1) Japanese encephalitis (JE) is a viral disease spread by mosquitoes that is endemic in many parts of Asia and the Pacific. India reports the highest number of JE cases annually, with an estimated actual number between 15,000-20,000 cases per year. 2) JE vaccination is the most important preventive measure according to WHO and IAP guidelines. The national vaccination program in India recommends routine vaccination with two doses of JE vaccine for children up to 15 years of age in endemic areas. 3) While mosquito and pig control efforts have not proven reliable at controlling JE, vaccination is currently the single most effective public health approach for prevention in India given the disease burden.

1. Japanese
Encephalitis
National Epidemiology, IAP recommendations & not much else !
Dr. Gaurav Gupta, Charak Clinics, Mohali

3. What are the top 3 diseases as per Case Fatality Rate in India as
per National Health Profile 2018?

4. 2nd highest death
rate in India2
2National Health Profile. 2018. https://cdn.downtoearth.org.in/pdf/NHP-2018.pdf

5. Geographical distribution of JE
Source: CDC. 2015
24 countries from Asia, Western
Pacific, and Part of Australia
are JE endemic.
Majority of India is considered
to be at risk of JE.

6. National
Epidemiology

7. JE cases reported to WHO3
Countries 2012 2013 2014 2015 2016 2017
India 745 1078 1657 1620 1627 2181
China 1763 2178 858 624 1130
Nepal 75 118 1304 937 98
Bangladesh 52 23 183 76 1294
Vietnam 183 224 421 368 357
Myanmar 14 3 50 113 393
Philippines 0 24 69 115 312
Malaysia 22 12 47 39 59
Cambodia 55 41 60 48 10
Sri Lanka 60 70 21 17 18
Indonesia 0 0 72 40 43
Republic of Korea 20 14 26 40 0
Laos 23 9 4 13 19
Japan 2 9 2 2 11
Australia 1 4 1 3 0
Timor 0 5 0 0 1
Papua New Guinea 0 0 1 4 0
As per the WHO estimates,
68000 JE cases occur every
year.
However only 10% of cases
are being reported.4
Recent data indicates
maximum number of cases
are being reported from India.
There is significant
underreporting.
Considering the above
evidence, the actual number
of JE cases in India could
be around 15000 to 20000
per year.
3http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencejapenc.html. 4Bull World Health Organ. 2011 Oct 1;89(10):766-74, 774A-774E.

8. Trends of JE cases in India since 20105
555
1214
745
1086
1661
1730
1676
2181
0
500
1000
1500
2000
2500
2010 2011 2012 2013 2014 2015 2016 2017
No.ofJEcases
Year
Reasons for Increasing JE cases
1. Spread of JE to newer states
Ex. Jharkhand, Odisha,
Manipur, Meghalaya, MP
2. Spread of JE to newer districts
within the same state
Ex. Bihar, UP, WB, MH & TN
3. Increasing cases from older
children and adults
Ex. UP, WB, Assam
4. Increasing surveillance efforts
Cases reported to National Vector Borne Disease Control Programme (NVBDCP)
5http://www.nvbdcp.gov.in/WriteReadData/l892s/20924647841544509054.pdf

9. JE burden - India
Mainly affected States6, 1
1. Assam
2. Uttar Pradesh
3. Odisha
4. West Bengal
5. Bihar
6. Tamil Nadu
Other endemic states
1. Jharkhand
2. Karnataka
3. Andhra Pradesh 10. Kerala
4. Telangana
5. Goa 11. Uttarakhand
6. Maharashtra 12. Meghalaya
7. Haryana 13. Punjab
8.Arunachal Pradesh 14. Tripura
9. Manipur 15. Nagaland
6. Operational Guide - Japanese Encephalitis Vaccination in India. MOHFW, GoI. Nov 2017.
Endemic in 268 districts

11. JE is spreading beyond endemic zones
https://timesofindia.indiatimes.com/city/pune/with-108-patients-je-spreads-
beyond-the-endemic-zone/articleshow/67099190.cms
Tip of Iceberg
Only 8 cases were reported in 2018 from
MH, but when fever surveillance was done
Govt found 108 JE infections.

12. JE cases/endemicity in Urban regions6
• Recent list of JE endemic districts includes many urban regions (State
Capitals)
• Kolkata, Patna, Lucknow, Goa, Trivandrum, Chennai, Ranga Reddy district
(Part of Hyderabad), etc.
• Even cases have been reported from Delhi and Bhopal
• Indicative of risk of JE in both rural and urban regions
• As per the “Operational Guide - Japanese Encephalitis Vaccination in India”
released by GoI in Nov 2017 children of both rural and urban regions needs to be given
JE vaccine.
6. Operational Guide - Japanese Encephalitis Vaccination in India. MOHFW, GoI. Nov 2017

13. JE in Punjab
http://indianexpress.com/article/cities/chandigarh/cases-of-japanese-encephalitis-have-risen-steeply-in-the-region/

15. JE locally in 2018
Hoshiarpur

16. JE endemic ? districts in Punjab & Haryana1
Punjab
Haryana
1 Operational Guidelines. National Programme for Prevention and Control of Japanese Encephalitis/ Acute Encephalitis Syndrome. 2014. Govt of India,
MOH& FW.
Nawanshahr

17. 7Int.J.Curr.Microbiol.App.Sci (2018) 7(3): 2822-2827

18. Preventive Measures
• Mosquito control (outdoor resting habits; indoor control measures ineffective)
ultra low volume fogging is only effective method
• Pig control
isolation of pigs, atleast 5 km away from human inhabitation
• Neither mosquito control nor pig control have proven to be reliable
effective public health measures to control JE in human (WHO JE Fact
sheet No. 386, March 2014)
• Vaccination is the single most important preventive measure
• WHO and IAP recommends vaccination for prevention

19. Recommendations for JE vaccination in India
IAPACVIP 2018 recommendations16
IAP recommends Routine & Catch-up vaccination for
• Children (till 15 years) living in JE endemic areas
• Travellers to endemic/epidemic areas, provided expected stay is for
minimum of 4 weeks
IAP ACVIP recommends 2 dose schedule of primary immunization (Routine)
JE1: 12 months age
JE2 : 13th month age
16Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP) Recommended Immunization Schedule (2018-19)
and Update on Immunization for Children Aged 0 Through 18 Years. https://indianpediatrics.net/dec2018/1066.pdf
For catch-up vaccination, the upper age has been increased to 18 years & the schedule is 2 doses 28 days
apart for inactivated JE vaccines.

20. National JE vaccination guidelines Govt of India6
• JE vaccination has Mass vaccination and Routine vaccination
• For Mass vaccination (1 yr to 15 yrs) one dose JE vaccine
• For routine vaccination under UIP, both Live attenuated and
Inactivated vero cell derived JE vaccines are used
• For routine vaccination will be used as 2 doses schedule (1st dose at
9-12 months, 2nd at 16-24 months)
GoI: Government of India, UIP: Universal Immunization programme.
6Operational Guide for Japanese Encephalitis Vaccination in India, MoHFW, 2017

21. JE vaccines in India
• Live attenuated SA-14-14-2 from China (Chengdu) Available only
through Govt. agencies
• Verocell derived Inactivated SA-14-14-2 vaccine (JEEV® in India &
internationally available as IXIARO®)
• Verocell derived Inactivated vaccine based on Indian Kolar strain
(JENVAC ®)

22. Some thoughts on JE Vaccination
Reasons NOT to use JE-V 1
• Not likely to be eradicable
• 15 % of AES cases ?
• Surveillance quality ?
• Less cases compared to say Rabies
• Urban vaccination ?
• Adult JE ?
Reasons to use JE-V
• Definitely exists, underdiagnosed
• Likely to increase – pigs
• Cheap vaccine
• Experience of Odisha, Pune
• No Rx, high CFR & morbidity
• Most effective option
1 Saxena S, Chaudhary P, Chauhan A. Japanese Encephalitis (JE): Population at Risk and Strategies to Control in India. Natl J
Community Med 2018;9(8):637-640

23. Missed something ?
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Acknowledgements: Dr. Siddalingaiah Ningaiah, Medical Advisor, Biological E vaccines