Key facts

 Japanese encephalitis virus (JEV) is a flavivirus related to dengue, yellow fever and West
Nile viruses, and is spread by mosquitoes.
 JEV is the main cause of viral encephalitis in many countries of Asia with an estimated
68 000 clinical cases every year.
 Although symptomatic Japanese encephalitis (JE) is rare, the case-fatality rate among those
with encephalitis can be as high as 30%. Permanent neurologic or psychiatric sequelae can
occur in 30%–50% of those with encephalitis.
 24 countries in the WHO South-East Asia and Western Pacific regions have endemic JEV
transmission, exposing more than 3 billion people to risks of infection.
 There is no cure for the disease. Treatment is focused on relieving severe clinical signs and
supporting the patient to overcome the infection.
 Safe and effective vaccines are available to prevent JE. WHO recommends that JE
vaccination be integrated into national immunization schedules in all areas where JE
disease is recognized as a public health issue.

Japanese encephalitis virus JEV is the most important cause of viral encephalitis in Asia. It is a
mosquito-borne flavivirus, and belongs to the same genus as dengue, yellow fever and West Nile
viruses.

The first case of Japanese encephalitis viral disease (JE) was documented in 1871 in Japan.

Signs and symptoms

Most JEV infections are mild (fever and headache) or without apparent symptoms, but
approximately 1 in 250 infections results in severe clinical illness. Severe disease is
characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma,
seizures, spastic paralysis and ultimately death. The case-fatality rate can be as high as 30%
among those with disease symptoms.

Of those who survive, 20%–30% suffer permanent intellectual, behavioural or neurological

problems such as paralysis, recurrent seizures or the inability to speak.

Transmission

24 countries in the WHO South-East Asia and Western Pacific regions have JEV transmission
risk, which includes more than 3 billion people.

JEV is transmitted to humans through bites from infected mosquitoes of the Culex species
(mainly Culex tritaeniorhynchus). Humans, once infected, do not develop sufficient viraemia to
infect feeding mosquitoes. The virus exists in a transmission cycle between mosquitoes, pigs
and/or water birds (enzootic cycle). The disease is predominantly found in rural and periurban
settings, where humans live in closer proximity to these vertebrate hosts.
In most temperate areas of Asia, JEV is transmitted mainly during the warm season, when large
epidemics can occur. In the tropics and subtropics, transmission can occur year-round but often
intensifies during the rainy season and pre-harvest period in rice-cultivating regions.

Symptoms
 Less than 1% of people infected with Japanese encephalitis (JE) virus develop clinical
illness.
 In persons who develop symptoms, the incubation period (time from infection until illness)
is typically 5-15 days.
 Initial symptoms often include fever, headache, and vomiting.
 Mental status changes, neurologic symptoms, weakness, and movement disorders might
develop over the next few days.
 Seizures are common, especially among children.
Treatment
 No specific treatments have been found to benefit patients with JE, but hospitalization for
supportive care and close observation is generally required.
 Treatment is symptomatic. Rest, fluids, and use of pain relievers and medication to reduce
fever may relieve some symptoms.
Outcome
 Among patients who develop encephalitis, 20% – 30% die.
 Although some symptoms improve after the acute illness, 30%-50% of survivors continue
to have neurologic, cognitive, or psychiatric symptoms.

Of course, it would also help to establish other preventive measures, such as applying insect
repellent on exposed skin, wearing proper clothing (long-sleeves, long pants, and socks if weather
permits), avoiding exposure to mosquitoes during peak feeding hours, making sure your doors and
windows are well-screened, and installing bed nets.

Health Assistant Secretary Eric Tayag on Wednesday said that the vaccine for the mosquito-
borne Japanese encephalitis is commercially available, but discouraged getting the shot
during the rainy season.

"Hindi ho namin nirerekomenda sapagkat hindi po pangkaraniwang binibigay ang bakuna,

commercially available po sa ngayon," Tayag said in an interview on News To Go on
Wednesday.

"Sa panahon na kung saan tumataas po yung kaso, sayang lang po ang pagpapabakuna. Ginagawa
po ang pagpapabakuna bago pa po ang tag-ulan," Tayag continued.

The Department of Health (DOH) said in a statement that the vaccine will be introduced to young
children in 2018 as soon as data confirms its efficacy.

It will be introduced during the off-peak season for the disease.

Tayag said that for the meantime, caution must be taken to prevent the spread of the disease, which
has been in the Philippines since the 1950s.
"Ang tagubilin ng ating kalihim, Secretary [Paulyn] Ubial, na ang pangunahing panlaban po natin
diyan ay kontra sa mga lamok," Tayag said.

He clarified that it is the Culex species of mosquitoes carries Japanese encephalitis, not the
Aedes aegypti that carries dengue, chikungunya, Zika fever, Mayaro and yellow fever viruses.

"Ang karaniwan, ang mga lamok na ito ay natatagpuan doon po kung saan mayroong
pinagtatamnan ng palay sapagkat sa mababaw na tubig po sila naglalagak ng itlog nila," he
said.

The DOH's Epidemiology Bureau has recorded 133 laboratory-confirmed Japanese

encephalitis cases all over the country from January to August 26.

It said that provinces in Central Luzon -- Aurora, Bataan, Bulacan, Nueva Ecija, Pampanga,
Tarlac And Zambales -- are considered hotspots for the disease and closely monitored.

The DOH said Japanese encephalitis is an inflammation of the brain that causes "fever, chills,
headache, fatigue, nausea, vomiting, confusion, and in severe cases, neck stiffness, seizures,
paralysis, and coma, which may lead to death."

It said symptoms usually do not manifest until five to 15 days after being bitten by a mosquito
and the disease itself does not have a known cure.

Those able to recover from the disease may still show signs of "neurologic complications such as
paralysis, recurrent seizures or inability to speak."

Meanwhile, Ubial urged the public to intensify efforts to prevent and control mosquito populations
and adhere to the 4S method.

4S stands for Search and destroy mosquito breeding places, use Self-protection measures,
Seek early consultation for fever lasting more than two days, and Say yes to fogging when
there is an impending outbreak.

"When we get sick or our children develop fever for two days or flu-like symptoms, seek
immediate consultation at the nearest health facilities. Let us avoid unnecessary and indiscriminate
fogging activities," Ubial said.