@article{fdi:010085942,
  title = {{C}hildhood encephalitis in the {G}reater {M}ekong region (the {S}outh{E}ast {A}sia {E}ncephalitis {P}roject) : a multicentre prospective study},
  author = {{P}ommier, {J}. {D}. and {G}orman, {C}. and {C}rabol, {Y}. and {B}leakley, {K}. and {S}othy, {H}. and {S}anty, {K}. and {T}ran, {H}. {T}. {T}. and {N}guyen, {L}. {V}. and {B}unnakea, {E}. and {H}laing, {C}. {S}. and {A}ye, {A}. {M}. {M}. and {C}appelle, {J}. and {H}errant, {M}. and {P}iola, {P}. and {R}osset, {B}. and {C}hevalier, {V}. and {T}arantola, {A}. and {C}hanna, {M}. and {H}onnorat, {J}. and {P}into, {A}. {L}. and {R}attanavong, {S}. and {V}ongsouvath, {M}. and {M}ayxay, {M}. and {P}hangmanixay, {S}. and {P}hongsavath, {K}. and {T}in, {O}. {S}. and {K}yaw, {L}. {L}. and {T}in, {H}. {H}. and {L}inn, {K}. and {T}ran, {T}. {M}. {H}. and {P}erot, {P}. and {T}huy, {N}. {T}. {T}. and {H}ien, {N}. and {P}han, {P}. {H}. and {B}uchy, {P}. and {D}ussart, {P}. and {L}aurent, {D}. and {E}loit, {M}. and {D}ubot {P}{\'e}r{\`e}s, {A}udrey and {L}ortholary, {O}. and de {L}amballerie, {X}. and {N}ewton, {P}. {N}. and {L}ecuit, {M}. and {SEA}e {C}onsortium},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {E}ncephalitis is a worldwide public health issue, with a substantially high burden among children in southeast {A}sia. {W}e aimed to determine the causes of encephalitis in children admitted to hospitals across the {G}reater {M}ekong region by implementing a comprehensive state-of-the-art diagnostic procedure harmonised across all centres, and identifying clinical characteristics related to patients' conditions. {M}ethods {I}n this multicentre, observational, prospective study of childhood encephalitis, four referral hospitals in {C}ambodia, {V}ietnam, {L}aos, and {M}yanmar recruited children (aged 28 days to 16 years) who presented with altered mental status lasting more than 24 h and two of the following minor criteria: fever (within the 72 h before or after presentation), one or more generalised or partial seizures (excluding febrile seizures), a new-onset focal neurological deficit, cerebrospinal fluid ({CSF}) white blood cell count of 5 per m{L} or higher, or brain imaging ({CT} or {MRI}) suggestive of lesions of encephalitis. {C}omprehensive diagnostic procedures were harmonised across all centres, with first-line testing was done on samples taken at inclusion and results delivered within 24 h of inclusion for main treatable causes of disease and second-line testing was done thereafter for mostly non-treatable causes. {A}n independent expert medical panel reviewed the charts and attribution of causes of all the included children. {U}sing multivariate analyses, we assessed risk factors associated with unfavourable outcomes (ie, severe neurological sequelae and death) at discharge using data from baseline and day 2 after inclusion. {T}his study is registered with {C}linical{T}rials.gov, {NCT}04089436, and is now complete. {F}indings {B}etween {J}uly 28, 2014, and {D}ec 31, 2017, 664 children with encephalitis were enrolled. {M}edian age was 4.3 years (1.8-8.8), 295 (44%) children were female, and 369 (56%) were male. {A} confirmed or probable cause of encephalitis was identified in 425 (64%) patients: 216 (33%) of 664 cases were due to {J}apanese encephalitis virus, 27 (4%) were due to dengue virus, 26 (4%) were due to influenza virus, 24 (4%) were due to herpes simplex virus 1, 18 (3%) were due to {M}ycobacterium tuberculosis, 17 (3%) were due to {S}treptococcus pneumoniae, 17 (3%) were due to enterovirus {A}71, 74 (9%) were due to other pathogens, and six (1%) were due to autoimmune encephalitis. {D}iagnosis was made within 24 h of admission to hospital for 83 (13%) of 664 children. 119 (18%) children had treatable conditions and 276 (42%) had conditions that could have been preventable by vaccination. {A}t time of discharge, 153 (23%) of 664 children had severe neurological sequelae and 83 (13%) had died. {I}n multivariate analyses, risk factors for unfavourable outcome were diagnosis of {M} tuberculosis infection upon admission (odds ratio 3.23 [95% {CI} 1.04-10.03]), coma on day 2 (2.90 [1.78-4.72]), supplementary oxygen requirement (1.89 [1.25-2.86]), and more than 1 week duration between symptom onset and admission to hospital (3.03 [1.68-5.48]). {A}t 1 year after inclusion, of 432 children who were discharged alive from hospital with follow-up data, 24 (5%) had died, 129 (30%) had neurological sequelae, and 279 (65%) had completely recovered. {I}nterpretation {I}n southeast {A}sia, most causes of childhood encephalitis are either preventable or treatable, with {J}apanese encephalitis virus being the most common cause. {W}e provide crucial information that could guide public health policy to improve diagnostic, vaccination, and early therapeutic guidelines on childhood encephalitis in the {G}reater {M}ekong region.},
  keywords = {{CAMBODGE} ; {VIET} {NAM} ; {LAOS} ; {MYANMAR} ; {ASIE} {DU} {SUD} {EST} ; {MEKONG} {REGION}},
  booktitle = {},
  journal = {{L}ancet {G}lobal {H}ealth},
  volume = {10},
  numero = {7},
  pages = {{E}989--{E}1002},
  ISSN = {2214-109{X}},
  year = {2022},
  DOI = {10.1016/{S}2214-109{X}(22)00174-7},
  URL = {https://www.documentation.ird.fr/hor/fdi:010085942},
}