GLOBAL SITUATION OF JECONTROL

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Table of contents
Background
Current Status
Strategy
Challenge
Conclusion

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BACKGROUND
Aetiology: Japanese encephalitis virus flavivirus
Could cause acute encephalitis paralysis, seizures,
coma and death
Most of infection: childhood (<15 years)
Case-fatality ratio: 20-30%
Serious neurologic sequelae: 30-50% survivor

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 Transmitted via mosquito Culex tritaeniorhynchus group (most

important), acquire virus from pigs and water birds
Vector: live in water pools and flooded rice fields
Diagnosis:
Viral / antigen / nucleic acid detection
Electron microscopy, virus isolation, IFA, EIA, RT-PCR

Antibody detection
ELISA, IFA, haemagglutination inhibition (HI) assay, complement fixation test
(CFT), plaque reduction neutralization test (PRNT)

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CURRENT STATUS
Global incidence: unknown
In Asia: at least 50,000 clinical cases reported annually

(approximately
67.900 cases annually in 24 Asian-endemic countries: incidence 1.8 /100 000 (Grant L
Campbell, et all)

Endemic Countries:

India
Nepal
Vietnam
Cambodia*
China
Indonesia
Japan

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Philippines
Korea
Thailand
South-eastern Russian Federation
Malaysia,
Laos
Myanmar

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 Limited to tropic-sub tropic regions

Occurred in previously non-endemic areas

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STRATEGY
Early case detection and treatment
Early diagnosis (JE virus specific lab test)
Proper management reduce case fatality

Vector control
Reduction of breeding sources
Insecticide use
Control of pig (segregating at least 4-5 km from human habitation,
immunization)

IEC
Media advocacy
Health education
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 Integration of JE within vaccine-preventable disease

Immunization

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CHALLENGES
Sustainable surveillance and diagnostics
Limited resources
Access to a safe and affordable vaccine
Pig husbandry regulation

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Example: India (1)

7.2% JE positivity among AES cases (>90% of cases are
children missed during campaigns)
Campaigns among 1-15 year olds with single dose of live,
attenuated SA 14-14-2 vaccine
44.5 million immunized in 2006-2008 campaigns
Inclusion of vaccine in RI among 16-24 month olds in new
birth cohorts

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Example: India (2)

Continue surveillance of disease burden with focus on
improved coordination (clinician, lab, health dept)
Identification of non-JE viruses for comprehensive AES
control strategy
Campaigns to cover 110 endemic districts in 11 states by
2010, targeting 86.5 million children

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CONCLUSION
Laboratory support is crucial for diagnosis to strengthen
surveillance (regional WHO JE Lab network)
Need resources mobilization to maintain JE control
programme (vaccines are included among GAVI Alliance
priorities for future support).
Immunization is encouraged on controlling JE

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