Spatial epidemiology of Japanese encephalitis virus and other infections of the central nervous system in Lao PDR (2003 – 2011): a retrospective analysis

Abstract

ABSTRACTBackgroundCentral nervous system (CNS) infections are important contributors to morbidity and mortality and the causative agents for ∼50% patients are never identified. The causative agents of some CNS infections have distinct spatial and temporal patterns.Methodology/Principal FindingsHere we present the results of a spatial epidemiological and ecological analysis of CNS infections in Lao PDR (2003 – 2011). The data came from hospitalizations for suspected CNS infection at Mahosot Hospital in Vientiane. Out of 1,065 patients, 450 were assigned a confirmed diagnosis. While many communities in Lao PDR are in rural and remote locations, most patients in these data came from villages along major roads. Japanese encephalitis virus ((JEV); n=94) and Cryptococcus spp. (n=70) were the most common infections. JEV infections peaked in the rainy season and JEV patients came from villages with higher surface flooding during the same month as admission. JEV infections were spatially dispersed throughout rural areas and were most common in children. Cryptococcus spp. infections clustered near Vientiane (an urban area) and among adults.Conclusions/SignificanceThe spatial and temporal patterns identified in this analysis are related to complex environmental, social, and geographic factors. For example, JEV infected patients came from locations with environmental conditions (surface water) that are suitable to support larger mosquito vector populations. Most patients in these data came from villages that are near major roads; likely the result of geographic and financial access to healthcare and also indicating that CNS diseases are underestimated in the region (especially from more remote areas). As Lao PDR is undergoing major developmental and environmental changes, the space-time distributions of the causative agents of CNS infection will also likely change. There is a major need for increased diagnostic abilities; increased access to healthcare, especially for rural populations; and for increased surveillance throughout the nation.AUTHOR SUMMARYInfections of the central nervous system (CNS) are important with regard to public health. However many CNS infections are never diagnosed. In this analysis we investigated spatial and temporal patterns in hospitalized patients with suspected CNS infections in Lao PDR. We found that patients were most likely to come from villages located along major roads and highways. Patients from remote areas may have more difficulty reaching healthcare facilities. The most commonly diagnosed infection in these patients was Japanese encephalitis virus (JEV). Patients with this disease came from locations that were optimal for the mosquito vectors that spread JEV, rural areas with surface water and during the rainy season. Our analyses suggest that CNS infections should be a priority for public health workers in the region. Diagnostic capabilities should be increased throughout the nation; surveillance efforts should be broadened; and efforts should be increased toward providing easy access to healthcare for rural and remote populations.