{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T18:13:24Z","timestamp":1778350404392,"version":"3.51.4"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009505","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000}}],"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,21]],"date-time":"2021-06-21T00:00:00Z","timestamp":1624233600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Japanese encephalitis (JE) is a mosquito-borne disease and associated with high mortality and disability rate among symptomatic cases. In the absence of local data, this study estimated the economic burden and the disability-adjusted life years (DALYs) due to JE in Zhejiang Province, China during 2013\u20132018, to increase disease awareness and provide evidence for effective health policy.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methodology\/Principle findings<\/jats:title><jats:p>We merged multiple data sources, including National Notifiable Disease Registry System (NNDRS), patient interviews and medical records from corresponding hospitals for JE cases which occurred during 2013\u20132018 in Zhejiang Province. Direct costs were extracted from hospitals\u2019 billing systems and patient interviews. Indirect costs and disease burden were calculated based on questionnaire survey from patient interviews and follow-up assessment by general practitioners. Given under-reporting, an expansion factor (EF) was applied to extrapolate the JE burden to the provincial level. The total economic burden of JE during 2013\u20132018 was estimated at US $12.01 million with an EF = 3. Of this, $8.32 million was due to direct economic cost and $3.69 million to indirect cost. The disease burden of JE was 42.75 DALYs per million population (28.44 YLD, 14.28 YLL) according to the 1990 Global Burden of Disease (GBD 1990) methodology and 80.01 DALYs (53.67YLD, 26.34YLL) according to the GBD 2010 methodology. Sensitivity analysis demonstrated that the overall economic burden varied from US$ 1.73\u201336.42 million. The greatest variation was due to the prognosis of illness (-85.57%-203.17%), followed by occupation (-34.07%-134.12%) and age (-72.97%-47.69%).<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Conclusions\/Significance<\/jats:title><jats:p>JE imposes a heavy burden for families and society in Zhejiang Province. This study provides comprehensive empirical estimates of JE burden to increase awareness and strengthen knowledge of the public. These data may support provincial level public health decision making for prevention and control of JE. Ongoing surveillance for acute meningitis and encephalitis syndrome (AEMS) in sentinel hospitals, is needed to further refine estimates of JE burden.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pntd.0009505","type":"journal-article","created":{"date-parts":[[2021,6,21]],"date-time":"2021-06-21T17:38:01Z","timestamp":1624297081000},"page":"e0009505","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Economic and disease burden of Japanese encephalitis in Zhejiang Province, 2013\u20132018"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7299-6527","authenticated-orcid":true,"given":"Xuan","family":"Deng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Yan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8390-9417","authenticated-orcid":true,"given":"Zi-qiao","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xue-wen","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0863-5177","authenticated-orcid":true,"given":"Hanqing","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,6,21]]},"reference":[{"issue":"5","key":"pntd.0009505.ref001","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1038\/nrneurol.2018.30","article-title":"Japanese encephalitis\u2014the prospects for new treatments","volume":"14","author":"L Turtle","year":"2018","journal-title":"Nat Rev Neurol"},{"issue":"3","key":"pntd.0009505.ref002","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.vaccine.2015.07.057","article-title":"Japanese Encephalitis Vaccines: WHO position paper, February 2015\u2014Recommendations","volume":"34","author":"WHO","year":"2016","journal-title":"Vaccine"},{"key":"pntd.0009505.ref003","first-page":"435","article-title":"Epidemiology of Japanese encephalitis: past, present, and future prospects","volume":"11","author":"H Wang","year":"2015","journal-title":"Ther Clin Risk Manag"},{"issue":"10","key":"pntd.0009505.ref004","doi-asserted-by":"crossref","first-page":"766","DOI":"10.2471\/BLT.10.085233","article-title":"Estimated global incidence of Japanese encephalitis: a systematic review","volume":"89","author":"GL Campbell","year":"2011","journal-title":"Bull World Health Organ"},{"key":"pntd.0009505.ref005","doi-asserted-by":"crossref","first-page":"e51027","DOI":"10.7554\/eLife.51027","article-title":"Estimates of the global burden of Japanese encephalitis and the impact of vaccination from 2000\u20132015","volume":"9","author":"TM Quan","year":"2020","journal-title":"Elife."},{"key":"pntd.0009505.ref006","unstructured":"WHO. Japanese encephalitis reported cases. Available from: https:\/\/apps.who.int\/immunization_monitoring\/globalsummary\/timeseries\/tsincidencejapenc.html."},{"issue":"8","key":"pntd.0009505.ref007","doi-asserted-by":"crossref","first-page":"e0004936","DOI":"10.1371\/journal.pntd.0004936","article-title":"Sero-Molecular Epidemiology of Japanese Encephalitis in Zhejiang, an Eastern Province of China","volume":"10","author":"JR Pan","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0009505.ref008","first-page":"1","article-title":"Epidemiology of Japanese encephalitis in China, 2014\u20132018","volume":"26","author":"D Wu","year":"2020","journal-title":"Chinese journal of vaccines and immunization"},{"issue":"8","key":"pntd.0009505.ref009","doi-asserted-by":"crossref","first-page":"e0008574","DOI":"10.1371\/journal.pntd.0008574","article-title":"Serological and molecular epidemiology of Japanese Encephalitis in Zhejiang, China, 2015\u20132018","volume":"14","author":"X Deng","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"11","key":"pntd.0009505.ref010","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1111\/j.1365-3156.2009.02380.x","article-title":"Epidemiology and burden of disease from Japanese encephalitis in Cambodia: results from two years of sentinel surveillance","volume":"14","author":"S Touch","year":"2009","journal-title":"Trop Med Int Health"},{"issue":"37","key":"pntd.0009505.ref011","doi-asserted-by":"crossref","first-page":"5569","DOI":"10.1016\/j.vaccine.2012.05.068","article-title":"An economic evaluation of the use of Japanese encephalitis vaccine in the expanded program of immunization of Guizhou province, China","volume":"30","author":"ZD Yin","year":"2012","journal-title":"Vaccine"},{"key":"pntd.0009505.ref012","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.ijid.2020.07.026","article-title":"Hospital-based surveillance for Japanese encephalitis in Bangladesh, 2007\u20132016: Implications for introduction of immunization","volume":"99","author":"KK Paul","year":"2020","journal-title":"Int J Infect Dis"},{"issue":"3","key":"pntd.0009505.ref013","first-page":"246","article-title":"Analysis on disease burdern of Japanese encephalitis (JE) in Gansu province","volume":"16","author":"XX Wang","year":"2010","journal-title":"Zhongguo Yi Miao He Mian Yi"},{"issue":"17","key":"pntd.0009505.ref014","doi-asserted-by":"crossref","first-page":"3351","DOI":"10.1016\/j.vaccine.2020.02.032","article-title":"Comparative economic analysis of strategies for Japanese encephalitis vaccination of U.S. travelers","volume":"38","author":"C Carias","year":"2020","journal-title":"Vaccine"},{"key":"pntd.0009505.ref015","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1741-7015-4-8","article-title":"A hospital-based surveillance for Japanese encephalitis in Bali, Indonesia","volume":"4","author":"K Kari","year":"2006","journal-title":"BMC Med"},{"issue":"3","key":"pntd.0009505.ref016","doi-asserted-by":"crossref","first-page":"e0003547","DOI":"10.1371\/journal.pntd.0003547","article-title":"Economic and disease burden of dengue in Mexico","volume":"9","author":"EA Undurraga","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0009505.ref017","doi-asserted-by":"crossref","first-page":"e0007038","DOI":"10.1371\/journal.pntd.0007038","article-title":"Economic burden of dengue in Indonesia","volume":"13","author":"M Nadjib","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0009505.ref018","doi-asserted-by":"crossref","first-page":"e2055","DOI":"10.1371\/journal.pntd.0002055","article-title":"Economic and disease burden of dengue in Southeast Asia","volume":"7","author":"DS Shepard","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0009505.ref019","unstructured":"Yin ZD. An epidemiological survey for adult Japanese Encephalitis and health economic evaluation for vaccination in 2 prefectures, China. Doctoral Dissertation, China CDC. 2011. Available from: http:\/\/cdmd.cnki.com.cn\/Article\/CDMD-84501-1011210939.htm."},{"issue":"5","key":"pntd.0009505.ref020","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/rmv.1710","article-title":"Japanese encephalitis and Japanese encephalitis virus in mainland China","volume":"22","author":"Y Zheng","year":"2012","journal-title":"Rev Med Virol"},{"key":"pntd.0009505.ref021","unstructured":"Zhejiang Provincial Bureau of Statistics, 2019. Statistical Yearbook [cited 25 August 2020]. Available from: http:\/\/tjj.zj.gov.cn\/."},{"key":"pntd.0009505.ref022","unstructured":"World Bank, 2018. Official exchange rate [cited 25 August 2020]. Available from: https:\/\/data.worldbank.org\/indicator\/PA.NUS.FCRF?end=2019&start=2019&view=map&year=2018."},{"issue":"3","key":"pntd.0009505.ref023","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1007\/s00038-014-0553-y","article-title":"DALY calculation in practice: a stepwise approach","volume":"59","author":"B Devleesschauwer","year":"2014","journal-title":"Int J Public Health"},{"key":"pntd.0009505.ref024","volume-title":"The Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020","author":"CJL Murray","year":"1996"},{"issue":"3","key":"pntd.0009505.ref025","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s00038-014-0552-z","article-title":"Calculating disability-adjusted life years to quantify burden of disease","volume":"59","author":"B Devleesschauwer","year":"2014","journal-title":"Int J Public Health"},{"key":"pntd.0009505.ref026","unstructured":"World Health Organization. The global burden of disease: 2004 update. [cited 31 July 2020]. Available from: http:\/\/www.who.int\/healthinfo\/global_burden_disease\/2004_report_update\/en\/index.html."},{"key":"pntd.0009505.ref027","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/S0140-6736(12)61689-4","article-title":"Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990\u20132010: a systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"CJ Murray","year":"2012","journal-title":"Lancet"},{"key":"pntd.0009505.ref028","volume-title":"WHO methods data sources for global burden of disease estimates 2000\u20132016","author":"World Health Organization","year":"2018"},{"issue":"3","key":"pntd.0009505.ref029","first-page":"429","article-title":"Quantifying the burden of disease: the technical basis for disability-adjusted life years","volume":"72","author":"CJ Murray","year":"1994","journal-title":"Bull World Health Organ"},{"key":"pntd.0009505.ref030","unstructured":"World Health Organization annex. Table 3: Disability weights. [cited 31 July 2020] Available from: http:\/\/www.who.int\/entity\/healthinfo\/bodreferencedisabilityweights.xls. Accessed 29 April 2008."},{"issue":"13","key":"pntd.0009505.ref031","doi-asserted-by":"crossref","first-page":"2833","DOI":"10.1016\/j.vaccine.2020.02.018","article-title":"Japanese encephalitis vaccination in the Philippines: A cost-effectiveness analysis comparing alternative delivery strategies","volume":"38","author":"E Vodicka","year":"2020","journal-title":"Vaccine"},{"issue":"1","key":"pntd.0009505.ref032","doi-asserted-by":"crossref","first-page":"47","DOI":"10.4103\/0972-9062.130153","article-title":"Economic evaluation of Japanese encephalitis vaccination programme in Uttar Pradesh, India: A cost-benefit study","volume":"51","author":"K Singh","year":"2014","journal-title":"J Vector Borne Dis"},{"issue":"29","key":"pntd.0009505.ref033","doi-asserted-by":"crossref","first-page":"4593","DOI":"10.1016\/j.vaccine.2010.04.086","article-title":"A cost\u2013effectiveness analysis of Japanese encephalitis vaccine in Cambodia","volume":"28","author":"S Touch","year":"2010","journal-title":"Vaccine"},{"issue":"35","key":"pntd.0009505.ref034","doi-asserted-by":"crossref","first-page":"4456","DOI":"10.1016\/j.vaccine.2008.06.050","article-title":"Cost-effectiveness of Japanese encephalitis (JE) immunization in Bali, Indonesia","volume":"26","author":"W Liu","year":"2008","journal-title":"Vaccine"},{"issue":"3","key":"pntd.0009505.ref035","first-page":"17","article-title":"Analysis on disease burden of Japanese encephalitis in Jiangsu province","volume":"20","author":"ZL Li","year":"2009","journal-title":"Jiangsu J Prev Med"},{"issue":"5","key":"pntd.0009505.ref036","first-page":"334","article-title":"Cost-effectiveness of routine immunization to control Japanese encephalitis in Shanghai, China","volume":"81","author":"D Ding","year":"2003","journal-title":"Bull World Health Organ"},{"issue":"6","key":"pntd.0009505.ref037","doi-asserted-by":"crossref","first-page":"e389","DOI":"10.1016\/j.ijid.2009.01.009","article-title":"Outcome and extent of disability following Japanese encephalitis in Indonesian children","volume":"13","author":"MS Maha","year":"2009","journal-title":"Int J Infect Dis"},{"key":"pntd.0009505.ref038","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s41182-020-00200-3","article-title":"The burden of Japanese encephalitis, the catch-up vaccination campaign, and health service providers\u2019 perceptions in Myanmar: 2012\u20132017.","volume":"48","author":"AYN Win","year":"2020","journal-title":"Trop Med Health"},{"issue":"1","key":"pntd.0009505.ref039","doi-asserted-by":"crossref","first-page":"e2533","DOI":"10.1371\/journal.pntd.0002533","article-title":"Estimating the burden of Japanese encephalitis virus and other encephalitides in countries of the mekong region","volume":"8","author":"A Tarantola","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"issue":"2","key":"pntd.0009505.ref040","first-page":"164","article-title":"Acute meningitis and encephalitis syndrome surveillance disease burden in four China prefectures","volume":"53","author":"D Wu","year":"2019","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi"},{"issue":"4","key":"pntd.0009505.ref041","doi-asserted-by":"crossref","first-page":"766","DOI":"10.4269\/ajtmh.2010.09-0748","article-title":"Japanese encephalitis disease burden and clinical features of Japanese encephalitis in four cities in the People\u2019s Republic of China","volume":"83","author":"ZD Yin","year":"2010","journal-title":"Am J Trop Med Hyg"},{"issue":"7","key":"pntd.0009505.ref042","first-page":"PA666","article-title":"Japanese encephalitis in Asia: clinical burden and cost-effectiveness of vaccination program","volume":"15","author":"A Wadhwa","year":"2012","journal-title":"Infection-Clinical Outcomes Studies"},{"issue":"1","key":"pntd.0009505.ref043","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1478-7954-9-1","article-title":"Measuring the burden of arboviral diseases: the spectrum of morbidity and mortality from four prevalent infections","volume":"9","author":"AD Labeaud","year":"2011","journal-title":"Popul Health Metr"},{"key":"pntd.0009505.ref044","unstructured":"The United Nations. World Population Prospects 2019. Available from: https:\/\/population.un.org\/wpp\/Download\/Standard\/Population\/."},{"issue":"6","key":"pntd.0009505.ref045","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.4269\/ajtmh.14-0148","article-title":"Neurological sequelae of hospitalized Japanese encephalitis cases in Gansu province, China","volume":"92","author":"ZD Yin","year":"2015","journal-title":"Am J Trop Med Hyg"},{"issue":"4","key":"pntd.0009505.ref046","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1086\/590008","article-title":"The epidemiology, clinical features, and long-term prognosis of Japanese Encephalitis in Central Sarawak, Malaysia, 1997\u20132005","volume":"47","author":"MH Ooi","year":"2008","journal-title":"Clin Infect Dis"},{"issue":"11","key":"pntd.0009505.ref047","doi-asserted-by":"crossref","first-page":"2571","DOI":"10.1080\/21645515.2019.1599673","article-title":"Economic burden and associated factors of measles patients in Zhejiang Province, China","volume":"15","author":"X Deng","year":"2019","journal-title":"Hum Vaccin Immunother"},{"issue":"2 Suppl","key":"pntd.0009505.ref048","doi-asserted-by":"crossref","first-page":"41S","DOI":"10.1177\/1010539514560057","article-title":"Direct economic burden and influencing factors in patients with hepatitis B virus related diseases in Jiangsu, China","volume":"27","author":"H Zhang","year":"2015","journal-title":"Asia Pac J Public Health"},{"issue":"2","key":"pntd.0009505.ref049","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1002\/mds.27579","article-title":"The long-term direct and indirect economic burden among Parkinson\u2019s disease caregivers in the United States","volume":"34","author":"P Martinez-Martin","year":"2019","journal-title":"Mov Disord"},{"issue":"8","key":"pntd.0009505.ref050","doi-asserted-by":"crossref","first-page":"584","DOI":"10.2471\/BLT.09.071357","article-title":"Disability after encephalitis: development and validation of a new outcome score","volume":"88","author":"P Lewthwaite","year":"2010","journal-title":"Bull World Health Organ"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0009505","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009505","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,2]],"date-time":"2024-09-02T08:20:08Z","timestamp":1725265208000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009505"}},"subtitle":[],"editor":[{"given":"Michael Benjamin","family":"Arndt","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,6,21]]},"references-count":50,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0009505","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0009505","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,21]]}}}