Australia records fifth Japanese encephalitis death

Morgan Liotta

24/05/2022 4:53:38 PM

The latest confirmed death has prompted health authorities to remind GPs of their role in vaccination uptake.

People among the high-risk groups are advised to avoid mosquito exposure and speak to their GP about vaccinations.

A man in his 60s who was diagnosed with Japanese encephalitis (JE) in early March died at Albury Base Hospital on Friday 20 May, marking the second JE death in the state, NSW Health has confirmed.
This brings Australia’s death toll from the mosquito-borne virus to five, following the death of another New South Wales man in his 70s in February, and deaths in Victoria, Queensland and South Australia earlier this year.
As of 18 May, the Department of Health confirms there are 42 human cases of JE in Australia, with the majority (13) confirmed in New South Wales.
Victoria has 10 confirmed cases, South Australia four, and Queensland two. A further 13 across the four states are considered ‘probable cases’ where the person has been linked epidemiologically and/or has symptoms of the disease and has laboratory suggestive evidence.
The current outbreak represents the first locally acquired cases detected on the Australian mainland since 1998 and was declared a Communicable Disease Incident of National Significance on 4 March by the Australian Government.
With the state’s second death and growing outbreak, NSW Health is urging local healthcare providers to remain vigilant and promote vaccination for at-risk populations.
Risk of local infection is highest for:

  • people working at and/or living close to piggeries which have tested positive for JE
  • animal transport workers
  • veterinarians and students working with pigs
  • entomologists
  • laboratory workers handling JE
  • those who engage in outdoor activities near mosquito populations, such as camping and fishing, particularly near waterways.
GPs and other local healthcare providers are reminded to ensure all people currently in the ‘high-risk of exposure’ categories have access to the vaccine.
There are two registered JE vaccines available in Australia, recommended for those at highest risk of infection, and not for use in the general population.
Imojev – a live attenuated JE vaccine administered via subcutaneous injection with a primary course of one dose, registered for use in people aged ≥9 months.
  • – an inactivated JE vaccine administered via intramuscular injection with a primary course of two doses, registered for use in people aged ≥18 years.

Previous advice from the Australian Immunisation Handbook recommended routine JE vaccination only for laboratory workers who may be exposed to the virus, people travelling to endemic areas during transmission season, and people who live or work on the outer Torres Strait Islands.
Expanding the vaccination program to other at-risk groups, in addition to ongoing state and territory government advice to avoid exposure to mosquitoes, has answered the calls of local governments and health experts.
New South Wales virologist Professor Dominic Dwyer told newsGP in March that expanding the vaccine to people who work in piggeries would be a ‘logical place to start’, and recommended that GPs remain alert to the evolving situation.
‘There’s massive amounts of water in the outback and that has been accompanied by high mosquito numbers,’ he said.
‘So you’ve got the mosquitoes, you’ve got the pigs, which are like an amplifying host of JE, and then you’ve got humans in proximity.
‘[The] general message is people need to be aware that this is around; be aware of the disease, be aware of the risk, and know what tests to do if [patients are] worried about it and know that there’s a vaccine.’
In March this year, the Federal Government announced it would invest in a further 130,000 vaccine doses in response to the JE outbreak spreading across regional and remote areas of New South Wales, Victoria, Queensland and South Australia.
The current advice for GPs is that JE vaccination for non-high-risk groups in the community is not recommended.
‘Vaccines are available to order from the State Vaccine Centre strictly for administration to patients in the groups recommended by CDNA [Communicable Diseases Network Australia],’ NSW Health said.
Orders are limited to 10 vaccine doses per clinic, with NSW clinics advised to contact their local public health unit for larger orders.
Symptoms of JE include:

  • fever and headache variably accompanied by neck stiffness
  • disorientation
  • tremor
  • coma
  • convulsions  
  • paralysis.
‘If patients present with symptoms of encephalitis, include JE in your differential diagnosis if they live or have visited rural areas, especially if they were near pig farms or report being bitten by mosquitos,’ NSW Health recommends.
Patients with suspected JE are advised to be referred to hospital for management and further investigation.
The Australian Immunisation Handbook has up-to-date recommendations for vaccine dosage and administration for JE.
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infectious disease outbreak Japanese encephalitis: mosquito-borne vaccine virus

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