Japanese Encephalitis Vaccine

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Japanese Encephalitis Vaccine

Postby holidayinkh » Wed Apr 17, 2013 4:13 am

Just wondering... How many expats living in Cambodia actually have and keep their JE vaccinations up to date?
(i.e. if you are an expat living there, do you?)

Those of you that do keep it up to date, do you usually just get a booster in Phnom Penh when necessary?

I find myself too late to get an appointment for this vaccine before I leave to PP, and am likely just going to leave it until I get there... If at all.

Thanks & cheers
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Re: Japanese Encephalitis Vaccine

Postby OrangeDragon » Wed Apr 17, 2013 5:05 am

i only get it when planning to sleep in a pig pen.

you have a .01-.005% chance of getting it here.... pretty unlikely.
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Re: Japanese Encephalitis Vaccine

Postby diamond lady » Wed Apr 17, 2013 10:02 am

I got this 9 years ago when travelling to East Timor because at the time it was highly recommended for travelling there. I have never reboosted and never will, now that I know more about vaccines.

My understanding is you only need to be concerned about JE if travelling/staying in areas with lots of both rice and pig farming.

From one study:

Based on the assumptions noted above, we estimated that approximately 67 900 JE cases typically occur annually in the 24 JE-endemic countries, for an incidence of 1.8 per 100 000 overall (Table 3). Approximately 33 900 (50%) of these cases occur in China (excluding Taiwan) and approximately 55 000 (81%) occur in areas with well established or developing JE vaccination programmes, while approximately 12 900 (19%) occur in areas with minimal or no JE vaccination programmes. Approximately 51 000 (75%) of these cases occur in children aged 0–14 years, which gives an estimated overall annual incidence of 5.4 per 100 000 in this age group.

http://www.who.int/bulletin/volumes/89/10/10-085233/en/
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Re: Japanese Encephalitis Vaccine

Postby diamond lady » Wed Apr 17, 2013 10:08 am

My best advice would be to find someone really knowledgable about tropical disease risk, preferably who has no vested interest in you spending $$ on getting vaccinated, and have a discussion with them about risks vs benefits. That is, the risks of taking the vaccine vs the benefits gained, in the context of your risk of actually getting JE in terms of where you'll be and what you'll be doing.
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Re: Japanese Encephalitis Vaccine

Postby vladimir » Wed Apr 17, 2013 10:28 am

diamond lady wrote:My understanding is you only need to be concerned about JE if travelling/staying in areas with lots of both rice and pig farming.


Which sums up most of even suburban/rural SE Asia, I think.
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Re: Japanese Encephalitis Vaccine

Postby diamond lady » Wed Apr 17, 2013 10:44 am

Sure, but prevalence isn't high, as the figures indicate, so I guess things like long-term, close-contact exposure and other factors play a part, as OD alluded to.

It's one of those scary ones simply because of the IF. If you get it, you can die or suffer neurological damage. If..... So for me, the real question is, what are the chances of me getting it in my individual situation? And, how effective is the vaccine and what risks does taking it pose?
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Re: Japanese Encephalitis Vaccine

Postby OrangeDragon » Wed Apr 17, 2013 10:54 am

your money is better invested in buying other things to protect you from other incidents. like thick rubber shoes to avoid lightning strikes. betting it all on black (repeatedly). a body guard to run interference and prevent you from getting hit in traffic.
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Re: Japanese Encephalitis Vaccine

Postby Lucky Lucan » Wed Apr 17, 2013 10:57 am

holidayinkh wrote:Just wondering... How many expats living in Cambodia actually have and keep their JE vaccinations up to date?


I don't know anyone who does that or takes anti-malarials.
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Re: Japanese Encephalitis Vaccine

Postby Bosco » Wed Apr 17, 2013 11:33 am

I foolishly acceded to that vaccination in Ireland in the late 90's from a doctor who told me I simply couldn't travel to Cambodia without it. For me it was a horrible experience, I felt sick for weeks after. Fair enough being ill is not too common but given the incidence of the disease here I think you'd be better spending your money on an advanced driving course.
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Re: Japanese Encephalitis Vaccine

Postby chubacca » Wed Apr 17, 2013 12:53 pm

A 2009 report of meningoencephalitis in Cambodia over years 2006-2007 showed that of the near 600 cases in children under the age of 14 that year, 1/5 had JE (Tropical Medicine and International Health Vol 14 Issue 11 1365–1373, November 2009). The incidence rate based on this report is 11.1/100000. That isn't too disimilar to some other Asian countries. Of the identified JE patients, 1 in 4 either died or were disables. This data was gathered from 6 sites - the National Pediatric Hospital (Phnom Penh) and Angkor Hospital for Children (Siem Reap), four main provincial hospitals in Battambang, Kampong Cham, Takeo and Svay Rieng provinces. Also of note is that as JE is a severe illness that can be rapidly fatal, cases that died without presenting to hospital would have been missed.
Given there has been no published report on incidence rates in adults in Cambodia, and just the fact that there is a relatively modest infection rate in children, it would be wise to not dismiss this as an unlikely disease that won't infect you - sure chances as slim, but not as slim as some posters have muted here!
If you are worried, get the jab; if you are living in the rurals, get the jab; if you have children*, I know which I would choose for them, if not for me!

* the vaccine is actually not recommended to be used in children <17yo in the USA - however, for those that are travelling to infected areas, there is proviso to consider it. There are some issues regarding side effects.

To the OP - have you already had 2 shots, and wondering if you should do your third booster here? Or have you just had the 1st? Either way, you can get the shot in Phnom Penh, the Pasteur Institute will do them for a fee, as will no doubt other centres.
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Re: Japanese Encephalitis Vaccine

Postby Bosco » Wed Apr 17, 2013 2:55 pm

@Chubacca, I'm sure I discovered a report way back then on the general population that gave an even higher instance than what you are quoting here. However the prevalence was amongst rice paddy workers/dwellers and when you stripped them out there was almost no chance of contracting it.
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Re: Japanese Encephalitis Vaccine

Postby OrangeDragon » Wed Apr 17, 2013 3:54 pm

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Re: Japanese Encephalitis Vaccine

Postby Bosco » Wed Apr 17, 2013 4:41 pm

OrangeDragon wrote:2012 data:
http://www.plosntds.org/article/info%3A ... td.0001678

heavy reading though...

Nice Googling OD. However this study looks at the incidence of the disease as opposed to the incidence of the disease in humans and the resulting deaths from same. The report I saw was probably from around the year 2000.
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Re: Japanese Encephalitis Vaccine

Postby OrangeDragon » Wed Apr 17, 2013 5:18 pm

the thing i keyed on was the incidence of the mosquito that carries the disease. a key factor in it's transmission, and as such your risk. as chewy pointed out, reporting on "reported cases" is going to have a lot of variance and be fairly inaccurate as a guide on your risk levels. too many variables like access to medical care, accuracy of diagnosis, accuracy of reporting [not out of the realm of possibility for the doctors here to be told to not report as much in fear of hurting tourist levels, and do all of those cheapo clinics report in?], and so on. best bet is to look at saturation of the virus and of the virus transmission source. sort of makes me want to go get a JE vaccine now honestly.

from that report, other than a few key areas, incidence of that specific mosquito was pretty low here. what i found surprising was, after i did an overlay with google maps to pin-point actual locations, PP is one of the medium-higher density areas.

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Re: Japanese Encephalitis Vaccine

Postby Bosco » Wed Apr 17, 2013 5:31 pm

Yes, but the key is to look at the incidence in humans. For example the disease may be hugely prominent in areas of Indonesia but as there are few pigs there to speak of it is being carried on other animals which are less likely to lead to transmission. The only thing that matters is the rate of humans infected which Chubacca gives above. My point is that even with figures far worse than the ones he gives the threat for normal foreigner activities here is not severe enough to warrant vaccination for me, in my view. Clearly the Australian government does not feel the same way about this as it has a full vaccination program in the affected areas. I am not, however, in the pay of the pharmaceutical companies (at least not since I worked for Pfizer many moons ago!).
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