Clinical Update

Updated Recommendations to Prevent Japanese Encephalitis in Travelers

In July 2019, the Advisory Committee on Immunization Practices (ACIP)

published updated recommendations regarding prevention of Japanese
encephalitis (JE) among US travelers.

JE virus spreads to travelers through mosquito bites and is a risk throughout

most of Asia and parts of the western Pacific (see risk areas and transmission
season). Although most travelers are at very low risk of disease, some may be
at a greater risk because of their travel plans. Factors that increase a traveler’s
risk of exposure include

 Travel in risk areas for prolonged periods

 Travel during the JE transmission season
 Spending time in rural areas
 Participating in outdoor activities (such as hiking or camping) that
increase the risk of exposure to the mosquitoes that spread JE
 Staying in accommodations that lack air conditioning, window and door
screens, or bed nets, thereby increasing the risk of exposure to infected
mosquitoes

Most people infected with the JE virus do not have symptoms or have
only mild symptoms. However, a small percentage of people develop brain
inflammation with symptoms of headache, fever, convulsions, and coma. This
can be fatal or have serious long-term consequences.

One JE vaccine (Ixiaro) is licensed in the United States to prevent infection in

people aged 2 months or older. ACIP recommends Ixiaro for people moving to
risk areas to live, longer-term (for example, 1 month or longer) travelers to risk
areas, and frequent travelers to risk areas. Consider vaccination for shorter-
term travelers (for example, less than 1 month) at increased risk of exposure to
JE based on the risk factors listed above. Also consider vaccination for travelers
not sure about their exact duration of travel, destinations, or activities.

ACIP does not recommend vaccination for travelers with low-risk itineraries,

such as shorter-term travel limited to urban areas or travel that occurs outside
the JE transmission season.

Ixiaro is given as a two-dose series, with doses spaced 28 days apart. Adults
aged 18–65 years can get the second dose as early as 7 days after the first.
Give the second dose at least 1 week before travel. Administer a booster dose
at least 1 year after completion of the primary series to travelers who remain
at risk for JE infection.

All travelers should also take steps to prevent insect bites to prevent JE as well
as other infections transmitted by insects.

More Information

 Japanese Encephalitis Vaccine: Recommendations of the Advisory

Committee on Immunization Practices
 Japanese Encephalitis
 Japanese Encephalitis (in the Yellow Book)
 Ixiaro Prescribing Information