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Japanese Encephalitis and Immunization

What is Japanese Encephalitis?

Japanese encephalitis (JE) is an infection caused by a virus that is spread by mosquitoes. It is the leading cause of viral infections of the brain in Asia. Cases occur mostly during the summer and fall in temperate zones and during the rainy season in tropical zones of Asia but transmission can occur year round. There is an increased risk in rice-growing and pig-farming rural areas. About 10 to 25 per cent of JE-infected persons who develop encephalitis die and an additional 50 per cent have lasting neurological damage. If a pregnant woman becomes infected with JE during the 1st and 2nd trimester, the unborn baby can be infected and the mother may have a miscarriage.

How can you prevent Japanese encephalitis?

Take special precautions against mosquito bites when you are travelling or visiting a high-risk area:

Use a portable bednet if sleeping in a rural area.
Minimize outdoor activity at dusk and dawn.
Stay in air-conditioned or well-screened rooms.
Use protective clothing and mosquito repellent containing DEET.
Receive Japanese encephalitis immunization.

Who should be immunized against Japanese encephalitis?

Travellers who are over one year of age who will spend 30 days or more in locations where the disease occurs and during the seasons that it can be spread, especially if travel will include rural areas;
Travellers who will spend fewer than 30 days but will be in locations where the disease is common or who will have extensive outdoor rural exposure;
All laboratory personnel working with JE.

Persons receiving JE vaccine should be observed for 30 minutes after immunization and warned about the possibility of delayed reactions. Persons should not embark on international travel within 10 days of immunization because of the possibility of delayed allergic reactions. They should be advised to remain in an area with ready access to medical care for 10 days after immunization. There is no data on the effect of concurrent administration of other vaccinations, drugs or biologics on the safety and effectiveness of JE vaccine.

Who should not be immunized against Japanese encephalitis vaccination?

Those who have had an allergic reaction to any previous dose of JE vaccine;
Those who are hypersensitive to thimerosal and /or to proteins of rodents or neural origin;
Those who have a history of hives as a reaction to drugs, bee stings or insect bites or hives due to unknown causes .

Caution: The vaccine has not been assessed in pregnancy. Pregnant women who must travel to areas where the risk of JE infection is high should be vaccinated when the risks of infection to the mother and developing fetus exceed the theoretical risk of immunization.

How is Japanese encephalitis immunization given?

Immunization with JE vaccine consists of three injections given on days 0, 7 and 30. When time does not permit, they may be administered five to seven days apart, but the response may not be as good.

No definite recommendations can be made regarding the timing of boosters.

What are the possible reactions to the Japanese encephalitis vaccination?

The most common reported reactions are redness, swelling and pain at the injection site. About 10 per cent of people receiving JE vaccination report systemic side effects including fever, headaches, malaise, rash, chills, dizziness, myalgia, nausea, vomiting and abdominal pain. None of these is considered to be life threatening. Reactions have been reported from 12 hours to as long as two weeks after injections. More serious reactions are extremely uncommon.

If you have any questions or experience any unusual reactions, contact your doctor or the person who provided the immunization.

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