Japanese encephalitis primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Primary Prevention

• Use insect repellent and wear long pants and sleeves
• Sleep in air-conditioned or well-screened rooms or use bednets
• A vaccine against JE virus is available.

Japanese Encephalitis Vaccine

Vaccine

• U.S. Expatriates: Japanese encephalitis vaccine is recommended for persons who plan to reside in areas where Japanese encephalitis is endemic or epidemic (residence during a transmission season). Risk for acquiring Japanese encephalitis is highly variable within the endemic regions. The incidence of Japanese encephalitis in the location of intended residence, the conditions of housing, nature of activities, and the possibility of unexpected travel to high-risk areas are factors that should be considered in the decision to seek vaccination.

• Travelers: Japanese encephalitis vaccine is NOT recommended for all travelers to Asia. In general, vaccine should be offered to persons spending a month or longer in endemic areas during the trans-mission season, especially if travel will include rural areas. Under specific circumstances, vaccine should be considered for persons spending <30 days in endemic areas, e.g., travelers to areas experiencing epidemic transmission and persons whose activities, such as extensive outdoor activities in rural areas, place them at high risk for exposure. In all instances, travelers should be advised to take personal precautions; e.g., to reduce exposure to mosquito bites. The decision to use Japanese encephalitis vaccine should balance the risks for exposure to the virus and for developing illness, the availability and acceptability of repellents and other alternative protective measures, and the side effects of vaccination. Risk assessments should be interpreted cautiously since risk can vary within areas and from year to year and available data are incomplete. Estimates suggest that risk of Japanese encephalitis in highly endemic areas during the transmission season can reach 1 per 5,000 per month of exposure; risk for most short-term travelers may be 1 per million. Although Japanese encephalitis vaccine is reactogenic, rates of serious allergic reactions (generalized urticaria or angioedema) are low (1 to 104 per 10,000). Advanced age may be a risk factor for developing symptomatic illness after infection. Japanese encephalitis acquired during pregnancy carries the potential for intrauterine infection and fetal death. These special factors should be considered when advising elderly persons and pregnant women who plan visits to areas where Japanese encephalitis is endemic.