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Long-Term Disability from Acute Childhood Japanese Encephalitis in Shanghai, China

We traced 85 Japanese encephalitis (JE) patients, 6–27 years after hospitalizations. The first control group was made up of 73 non-JE encephalitis patients 6–27 years previously, whereas the second control group was made up 78 neighborhood residents, matched to the 78 surviving JE cases by age, sex, and residence. All subjects were examined with neurologic examinations, intelligence quotient (IQ) measurement, Mini-Mental State Examinations (MMSE), and activities of daily living (ADL) assessments. At follow-up, 22% of JE patients had objective neurologic deficits compared with 3% of non-JE encephalitis patients. Moreover, 28% of JE patients had subnormal IQs, as opposed to 2% non-JE encephalitis patients. Abnormal ADL scores were only noted in 15% JE patients. All neighborhood controls had normal examination results, and one non-JE encephalitis case showed mildly reduced IQ. The study showed that significant neurologic and overall functional disability were evident in a high proportion of JE survivors many years after their index hospitalizations.

Received April 21, 2006. Accepted for publication March 28, 2007.

Acknowledgments: The authors thank Dr. Zhu Qi-Rong, Children’s Hospital, Fudan University, Shanghai, China, and Dr. Shen Bing and Dr. Xu Rui-Fang, Jing An and Qing Pu District Center of Disease Control, Shanghai, China for their great support.

Financial support: This project was supported financially by the Bill and Melinda Gates Children’s Vaccine Program at the Program for Appropriate Technology in Health, Seattle, WA (contract number 00-GAT.770-790-01149-LPS). IVI is supported by the governments of the Republic of Korea, Sweden, and Kuwait.

Disclaimer: The authors do not have a commercial or other association that might pose a conflict of interest. The sponsor of this study played no role in the design, execution, and analysis of the study, and was not involved in the decision to submit the paper for publication.

^* Address correspondence to Zhi-Yi Xu, Division of Translational Research, International Vaccine Institute, SNU Research Park, San 4-8, Bongcheon 7-dong, Kwanak-gu, Seoul 151-818, Republic of Korea. E-mail: xuzhiyi{at}ivi.int

Authors’ addresses: Ding Ding and Zhen Hong, Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China 200040, Telelphone and Fax: 86-21-62483421, E-mails: dding99{at}yahoo.com and zhong{at}shmu.edu.cn. Shou-jun Zhao, Department of Neurology, University of California San Francisco, 505 Parnassus Ave., Box 0114, San Francisco, CA 94143-0114, Telephone: 1-415-476-1488, Fax: 1-415-476-3428, E-mail: zhao538{at}itsa.ucsf.edu. John D. Clemens, Zhi-yi Xu, and Wei Liu, International Vaccine Institute, SNU Research Park, San 4-8, Bongcheon 7-dong, Kwanak-gu, Seoul, Republic of Korea 151-818, Telephone: 82-2-871-2801, Fax: 82-2-871-2803, E-mails: jclemens{at}ivi.int, xuzhiyi{at}ivi.int, and wliu{at}ivi.int. Bin Zhou, Bei Wang, Mao-sheng Huang, Jun Zeng, and Qi-hao Guo, Institute of Neurology, Fudan University, 12 Wu-lumuqi Zhong Road, Shanghai, China 200040, Telelphone and Fax: 86-21-62483421, E-mails: zhoubinjx{at}hotmail.com, huangquewb{at}163.com, mshuang{at}hotmail.com, junzeng{at}hotmail.com, and dr.guiqihao{at}126.com. Fang-biao Tao, School of Public Health, An-hui Medical University, Meishan Rd. Hefei, China 230032, Telephone and Fax: 86-551-5161179, E-mail: taofangbiao{at}yahoo.com.

Reprint requests: Zhi-yi Xu, International Vaccine Institute, SNU Research Park, San 4-8, Bongcheon 7-dong, Kwanak-gu, Seoul, Republic of Korea 151-818, E-mail: xuzhiyi{at}ivi.int.

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