harmonized laboratory-based surveillance processes, so that disease incidence can be compared between different regions and countries. This process prepares sites for the rigorous case detection, diagnosis, recording and analysis to meet good clinical practice standards necessary for clinical dengue vaccine trials. In addition to several years of laboratory-based dengue surveillance data, dengue vaccine trial site criteria include low population migration of an endemic disease area, documentation of other local flavivirus epidemiology, good medical infrastructure, political stability, and country and target population commitment to vaccine trials and need for vaccine. Prevention of dengue fever is the most suitable primary end point for a proof-of-concept dengue vaccine trial. However, such trials may provide insufficient information for stratified analysis of outcomes according to varied risk factors and virus serotype. Consequently large community-based demonstration trials may be necessary.
MeSH term(s)	Child ; Clinical Trials as Topic/methods ; Dengue/epidemiology ; Dengue/prevention & control ; Dengue Vaccines/administration & dosage ; Dengue Vaccines/immunology ; Geography ; Humans ; Population Surveillance/methods
Chemical Substances	Dengue Vaccines
Language	English
Publishing date	2009-10
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1446080-4
ISSN	1873-5967 ; 1386-6532
ISSN (online)	1873-5967
ISSN	1386-6532
DOI	10.1016/S1386-6532(09)70288-4
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Article ; Online: Estimating the cost of illness of acute Japanese encephalitis and sequelae care in Vietnam and Laos: A cross-sectional study.

Nguyen, An Le Thanh / Slavkovsky, Rose / Phan, Hai Thanh / Nguyen, Huong Thi Thu / Vannachone, Souphaphone / Le, Dang Hai / Dubot-Pérès, Audrey / Vongsouvath, Manivanh / Dinh, Son Thai / Marfin, Anthony A / Letson, G William / Vu, Huong Minh / Tham, Dung Chi / Mayxay, Mayfong / Ashley, Elizabeth A / Pham, Thai Quang / Pecenka, Clint

PLOS global public health

2023 Volume 3, Issue 6, Page(s) e0001873

Abstract: Background: Japanese encephalitis (JE) is a leading cause of acute encephalitis syndrome and resulting neurological disability in Asia and the Western Pacific. This study aims to estimate the cost of acute care, initial rehabilitation and sequelae care, ...

Abstract	Background: Japanese encephalitis (JE) is a leading cause of acute encephalitis syndrome and resulting neurological disability in Asia and the Western Pacific. This study aims to estimate the cost of acute care, initial rehabilitation and sequelae care, in Vietnam and Laos. Methodology: We conducted a cross-sectional retrospective study using a micro-costing approach from the health system and household perspectives. Out-of-pocket direct medical and non-medical costs, indirect costs, and family impact were reported by patients and/or caregivers. Hospitalization costs were extracted from hospital charts. Acute costs covered expenditures from pre-hospital to follow-up visits while sequelae care costs were estimated from expenditures in the last 90 days. All costs are in 2021 US dollars. Principal findings: 242 patients in two major sentinel sites in the North and South of Vietnam and 65 patients in a central hospital in Vientiane, Laos, with laboratory-confirmed JE were recruited regardless of age, sex, and ethnicity. In Vietnam, the mean total cost was $3,371 per acute JE episode (median $2,071, standard error [SE] $464) while annual costs were $404 for initial sequelae care (median $0, SE $220) and $320 for long-term sequelae care (median $0, SE $108). In Laos, the mean hospitalization costs in acute stage were $2,005 (median $1,698, SE $279) and the mean annual costs were $2,317 (median $0, SE $2,233) for initial sequelae care and $89 (median $0, SE $57) for long-term sequelae care. In both countries, most patients did not seek care for their sequelae. Families perceived extreme impact from JE and 20% to 30% of households still had sustained debts years after acute JE. Conclusions: JE patients and families in Vietnam and Laos suffer extreme medical, economic, and social hardship. This has policy implications for improving JE prevention in these two JE-endemic countries.
Language	English
Publishing date	2023-06-13
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0001873
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Article ; Online: The future of Japanese encephalitis vaccination: expert recommendations for achieving and maintaining optimal JE control.

Vannice, Kirsten S / Hills, Susan L / Schwartz, Lauren M / Barrett, Alan D / Heffelfinger, James / Hombach, Joachim / Letson, G William / Solomon, Tom / Marfin, Anthony A

NPJ vaccines

2021 Volume 6, Issue 1, Page(s) 82

Language	English
Publishing date	2021-06-15
Publishing country	England
Document type	Journal Article
ISSN	2059-0105
ISSN (online)	2059-0105
DOI	10.1038/s41541-021-00338-z
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Article ; Online: Dengue in the Middle East: a neglected, emerging disease of importance.

Amarasinghe, Ananda / Letson, G William

Transactions of the Royal Society of Tropical Medicine and Hygiene

2012 Volume 106, Issue 1, Page(s) 1–2

Abstract: Dengue transmission has increased worldwide, particularly in Asia and Latin America since the 1970s, but limited information on the disease is available from the Middle East. Saudi Arabia and Yemen have reported a few epidemics of dengue. Three of the ... ...

Abstract	Dengue transmission has increased worldwide, particularly in Asia and Latin America since the 1970s, but limited information on the disease is available from the Middle East. Saudi Arabia and Yemen have reported a few epidemics of dengue. Three of the four dengue virus serotypes (DENV-1-3) have been reported in the region. Climate conditions in the Middle East are not favourable for the disease vector, but all other risk factors for dengue are potentially increasing. The existence of a large immigrant work force from dengue-endemic countries, increased travel from and to dengue-endemic countries and increased urbanization are expected to increase the likelihood of the emergence of dengue in the Middle East.
MeSH term(s)	Animals ; Communicable Diseases, Emerging/epidemiology ; Communicable Diseases, Emerging/virology ; Dengue/epidemiology ; Dengue/prevention & control ; Dengue/transmission ; Dengue Virus/isolation & purification ; Densovirinae ; Disease Outbreaks/prevention & control ; Emigration and Immigration ; Humans ; Middle East/epidemiology ; Risk Factors ; Urbanization
Language	English
Publishing date	2012-01
Publishing country	England
Document type	Editorial ; Research Support, Non-U.S. Gov't
ZDB-ID	441375-1
ISSN	1878-3503 ; 0035-9203
ISSN (online)	1878-3503
ISSN	0035-9203
DOI	10.1016/j.trstmh.2011.08.014
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Article ; Online: Antibody persistence and immune memory response following primary vaccination and boosting with live attenuated SA 14-14-2 Japanese encephalitis vaccine (CD-JEV) in Bangladesh: A phase 4 open-label clinical trial.

Zaman, K / Yunus, Md / Aziz, Asma B / Feser, Jodi / Mooney, Jessica / Tang, Yuxiao / Ellison, Damon W / Thaisomboonsuk, Butsaya / Zhang, Lei / Neuzil, Kathleen M / Marfin, Anthony A / Letson, G William

Vaccine: X

2022 Volume 10, Page(s) 100143

Abstract: Introduction: Japanese encephalitis (JE) virus is one of the leading causes of viral encephalitis across temperate and tropical zones of Asia. The live attenuated SA 14-14-2 JE vaccine (CD-JEV) is one of three vaccines prequalified by the World Health ... ...

Abstract	Introduction: Japanese encephalitis (JE) virus is one of the leading causes of viral encephalitis across temperate and tropical zones of Asia. The live attenuated SA 14-14-2 JE vaccine (CD-JEV) is one of three vaccines prequalified by the World Health Organization (WHO) to prevent JE. WHO currently recommends a single CD-JEV dose for infants in endemic settings. However, in the absence of long-term immunogenicity data, WHO has indicated a need for long-term immunogenicity studies to inform optimal dosing schedules and determine the need for booster doses. Methods: This Phase 4, open-label clinical study measured neutralizing antibody (NAb) titers in Bangladeshi children three and four years after primary CD-JEV vaccination and 7 and 28 days after a booster CD-JEV vaccination given four years after primary vaccination. The study also assessed the tolerability and safety of the booster dose. A NAb titer of ≥1:10 was considered seroprotective. Results: Of 560 children vaccinated between 10 and 12 months of age with CD-JEV three years earlier and enrolled in this study from 30 July 2015 through 03 January 2016, 52 (9.3%; 95% CI: 7.2-12.0) had a seroprotective titer at enrollment. One year later, of 533 children, 66 (12.4%; 95% CI: 9.9-15.5) had a seroprotective titer before receiving a booster dose. Of 524 children who received a booster CD-JEV dose, 479 (91.4%; 95% CI: 88.7-93.5) and 514 (98.1%; 95% CI: 96.5-99.0) were seroprotected 7 and 28 days later, respectively. The geometric mean titer (GMT) was 6 (95% CI: 6-6) at baseline, 105 (95% CI: 93-119) 7 days post-booster, and 167 (95% CI: 152-183) 28 days post-booster. No vaccine-associated neurologic adverse events or other serious adverse events were noted following the booster dose. Conclusions: Although most children did not have measurable antibody titers three and four years after a single primary CD-JEV dose, more than 90% of seronegative children had a strong anamnestic response within one week of a booster dose. This suggests that these children were immune despite the absence of measurable NAb prior to their booster.ClinicalTrials.gov Identifier: NCT02514746.
Language	English
Publishing date	2022-02-05
Publishing country	England
Document type	Journal Article
ISSN	2590-1362
ISSN (online)	2590-1362
DOI	10.1016/j.jvacx.2022.100143
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Article ; Online: Persistence of IgM Antibodies after Vaccination with Live Attenuated Japanese Encephalitis Vaccine.

Hills, Susan L / Van Keulen, Alex / Feser, Jodi / Panella, Amanda / Letson, G William / Staples, J Erin / Marfin, Anthony A / Brault, Aaron C

The American journal of tropical medicine and hygiene

2020 Volume 104, Issue 2, Page(s) 576–579

Abstract: Japanese encephalitis (JE) is a vaccine-preventable, mosquito-borne disease. Substantial progress with JE control in Asia has been made during the past decade, with most endemic countries now having JE vaccination programs, commonly using live attenuated ...

Abstract	Japanese encephalitis (JE) is a vaccine-preventable, mosquito-borne disease. Substantial progress with JE control in Asia has been made during the past decade, with most endemic countries now having JE vaccination programs, commonly using live attenuated SA14-14-2 JE vaccine (trade name CD-JEV). If a child develops encephalitis during the weeks to months following CD-JEV vaccination and anti-JE virus IgM (JE IgM) antibody is detected in serum, the question arises if this is JE virus infection indicating vaccine failure, or persistent JE IgM antibody postvaccination. To better understand JE IgM seropositivity following vaccination, sera from 268 children from a previous CD-JEV study were tested by two different JE IgM assays to determine JE IgM antibody frequency on days 28, 180, and 365 postvaccination. With the CDC JE IgM antibody capture ELISA (MAC-ELISA), 110 children (41%) had JE IgM positive or equivocal results on their day 28 sample, and eight (3%) and two (1%) had positive or equivocal results on day 180 and day 365 samples, respectively. With the InBios JE Detect™ MAC-ELISA (Seattle, WA), 118 (44%) children had positive or equivocal results on day 28 sample, and three (1%) and one (0.4%) had positive or equivocal results on day 180 and day 365 samples, respectively. Our results indicate that more than 40% children vaccinated with CD-JEV can have JE IgM antibodies in their serum at 1 month postvaccination but JE IgM antibody is rare by 6 months. These data will help healthcare workers assess the likelihood that JE IgM antibodies in the serum of a child with encephalitis after vaccination are vaccine related.
MeSH term(s)	Antibodies, Neutralizing/blood ; Antibodies, Viral/blood ; Child ; Encephalitis Virus, Japanese/immunology ; Encephalitis, Japanese/immunology ; Encephalitis, Japanese/prevention & control ; Humans ; Immunoglobulin M/blood ; Japanese Encephalitis Vaccines/administration & dosage ; Japanese Encephalitis Vaccines/immunology ; Vaccination ; Vaccines, Attenuated/administration & dosage ; Vaccines, Attenuated/immunology
Chemical Substances	Antibodies, Neutralizing ; Antibodies, Viral ; Immunoglobulin M ; Japanese Encephalitis Vaccines ; Vaccines, Attenuated
Language	English
Publishing date	2020-11-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.20-1132
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Article ; Online: Cost of Acute and Sequelae Care for Japanese Encephalitis Patients, Bangladesh, 2011-2021.

Sultana, Rebeca / Slavkovsky, Rose / Ullah, Md Redowan / Tasnim, Zareen / Sultana, Sharmin / Khan, Shifat / Shirin, Tahmina / Haque, Shamsul / Hossen, Md Tanvir / Islam, Md Monjurul / Khanom, Jesmin Ara / Haque, Abrarul / Nazneen, Arifa / Rimi, Nadia Ali / Hossain, Kamal / Islam, Md Tanbirul / Hasan, Shariful / Yazdany, Md Shameem / Ahsan, Md Shamim /

Mehedi, Kamran / Marfin, Anthony A / Letson, G William / Pecenka, Clint / Nguyen, An Le Thanh

Emerging infectious diseases

2023 Volume 29, Issue 12, Page(s) 2488–2497

Abstract: Japanese encephalitis (JE) is associated with an immense social and economic burden. Published cost-of-illness data come primarily from decades-old studies. To determine the cost of care for patients with acute JE and initial and long-term sequelae from ... ...

Abstract	Japanese encephalitis (JE) is associated with an immense social and economic burden. Published cost-of-illness data come primarily from decades-old studies. To determine the cost of care for patients with acute JE and initial and long-term sequelae from the societal perspective, we recruited patients with laboratory-confirmed JE from the past 10 years of JE surveillance in Bangladesh and categorized them as acute care, initial sequalae, and long-term sequelae patients. Among 157 patients, we categorized 55 as acute, 65 as initial sequelae (53 as both categories), and 90 as long-term sequelae. The average (median) societal cost of an acute JE episode was US $929 ($909), of initial sequelae US $75 ($33), and of long-term sequelae US $47 ($14). Most families perceived the effect of JE on their well-being to be extreme and had sustained debt for JE expenses. Our data about the high cost of JE can be used by decision makers in Bangladesh.
MeSH term(s)	Humans ; Encephalitis, Japanese/epidemiology ; Bangladesh/epidemiology ; Critical Care ; Japanese Encephalitis Vaccines ; Encephalitis Virus, Japanese
Chemical Substances	Japanese Encephalitis Vaccines
Language	English
Publishing date	2023-11-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2912.230594
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Article: Genomic identification of sarcoma radiosensitivity and the clinical implications for radiation dose personalization.

Yang, George / Yuan, Zhigang / Ahmed, Kamran / Welsh, Eric A / Fulp, William J / Gonzalez, Ricardo J / Mullinax, John E / Letson, Douglas / Bui, Marilyn / Harrison, Louis B / Scott, Jacob G / Torres-Roca, Javier F / Naghavi, Arash O

Translational oncology

2021 Volume 14, Issue 10, Page(s) 101165

Abstract: Background: Soft-tissue sarcomas (STS) are heterogeneous with variable response to radiation therapy (RT). Utilizing the radiosensitivity index (RSI) we estimated the radiobiologic ratio of lethal to sublethal damage (α/β), genomic-adjusted radiation ... ...

Abstract	Background: Soft-tissue sarcomas (STS) are heterogeneous with variable response to radiation therapy (RT). Utilizing the radiosensitivity index (RSI) we estimated the radiobiologic ratio of lethal to sublethal damage (α/β), genomic-adjusted radiation dose(GARD), and in-turn a biological effective radiation dose (BED). Methods: Two independent cohorts of patients with soft-tissue sarcoma were identified. The first cohort included 217 genomically-profiled samples from our institutional prospective tissue collection protocol; RSI was calculated for these samples, which were then used to dichotomize the population as either highly radioresistant (HRR) or conventionally radioresistant (CRR). In addition, RSI was used to calculate α/β ratio and GARD, providing ideal dosing based on sarcoma genomic radiosensitivity. A second cohort comprising 399 non-metastatic-STS patients treated with neoadjuvant RT and surgery was used to validate our findings. Results: Based on the RSI of the sample cohort, 84% would historically be considered radioresistant. We identified a HRR subset that had a significant difference in the RSI, and clinically a lower tumor response to radiation (2.4% vs. 19.4%), 5-year locoregional-control (76.5% vs. 90.8%), and lower estimated α/β (3.29 vs. 5.98), when compared to CRR sarcoma. Using GARD, the dose required to optimize outcome in the HRR subset is a BED Conclusions: We demonstrate that on a genomic scale, that although STS is radioresistant overall, they are heterogeneous in terms of radiosensitivity. We validated this clinically and estimated an α/β ratio and dosing that would optimize outcome, personalizing dose.
Language	English
Publishing date	2021-07-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2443840-6
ISSN	1936-5233
ISSN	1936-5233
DOI	10.1016/j.tranon.2021.101165
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Article ; Online: Japanese Encephalitis Virus as Cause of Acute Encephalitis, Bhutan.

Wangchuk, Sonam / Tamang, Tshewang Dorji / Darnal, Jit Bahadur / Pelden, Sonam / Lhazeen, Karma / Mynak, Mimi Lhamu / Letson, G William / Khare, Shalini / Leader, Brandon Troy / Marfin, Anthony A / Hills, Susan L

Emerging infectious diseases

2020 Volume 26, Issue 9, Page(s) 2239–2242

Abstract: In 2011, Bhutan's Royal Centre for Disease Control began Japanese encephalitis (JE) surveillance at 5 sentinel hospitals throughout Bhutan. During 2011-2018, a total of 20 JE cases were detected, indicating JE virus causes encephalitis in Bhutan. ... ...

Abstract	In 2011, Bhutan's Royal Centre for Disease Control began Japanese encephalitis (JE) surveillance at 5 sentinel hospitals throughout Bhutan. During 2011-2018, a total of 20 JE cases were detected, indicating JE virus causes encephalitis in Bhutan. Maintaining JE surveillance will help improve understanding of JE epidemiology in this country.
MeSH term(s)	Bhutan/epidemiology ; Encephalitis ; Encephalitis Virus, Japanese ; Encephalitis, Japanese/epidemiology ; Hospitals ; Humans
Language	English
Publishing date	2020-09-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2609.200620
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