Japanese Encephalitis

Japanese Encephalitis Virus Spread By Mosquitoes, Pigs, and Sheep

Karen McClorey Hackett — Mon, 19 May 2025 18:42:14 +0000

Reviewer:

Japanese encephalitis virus (JEV), the causative agent of Japanese encephalitis (JE), affected an estimated 69,000 individuals in 2024.

Although JE is vaccine-preventable, it remains endemic in 24 countries and territories across Asia and Oceania, where it has a mortality rate of about 20%.

Since its identification in Japan in 1871, the transmission cycle of JEV has involved pigs and birds as amplifying hosts and mosquitoes as vectors.

However, sheep may be a factor contributing to the transmission cycle.

The results from a study published May 16, 2025, revealed that sheep are susceptible to JEV infection and develop viremia, with levels and duration comparable to those observed in pigs.

Additionally, mosquitoes fed viremic sheep blood showed an infection rate of 40.6 to 57.1%.

These researchers wrote, 'These findings indicate that sheep can serve as amplifying hosts for JEV, potentially contributing to JEV transmission and increasing the public health risk of human infections in specific regions where sheep are bred but pigs are not. This cycle exists along with the well-known pig-associated rural domestic and bird-associated wild cycles.'

In the United States, a risk assessment considered that the potential of introducing JEV into the U.S. may be highest in California due to the frequency of international arrivals from Asia and Oceania.

As of May 19, 2025, the U.S. Centers for Disease Control and Prevention (CDC) says JE survivors are estimated to live normally, but 49% of patients report neurological sequelae.

The CDC recommends JE vaccination when visiting outbreak areas. The Japanese encephalitis vaccine (IXIARO) is U.S. FDA-approved and recommended for travelers in 2025. Travel clinics and pharmacies offer vaccination appointments, which are suggested at least one month before departing abroad.

Sub Title:

Japanese Encephalitis vaccinations recommended when visiting endemic areas in May 2025

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Sheep serve as amplifying hosts of Japanese encephalitis virus

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Japanese Encephalitis Causes Second Death in Australia's NSW

Karen McClorey Hackett — Fri, 14 Mar 2025 20:29:45 +0000

Reviewer:

Robert Carlson, MD

According to the World Health Organization (WHO), the Japanese encephalitis virus (JEV) is the leading cause of viral encephalitis in twenty-four countries.

Since 2022, when Australia's government declared a Japanese encephalitis virus (JEV) outbreak of National Significance, infected mosquitoes have spread this flavivirus into most of the country. Pigs have also served as an amplifier host.

As of March 14, 2025, JEV cases and related fatalities have been confirmed in Queensland, New South Wales (NSW), South Australia, Victoria, Australian Capital Territory, Tasmania, Western Australia, the Northern Territory, and parts of the Torres Strait region.

Unfortunately, NSW Health today confirmed a second JEV death this year.

A man in his 70s, who may have acquired JEV while visiting the Murrumbidgee River region, died in early March 2025.

This is the second death from JE acquired in Australia's southeast area this year and the fourth since the virus was first detected in NSW.

Additionally, one probable case of JE infection has been identified in a man in northern NSW. He likely acquired the infection when travelling between Moree Plains, Tamworth, and Gunnedah shires. He is now recovering at home.

This is the fifth person infected with JE in NSW this season.

NSW Health's Executive Director of Health Protection, Dr Jeremy McAnulty, said in a press release, "People need to take mosquito-borne infections seriously, especially as people start the clean-up from recent floods in an environment where mosquitos thrive."

"Standing water, like that left after mass rainfall and floods, makes for ideal breeding grounds for mosquitoes. This increases people's risk of being bitten, especially if they're working outdoors," added Dr McAnulty.

As of March 2025, the WHO says safe and effective vaccines are available to prevent JE.

In Australia, the JE vaccine is free for people who meet the eligibility criteria and is available through local General Practitioners, Aboriginal health services, and pharmacists.

In the United States, one JE vaccine (IXIARO) is U.S. FDA-approved, and the CDC recommends it for travelers visiting endemic areas in 2025.

Last year, about 650,000 people from the U.S. visited Australia, including the NSW's capital city, Sydney, with over 5 million residents. The vast majority are unprotected against JEV infections.

Furthermore, the CDC suggests other travel vaccines for Australians visiting this year. These vaccines are commercially offered at travel clinics and pharmacies in the U.S.

Sub Title:

Japanese Encephalitis is a vaccine preventable disease in 2025

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Japanese Encephalitis Virus Detected in Lake Wyangan Mosquitoes

Karen McClorey Hackett — Mon, 16 Dec 2024 18:22:46 +0000

Reviewer:

Robert Carlson, MD

Located on Australia's southeast coast, New South Wales (NSW) Health recently reminded everyone to take action to avoid virus-carrying mosquitoes this summer.

NSW Health's Executive Director of Health Protection, Dr. Jeremy McAnulty, said in a media release on December 7, 2024, that mosquitoes thrive in warm conditions, increasing the risk of mosquito-borne illnesses such as Japanese encephalitis in parts of NSW.

Almost two-thirds of NSW's population, 5.3 million, lives in the greater Sydney area along Australia's southeast coast. Over 3.7 million international travelers visited NSW in the year ending June 2024.

"Each year, NSW Health undertakes mosquito surveillance across NSW from November to April, which provides important information about when mosquito-borne disease risk is elevated," Dr. McAnulty stated.

"As part of this routine surveillance, the Japanese encephalitis virus (JEV) was recently detected in a mosquito sample in Lake Wyangan, located northwest of Griffith, on December 3, 2024."

Griffith City Council urges residents to follow the "Spray up, Cover up, Clean up, Screen up!" guidelines.

NSW Health did confirm that there have been no human cases of JEV since October 2022.

However, mosquitos in NSW can potentially carry a range of other viruses for which there are no vaccines, including Murray Valley encephalitis, Ross River, and Barmah Forest viruses.

"This is a timely reminder, both to Griffith residents and to anyone planning to enjoy the outdoors, to take protective measures this summer against mosquitoes," he said.

Australia is not alone, as over 20 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.

In NSW, a free JEV vaccination is available through local General Practitioners, Aboriginal health services, and pharmacists for people aged two months or older.

"Japanese Encephalitis is a serious disease with a 20-30% mortality rate," commented Crockett Tidwell RPh, CDCES, CTH, International Society of Travel Medicine Certificate in Travel Health™.

"Travelers should take time to understand their risk and mitigate that risk by preventing mosquito bites and getting vaccinated when indicated," added Tidwell, Clinical Services Manager at United Supermarkets, Lubbock, Texas.

In the United States, Valneva SE's IXIARO® (JESPECT®) inactivated, adsorbed, Vero cell culture-derived Japanese encephalitis virus vaccine are commercially available at travel clinics and pharmacies in 2024.

Note - This article was updated on Dec. 18, 2024, for headline and related local content.

Sub Title:

Australia offers vaccinations against Japanese Encephalitis

Reference:

NSW residents urged to take care this mosquito season

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Nepal's Japanese Encephalitis Outbreak Claims 17 Lives

Donald Hackett — Sat, 05 Oct 2024 11:03:39 +0000

Reviewer:

Robert Carlson, MD

Over the past few decades, Japanese encephalitis (JE) has been a significant concern in the Federal Democratic Republic of Nepal, particularly during the annual monsoon season in the Himalayan Mountains.

According to news from The Kathmandu Post, 63 people have been infected with the mosquito-borne zoonotic viral disease since June 2024. Tragically, as of September 22, 2024, 17 people, including children, have died from JE infections this year.

This ongoing JE outbreak has been detected in 29 Nepal districts, including those in the Kathmandu Valley, which is located at 5,000 feet, where virus-carrying mosquitoes are found.

Nepal's health department estimates that about 12 million people, out of a total population of 31 million, are at risk of JE in 2024. Additionally, many of the one million visitors to Nepal this year may need protection from JE.

The U.S. Centers for Disease Control and Prevention (CDC) says the JE virus is transmitted to humans through the bite of infected Culex mosquitoes. Pigs play an essential role in the natural cycle and serve as an amplifier host without suffering from disease. They maintain prolonged high-level viremia, which allows mosquitoes to get infected easily.

People are dead-end hosts in the JEV transmission cycle, says the CDC.

As of October 2024, the CDC has identified 24 countries in Southeast Asia and the Western Pacific Region reporting JE cases.

For example, in May 2024, Taiwan recorded two JE patients, including one death.

And in India, where JE has been detected since 1952, a child in Jabalpur reportedly died due to JE infection last month.

Also included in the KP news article, Dr. Abhiyan Gautam, chief of the Immunisation Section at the Family Welfare Division, stated, "We have also requested various aid agencies, including the Global Alliance for Vaccines and Immunisation, to supply JE vaccine."

Recent data from Nepal's Health Ministry show that less than 50% of the infected patients were inoculated with the JE vaccine. JE vaccination is not routinely recommended for visitors hiking to higher elevations such as Mt. Everest or spending short periods in Kathmandu.

However, JE vaccination is recommended by the CDC for expatriates living in Nepal.

While there are very few local JEV cases in the United States, the CDC cautions the millions of Californians who travel west to Asia and Pacific Ocean countries to protect themselves from infection.

In the U.S., Valneva SE's IXIARO® (JESPECT®) vaccine has been approved by the U.S. FDA and CDC for many years. This safe and effective vaccine is authorized for most children and adults traveling to Japanese encephalitis endemic areas.

As of October 5, 2024, IXIARO is available at travel vaccine clinics and pharmacies in the U.S.

Sub Title:

One million Nepal visitors may need Japanese Encephalitis vaccination or booster dose in 2024

References:

US CDC Yellow Book 2024

Nepal vaccination data dashboard 2024

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Nepal Health Dept vaccination dashboard 2024

Australia's Japanese Encephalitis Outbreak Spreads Down South

Donald Hackett — Thu, 15 Dec 2022 16:57:29 +0000

Reviewer:

Holly Lutmer PharmD

Robert Carlson, MD

As Australia heads into its summer season, a Japanese encephalitis (JE) outbreak is expanding in rural areas surrounding the Murray River.

In November 2022, the JE virus was detected in pigs in the Murray River region, confirming the risk for JE in humans in this area.

The Murray River is located in Southeastern Australia and is the third longest navigable river in the world, after the Amazon and Nile.

Australia's JE outbreak began in 2021.

Then, on March 6, 2022, the government declared the JE outbreak in Queensland a Communicable Disease Incident of National Significance.

A mathematical model published in Clinical Infectious Diseases in October 2021, led by the QIMR Berghofer Medical Research Institute in Brisbane, suggested that up to 750,000 people across Australia could be at risk of exposure to the JE virus (JEV).

To notify travelers, the U.S. Centers for Disease Control and Prevention (CDC) published an updated Level 2 travel advisory on December 14, 2022.

However, most travelers to Australia are at very low risk for JE, says the CDC.

But, JE vaccination is recommended for longer-term (one month) travel to areas surrounding the Murray River and Outer Torres Strait Islands.

However, for most travelers, the chance of getting infected with JEV is low, says the CDC.

There are two ways to protect yourself from JEV infection:

Avoiding being bitten by mosquitos is one way.

The JEV is spread to people through the bite of an infected mosquito.

Most people who get infected experience mild or no symptoms. In people who develop severe disease, early symptoms include fever, headache, and vomiting. Seizures are more common in children, says the CDC.

The second prevention tactic is to be vaccinated.

There are two JEV vaccines available globally.

For example, Valneva SE's Ixiaro is an inactivated, adsorbed Vero cell culture-derived vaccine approved by the U.S. FDA.

Ixiaro is available in the U.S. at certified travel clinics and pharmacies.

The CDC suggests other travel vaccinations when planning a visit to Australia.

Vax-Before-Travel publishes fact-checked, research-based travel information manually curated for mobile readers.

Sub Title:

Japanese encephalitis confirmed in Asia and Western Pacific

References:

JE Outbreak Declared in Australia

What is Japanese encephalitis?

US CDC Alert - Level 2, Practice Enhanced Precautions

Australia JE outbreak notice

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Australia’s Japanese Encephalitis Outbreak Turns Fatal

Don Hackett — Tue, 03 May 2022 14:54:28 +0000

Reviewer:

Robert Carlson, MD

Holly Lutmer PharmD

The World Health Organization (WHO) reported Australia’s recent Japanese Encephalitis (JE) outbreak continues spreading unabated.

The first human JE case was reported in early March 2022 from Queensland.

As of April 28, 2022, Australian health authorities reported a cumulative 37 human cases of Japanese encephalitis (25 laboratory-confirmed cases and 12 probable cases) and 3 related fatalities in four Australian states.

This outbreak represents the first locally-acquired JE cases detected on the Australian mainland since 1998.

The number of JE cases and deaths reported in 2022 is unusually high as compared to the previous ten years.

The WHO says the current events represent a significant change in the presence of the virus in Australia.

The Australian Government has declared the JE outbreak a Communicable Disease Incident of National Significance under the Emergency Response Plan for Communicable Disease Incidents of National Significance.

Although a rare disease in humans, JE is a serious viral infection caused by the JEV spread by infected Culex spp. Mosquitos. But, JEV cannot be transmitted from human to human, or by consuming meat from an infected animal.

However, in an immunologically naïve population, all age groups are at risk for JEV infection.

There are no treatments for JE and the case fatality rate among symptomatic cases can be as high as 30%. Permanent neurologic or psychiatric sequelae can occur in 30–50% of cases with encephalitis.

Local transmission of JEV to humans requires environmental conditions capable of sustaining an enzootic cycle. Thus, the risk of infection can vary substantially within any endemic country.

JE transmission does intensify during rainy seasons, during which vector populations increase.

Internationally, there has not yet been evidence of increased JEV transmission following major floods or tsunamis.

This means, that the risk at the regional and global level is assessed as low by the WHO.

The WHO recommends the implementation of activities to remove potential mosquito breeding sites, reduce vector populations and minimize individual exposures, including vector control strategies.

Homes near pig farms or animal shelters should be protected with mosquito-proof screens on windows and doors.

Furthermore, the WHO encourages vaccine strategies should be designed and implemented.

Due to the need for rapid production of protective antibodies, rapid deployment of at least one dose of live attenuated or live recombinant vaccines should be used.

And JE vaccination should be integrated into national immunization schedules in all areas where JE is recognized as a public health priority.

There are two JE vaccines for humans registered for use in Australia only advised for risk groups.

France-based Valneva SE's IXIARO is the only JEV preventive vaccine approved by the U.S. FDA. Currently, Ixiaro is licensed in Australia, where it is marketed as JESPECT®.

Ixiaro is an inactivated, adsorbed Vero cell culture-derived vaccine developed through a cooperative agreement with the Walter Reed Army Institute of Research. It is prepared by propagating JEV strain SA14-14-2 in Vero cells.

Unfortunately, immunocompromised individuals may have a diminished immune response to IXIARO.

Vaccination appointments for Ixiaro and other travel vaccines can be requested at this weblink.

Moreover, the WHO advises against applying any travel or trade restrictions based on the current information available on this event.

On March 22, 2022, the U.S. CDC issued a Level 2 Travel Advisory regarding Australia’s JEV outbreak.

Vax-Before-Travel publishes fact-checked research-based travel vaccine news.

Sub Title:

IXIARO is the only Japanese Encephalitis Virus vaccine approved by the FDA

References:

WHO:Japanese encephalitis - Australia

Ixiaro Japanese Encephalitis Vaccine

CDC: Japanese Encephalitis in Australia

Japanese Encephalitis Outbreak

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US Miltary Purchases 80,000 Doses of Japanese Encephalitis Vaccines

Don Hackett — Tue, 14 Jan 2020 13:23:13 +0000

Reviewer:

Danielle Reiter, RN

Robert Carlson, MD

The U.S. Department of Defense (DoD) has exercised an option to purchase 80,000 additional doses of its Japanese encephalitis (JE) vaccine IXIARO®.

IXIARO is the only vaccine approved by the U.S. Food and Drug Administration (FDA) indicated for the prevention of disease caused by the JE virus, approved for use in individuals 2 months of age and older.

According to a press release issued by France-based Valneva SE on January 14, 2020, the option brings the total value of the contract signed with the DoD in January 2019 to $70 million dollars.

Franck Grimaud, Chief Business Officer of Valneva commented in a press release, “We thank the DoD for their renewed confidence in helping them protect military personnel and their families from Japanese encephalitis.”

The IXIARO vaccine was developed through a cooperative research and development agreement with the Walter Reed Army Institute of Research. Valneva markets and distributes IXIARO directly to the U.S. military and U.S. private market.

Vaccination with IXIARO may not protect all individuals.

Immunocompromised individuals may have a diminished immune response to IXIARO and syncope (fainting) can occur in association with administration of injectable vaccines.

The most common (>10%) adverse reactions were: fever, irritability, diarrhea, and injection site redness in infants 2 months to <1 year of age; fever in children 1 to <12 years of age; pain and tenderness in adolescents 12 to <18 years of age; and, headache, muscle pain, and injection site pain and tenderness in adults.

Healthcare practitioners are encouraged to report negative side effects of vaccines to the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).

The Japanese encephalitis virus is the leading cause of vaccine-preventable encephalitis in Asia and the western Pacific. This disease is spread through mosquito bites, says the CDC.

Most people infected with JE do not have symptoms or have only mild symptoms.

However, a small percentage of infected people develop inflammation of the brain, with symptoms including sudden onset of headache, high fever, disorientation, coma, tremors, and convulsions.

The CDC’s Advisory Committee on Immunization Practices (ACIP) committee published on July 19, 2019, updated guidance which clarifies the types of international travelers who are at risk for Japanese encephalitis.

The ACIP’s new JE recommendation for U.S. travelers are as follows:

JE vaccination is recommended for persons moving to a JE-endemic country to take up residence more than 1-month in JE-endemic areas, and frequent travelers to JE-endemic areas.
JE vaccine should also be considered for shorter-term travelers with an increased risk of JE based on planned travel duration, season, location, activities, and accommodations.
JE vaccine is not recommended for travelers with very low-risk itineraries, such as urban travel only for a short duration, or travel outside of a well-defined JE virus transmission season.

Valneva is a specialty vaccine company providing prevention against diseases with major unmet medical needs. Valneva’s portfolio includes vaccines for travelers: IXIARO®/JESPECT® which are indicated for the prevention of Japanese encephalitis.

More information is available at Valneva.

Sub Title:

Valneva IXIARO helps prevent Japanese Encephalitis virus which is a leading cause of vaccine preventable encephalitis

References:

Valneva: US DoD Exercises Option on IXIARO® Supply Contract Bringing Total Value to $70 Million

CDC: Japanese Encephalitis Vaccine

New Japanese Encephalitis Vaccination Guidelines for International Travelers

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ACIP Expands Japanese Encephalitis Vaccination Recommendations

Don Hackett — Fri, 01 Mar 2019 15:03:44 +0000

Reviewer:

Robert Carlson, MD

Danielle Reiter, RN

John Paul Sanchez, PharmD

According to 2 unanimous votes by the Advisory Committee on Immunization Practices (ACIP) committee at its February 27, 2019 meeting, Japanese Encephalitis (JE) virus vaccination recommendations have been expanded.

JE is the leading cause of vaccine-preventable encephalitis and is estimated to cause over 68,000 clinical cases yearly.

While extremely rare for USA international travelers, this mosquito-borne flavivirus can be severe.

The ACIP committee voted to recommend vaccination for persons moving to endemic areas, or who travel to these areas frequently or stay for long-term visits.

But, the JE vaccine is not recommended for travelers who are at very low risk.

The ACIP committee also strengthened its language on booster doses to say they should, instead of may, be given at least 1 year after the primary series if the person is experiencing ongoing exposure or re-exposure to the JE virus.

ACIP also said this recommendation would apply to children, as well as adults.

This recommendation follows a randomized trial that showed among those receiving a booster vaccination, 100 percent of the people were seroprotected both at 28 days, and 2 years after the booster dose.

The JE vaccine Ixiaro is a vaccine containing the inactivated virus strain SA14-14-2 adjuvanted with aluminum hydroxide. It is prepared using tissue culture rather than live organisms and does not contain any stabilizers such as gelatin or preservatives in its formulation.

Ixiaro was first approved in the USA on March 30, 2009.

If the CDC director approves these ACIP recommendations, it will be published in the Morbidity and Mortality Weekly Report.

Sub Title:

Ixiaro is a Japanese Encephalitis vaccine containing the inactivated virus strain SA14-14-2 adjuvanted with aluminum hydroxide

References:

Advisory Committee on Immunization Practices (ACIP)

Japanese Encephalitis

Long-term immunogenicity of an initial booster dose of an inactivated, Vero cell culture-derived Japanese encephalitis vaccine

Pediatric Safety and Utilization Review for the Pediatric Advisory Committee (PAC) Meeting

ACIP discusses flu vaccine data, JEV recommendations

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Japanese Encephalitis Vaccine Received Accelerated Dosing Regimen

Don Hackett — Sat, 06 Oct 2018 18:50:19 +0000

Reviewer:

Robert Carlson, MD

Danielle Reiter, RN

An accelerated dosing regimen for IXIARO (Japanese Encephalitis Vaccine, Inactivated, Adsorbed), received U.S. Food and Drug Administration (FDA) approval.

IXIARO is the only vaccine approved in the United States indicated for protection against disease caused by Japanese encephalitis (JE) virus.

Japanese encephalitis is a rare but serious disease which is endemic to 24 countries in Asia and parts of the Western Pacific, says the World Health Organization (WHO).

For effective protection from the JE virus, adults aged 18 to 65 years may now receive 2 separate doses of IXIARO seven days apart. Previously, the time between doses for this age group was 28 days.

Moreover, there is no specific treatment for JE, says the WHO.

This new dosing schedule is important for international travelers.

According to Valneva, a recent survey found that 72 percent of U.S. adults who traveled to Asia for 10 or more days reported visiting at least one area, or participating in an activity, that put them at an increased risk for exposure to JE virus and, based on guidelines, should consider a vaccine along with other protective measures.

However, the same survey found that more than one-third began preparing for travel less than a month before departure.

The standard 28-day immunization schedule still applies to children 2 months to 17 years and adults 66 years and older; adults aged 18 to 65 years may also follow this schedule.

The accelerated and the standard dosing schedules must be completed at least 7 days before travel to endemic areas.

The Centers for Disease Control and Prevention (CDC) recommends that, in addition to personal protective measures, travelers who spend 30 days or more in a JE-endemic region be vaccinated prior to arrival.

Charles Daily, Valneva General Manager, U.S, said in a press release, “For travelers who do seek protection with a vaccine prior to travel, oftentimes they are not aware of the dosing schedule and therefore have not visited their doctor or pharmacist soon enough to allow for 2 doses.”

“For those whose travel plans change unexpectedly, this shorter vaccine dosing regimen may help to protect them in less time.”

Travel vaccine specialists can be contacted at Vax-Before-Travel.

About 68,000 cases of JE are estimated to occur each year, although the actual number of cases is likely much higher due to underreporting in rural areas, reports the WHO.

JE is fatal in up to 30 percent of those who show symptoms, and up to half of the survivors continue to have a neurologic, cognitive, and psychiatric impairment.

As an example, JE killed more than 1,200 children in only 1 month during an epidemic outbreak in Uttar Pradesh, India, and Nepal in 2005.

Vaccination with IXIARO may not protect all individuals.

Individuals with a weakened immune system may have a diminished immune response to IXIARO. Fainting may occur when receiving any injection, including IXIARO. Tell your healthcare practitioner if you have a history of fainting from injections.

You are encouraged to report negative side effects of vaccines to the FDA and the CDC. You should ask your healthcare practitioner for medical advice about adverse events.

For more information about JE and IXIARO, or for the full prescribing information.

Valneva USA, Inc. is a subsidiary of Valneva SE, a fully integrated, commercial-stage biotech company focused on developing innovative life-saving vaccines.

Sub Title:

Valneva IXIARO vaccine protects against disease caused by Japanese encephalitis

References:

Japanese encephalitis

Valneva Receives FDA Approval for Accelerated Vaccine Dosing Schedule for IXIARO®

Japanese Encephalitis

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