A decision support tool for risk-benefit analysis of Japanese encephalitis vaccine in travellers.

BACKGROUND: During pre-travel consultations, clinicians and travellers face the challenge of weighing the risks verus benefits of Japanese encephalitis (JE) vaccination due to the high cost of the vaccine, low incidence in travellers (~1 in 1 million), but potentially severe consequences (~30% case-fatality rate). Personalised JE risk assessment based on the travellers' demographics and travel itinerary is challenging using standard risk matrices. We developed an interactive digital tool to estimate risks of JE infection and severe health outcomes under different scenarios to facilitate shared decision-making between clinicians and travellers. METHODS: A Bayesian network (conditional probability) model risk-benefit analysis of JE vaccine in travellers was developed. The model considers travellers' characteristics (age, sex, co-morbidities), itinerary (destination, departure date, duration, setting of planned activities) and vaccination status to estimate the risks of JE infection, the development of symptomatic disease (meningitis, encephalitis), clinical outcomes (hospital admission, chronic neurological complications, death) and adverse events following immunization. RESULTS: In low-risk travellers (e.g. to urban areas for <1 month), the risk of developing JE and dying is low (<1 per million) irrespective of the destination; thus, the potential impact of JE vaccination in reducing the risk of clinical outcomes is limited. In high-risk travellers (e.g. to rural areas in high JE incidence destinations for >2 months), the risk of developing symptomatic disease and mortality is estimated at 9.5 and 1.4 per million, respectively. JE vaccination in this group would significantly reduce the risk of symptomatic disease and mortality (by ~80%) to 1.9 and 0.3 per million, respectively. CONCLUSION: The JE tool may assist decision-making by travellers and clinicians and could increase JE vaccine uptake. The tool will be updated as additional evidence becomes available. Future work needs to evaluate the usability of the tool. The interactive, scenario-based, personalised JE vaccine risk-benefit tool is freely available on www.VaxiCal.com.

Sumac (Rhus coriaria L.) anthocyanin loaded-pectin and chitosan nanofiber matrices for real-time monitoring of shrimp freshness.

In this study, pectin (PC)/chitosan nanofiber (ChNF) films containing a novel anthocyanin from sumac extract were successfully developed for freshness monitoring and shelf-life extension of shrimp. The physical, barrier, morphological, color, and antibacterial properties of biodegradable films were evaluated. The addition of sumac anthocyanins to the films caused intramolecular interactions (such as hydrogen bonds) in the film structure, as confirmed by using attenuated total reflectance Fourier transform infrared (ATR-FTIR) analysis, suggesting good compatibility of film ingredients. Also, intelligent films showed significant sensitivity to ammonia vapors and changed color from reddish to olive color at the first 5 min. Moreover, the results showed that PC/ChNF and PC/ChNF/sumac films have significant antibacterial activity against Gram-positive bacteria and Gram-negative bacteria. In addition to the good functional characteristics of the smart film, the resulting films showed acceptable physicomechanical properties. So, PC/ChNF/sumac smart film exhibited the strength = 60 MPa with the flexibility = 23.3 %. Likewise, water vapor barrier reduced from 2.5 (×10-11 g. m/m2. s. Pa) to 2.3 (×10-11 g. m/m2. s. Pa) after adding anthocyanin. The results of the application of intelligent film containing anthocyanins of sumac extract for shrimp freshness monitoring showed that the color of the intelligent film changed from reddish to greenish color after 48 h of storage, which shows the high potential of the produced film for monitoring the spoilage of seafood products.