Republic of the Philippines

DEPARTMENT OF HEALTH
CENTER FOR HEALTH DEVELOPMENT
Cordillera Administrative Region
Baguio City
WHAT IS JAPANESE ENCEPHALITIS?
• Japanese encephalitis (JE) is a
serious and disabling illness
• Virus transmitted by certain
kinds of mosquitoes
• It infects the brain which causes
inflammation and swelling
• Can cause long-lasting brain
damage leading to disabilities Photo credit: PATH/Aaron Joel Santos

among survivors.

Department of Health – Center for Health Development - CAR

 Japanese Encephalitis (JE) Disease and
Burden
• Vector-borne zoonotic viral disease that
occurs in nearly all Asian countries
• Most Japanese encephalitis virus infections
asymptomatic
• ~1:250 develop clinical disease
suffer serious brain damage,
• Case fatality rate: Up to 30% including paralysis and mental
• Long-term neurologic sequelae in disability.
~30% of survivors The disease can cause irreversible
neurologic damage.
• 13,600 to 20,400 deaths each year

Source: Japanese encephalitis: surveillance and immunization in Asia and

the Western Pacific, 2016, J.Heffelfinger, X. Li, N.Batmunkh, V. Grabovac, S.
Diorditsa,

Department of Health – Center for Health Development - CAR

Geographic distribution of JE
• Western Pacific Region (WPR)
– Australia, Brunei, Cambodia, China (and Taiwan),
Japan, Korea (Rep. of), Lao PDR, Malaysia, PNG,
Philippines, Singapore, Viet Nam
• South-East Asia Region (SEAR)
– Bangladesh, Bhutan, India, Indonesia, Korea
(DPR), Myanmar, Nepal, Sri Lanka, Thailand, Timor
Leste
• Eastern Mediterranean Region
– Pakistan
• European Region
– Russia
Source: Japanese encephalitis: surveillance and immunization in Asia and
the Western Pacific, 2016, J.Heffelfinger, X. Li, N.Batmunkh, V. Grabovac, S.
Diorditsa,
Estimated Incidence of Japanese encephalitis
in the Western Pacific Region

• Estimated global incidence: 1.8 cases/100,000

• 0-14 years: 5.4/100,000
• ≥15 years: 0.6/100,000
• In the Western Pacific Region: 40,400 JE cases annually
• Overall incidence in endemic areas: 2.3/100,000
• 31,000 (75%) cases in children aged 0-14 years

Source: Japanese encephalitis: surveillance and immunization in Asia and

the Western Pacific, 2016, J.Heffelfinger, X. Li, N.Batmunkh, V. Grabovac, S.
Diorditsa,

Department of Health – Center for Health Development - CAR

 JE in the Philippines
• 1943 – Antibodies to JEV detected in horses (Hammon et al)
• 1953 – Studies showed high prevalence of JEV antibodies among
residents in Pampanga and Manila (Hammon et al)
• 1956- First serologically confirmed JE encephalitis case in the
Philippines (Southam)
• 1972- JEV identified as possible cause of encephalitis in the Philippines
(Venzon et al)
• 1977- First isolation of JEV among pools of Culex tritaeniorhynchus
and C. vishnui from Ilocos Sur (Trosper et al)

Department of Health – Center for Health Development - CAR

 Distribution of JE cases: 2011- 2017
2500 100%
2204
90%
Suspect JE confirmed
2000 1966
80%
70%
1500 60%
1158 50%
1000 40%

592
30%
500 352
392 20%
16%
10%
199 15%
11%
8% 9%
7% 6%
0 0%
1 2 3 4 5 6 7
 Peak of JE cases: 2011- 2017
300 60

250 50

200 40
No. of cases

No. of cases
150 30

100 20

50 10

0 0
 Age distribution of JE cases
2500

No. of Suspected JE cases (N=6819)

2086 Confirmed cases (N=888)

2000
No. of suspected cases

1500

1072 1104

1000
869
772

494
500 422
308
203
156
109
53 67
9 Source: RITM Data,
0
0 to 2 mos > 2 mos < 2... 2 to <5 yrs 5 to <10 yrs 10 to <15 yrs 15 to 18 yrs > 18 yrs Consolidated from Sentinel
Sites 2018

Department of Health – Center for Health Development - CAR

JAPANESE ENCEPHALITIS: CAR
SITUATION
Confirmed JE Cases by Province/Municipality Confirmed JE Cases by
of CAR, 2015 Province/Municipality of CAR, 2016

Source: DOH-CHD CAR Regional Epidemiology and Surveillance Unit,

2015-2018

Department of Health – Center for Health Development - CAR

 JAPANESE ENCEPHALITIS: CAR
SITUATION
Confirmed JE Cases by
Province/Municipality of CAR, 2017

Abra Luba 1
Bucay 1
Pilar 1
Total 7
Source: Regional Epidemiology and Surveillance Unit CAR, 2015-2018

Department of Health – Center for Health Development - CAR

 JAPANESE ENCEPHALITIS: CAR
SITUATION
Confirmed JE Cases by
Province/Municipality of CAR, 2018
Province Municipality/City No. of Cases Province Municipality/City No. of Cases
Abra Luba 1
Aguinaldo 1
Tubo 1
Ifugao Banaue 1
Calanasan 1
Mayoyao 1
Apayao Flora 1
Santa Marcela 1
Mountain Natonin 1
Luna 1 Prov.
Kalinga Tabuk 4 Baguio City 5

Source: Regional Epidemiology and Surveillance Unit CAR, 2015-2018

Department of Health – Center for Health Development - CAR

Japanese Encephalitis (JE)
Transmission, Vector Biology
and Vector Control
Japanese Encephalitis

A new vector-borne
disease threat
What are the Vectors of JE?
MAIN VECTOR

Culex tritaeniorhynchus

Cx. vishnui Cx. gelidus Cx. fuscocephala

SECONDARY VECTORS
Japanese Encephalitis Transmission
• High risk in areas in close proximity to rice paddies and pigsties
• A paddy can produce – 30,000 adults/ day

High Risk JEV

Transmission
 JE Transmission
• The virus is maintained in a cycle between mosquitoes
and vertebrate hosts, primarily pigs and wading birds.

• Humans are incidental or dead-end hosts, because they usually

do not develop high enough concentrations of JE virus in their
bloodstreams to infect feeding mosquitoes.
 Seasonal Transmission
• JE virus transmission occurs primarily in rural agricultural areas, often
associated with rice production and flooding irrigation. In some areas of
Asia, these conditions can occur near urban centers.

• In temperate areas of Asia, JE virus transmission is seasonal. Human

disease usually peaks in the summer and fall.

• In the subtropics and tropics, transmission can occur year-round, often

with a peak during the rainy season.
 What are the characteristics of
Culex mosquitoes?
• Culex tritaeniorhynchus is a small
brown mosquito; a native of northern
Asia, and parts of Africa (northeast
and sub-Saharan)

• principal vector of zoonotic and

human JE transmission

• First incriminated as a vector in 1938

 What are the characteristics of
Culex mosquitoes?
• Culex tritaeniorhynchus prefers to
breed in permanent, semi-permanent
and temporary groundwater, sunlit
with vegetation ex. rice fields,
ground pools, water hyacinth ponds,
slow streams and irrigation ditches.

• Adult females are strongly zoophilic,

feed mainly on cows and pigs at
night, but will also feed on birds and
humans.
Biting Behavior
Night time biters
Prefers large animals and birds
Mainly outdoor biter, but may enter animal sheds and human
dwellings at night to feed

Resting Behavior
Prefers to rest outdoors
Flight Range

2 km (1 day) to 8.4 km (7 days)

Presence of infected Culex

mosquitoes within in this perimeter
poses risk for JE transmission
 Socio-economic Impacts of JE
• Animals:
• Porcine (pigs): abortion, high mortality in piglets
• Equine (horses): 5% mortality during outbreaks

• Humans:
• Case fatality rate: up to 30%
• Long-term neurologic sequelae in ~30% of survivors
• suffer serious brain damage, including paralysis and mental disability.
• the disease can cause irreversible neurologic damage
• causes financial burden to the family
• Vector Control Measures
Vector Management and Control

• Self Protection – use of LLITN, bed nets, window and door

screens, repellents, wearing long loose clothes

• Indoor and outdoor residual spraying

• Management of irrigation systems, paddy flooding/ draining

schedule, clearing streams/irrigations from debris/ garbage, crop
rotation (dry and wet planting).
Acute Encephalitis Syndrome ( AES ):Suspected JE
Case

Department of Health – Center for Health Development - CAR

WHAT CAN WE DO TO PREVENT
JAPANESE ENCEPHALITIS?
• Integrated Vector
Management
Approach
- Integrate control • Vaccination
strategies to
manage vectors of
mosquito-borne
diseases
HOW IS JAPANESE ENCEPHALITIS
TREATED?
• There is no specific treatment for JE. However,
supportive care is important to reduce the risk of
death or disability.

Department of Health – Center for Health Development - CAR

 2015 WHO position on JE vaccine:
Surveillance
• Surveillance guidance:
• All JE-endemic countries are
encouraged to carry out at least
sentinel surveillance with laboratory
confirmation of JE
• In areas where there are suitable
environment for JE virus
transmission, vaccination should be
considered even if the number of
JE-confirmed cases is low.
 2015 WHO position on JE vaccine:
Main Recommendations
• There is little evidence to
support a reduction in JE
disease burden from
environmental
interventions other than
the vaccination of
humans.
 2015 WHO position on JE vaccine:
Main Recommendations
• The most effective immunization
strategy in JE endemic settings is
a one-time campaign in the
primary target population as
defined by local epidemiology
followed by incorporation of JE
vaccine into the routine
childhood immunization
program.
Progress in JE vaccination programmes in the Western
Pacific Region

10 of 12 WPR countries with endemic JE transmission have introduced JE

vaccine in some or all JE risk areas or have very low levels of disease without
vaccination:
• 8 countries have introduced JE vaccine in all risk areas: Australia, Cambodia, China,
Japan, Republic of Korea, Lao PDR, and Viet Nam
• 1 country has introduced into some risk areas: Malaysia
• 2 countries have very low levels of disease without vaccination: Brunei Darussalam
and Singapore
Of the 2 remaining countries:
• Philippines is planning a subnational campaign in 2019 followed by routine
introduction
• Papua New Guinea is collecting burden of disease data

Source: Weekly Epidemiological Review, 9 June 2017.

Year of JE vaccine introduction in WPR
countries
Plan for campaign in
Philippines in 2019
 DOH Recommendations: JE
Vaccination
2016: Conduct of JE Vaccination Cost Effectiveness Analysis
- JE vaccination has a high cost benefit as compared to no
vaccination at all.

Conclusion:

• The presented epidemiological data on the burden of disease

along with cost effectiveness analysis strongly support the
introduction of JE vaccine in the country
 JE Vaccine
• Three WHO-prequalified
vaccines
• JEEV (July 2013)
• CD.JEVAX (October 2013)
• IMOJEV (September 2014)
Name Company Technology Doses Age Presentation
JEEV Biological E Inactivated 2 doses 12-35 months Liquid
Vero cells 18-49 years 1 dose vial
CD.JEVAX CDIBP Live attenuated 1 dose ≥8 months Lyophilized
PHK cells 1 & 5 dose vials
IMOJEV Sanofi Pasteur Live 1 dose* ≥9 months Lyophilized
(GPO-MBP) recombinant 4 dose vial
Vero cells

Department of Health – Center for Health Development - CAR

 JE Vaccine
 CD-JEV (SA 14-14-2) is a WHO-prequalified
vaccine, which means it has been assessed
by the WHO and successfully meets quality,
safety, and efficacy standards for the target
population.
 CD-JEV has been widely used for over 10
years throughout Asia without safety
concerns identified.

Department of Health – Center for Health Development - CAR

 DO WE EXPECT ANY SIDE EFFECT FROM
THE VACCINATION?
• Some children may experience mild symptoms such as tenderness or
swelling at the injection site, rash, mild fever, nausea, or dizziness.
o These side effects are not serious and will not last more than a few days.
o Like any vaccine, there is always the possibility of serious side effects in
association with vaccination, but serious adverse events are rare.

NOTE: Any adverse events and other problems related to the

vaccines should be reported through the existing Adverse Event
Following Immunization (AEFI) Reporting System
Department of Health – Center for Health Development - CAR
WHAT ABOUT AEFI?
• An AEFI (Adverse Event Following Immunization) is any untoward medical
occurrence which follows immunization and does not necessarily have a
causal relationship with the usage of the vaccine.

• The adverse event may be any unfavorable or unintended sign, abnormal

laboratory finding, symptom or disease.

• WHO SHOULD REPORT AEFIs?

• All health professionals providing immunization services and clinical treatment of AEFIs
• Individuals who received the vaccination can report AEFIs to any health professional.
In cases of minors, parents or guardians can report the same

Department of Health – Center for Health Development - CAR

CAN THIS VACCINE BE GIVEN THE SAME
TIME AS THE OTHER VACCINES?

• YES.
• According to WHO, it is acceptable to give CD-JEV with
other vaccines, such as measles and measles-rubella.
No safety concerns have been identified in co-
administration.

Department of Health – Center for Health Development - CAR

PRECAUTIONS AND
CONTRAINDICATIONS
• Mild illness, such as an upper respiratory tract infection, is
NOT a contraindication. If a recipient has a mild illness, it is
okay to give them CD-JEV.
• Vaccination should be postponed when a fever is higher than
37.8⁰C and not given if there has been a prior severe
hypersensitivity reaction to any vaccine component.

Department of Health – Center for Health Development - CAR

 OPLAN CULEX
Japanese Encephalitis Vaccination
Campaign in CAR

Department of Health – Center for Health Development - CAR

 WHAT IS OPLAN CULEX?
( Please refer to DCCMC 2019-001 )
• OPLAN CULEX is the conduct of Mass Immunization Campaign of
Japanese Encephalitis vaccine in the Cordillera Administrative
Region
• Target eligible children: from 9 months up to 59 months (Target
Eligible Population for CAR: 174,981)
• Duration of immunization campaign: March 2019

Department of Health – Center for Health Development - CAR

 OPLAN CULEX Monitoring Team:
Kalinga and Apayao
Kalinga Apayao
PDOHO DOH-CHD-CAR PDOHO DOH-CHD-CAR
Dr. Bernadette Dr. Shelly Aral Ms. Elnoria Mr. Clint Gil
Andaya Dr. Anabelle Bugnosen Ildefonso
Dr. Judy Lacar Bawang Dr. Andrew Martin Ms. Candice
Mr. Remigio Basilan Mr. Roldan Liwaliw Ms. Charlyn Salingbay
Ms. Jennifer Ruiz Tagabing Ms. Victoria
Ms. Ellaine Kia Malicdan
Rosario Mr. Jonamar Pascua
 Pre- Implementation Activities
1. Planning: Provincial Microplan for Operations
2. Advocacy and Social Preparation
 DOH- CHD CAR Activities
 PHO/CHO/MHO
3. Capability- Building
 Vaccination Team: Operational details orientation c/o
Provincial DOH Office and Provincial Health Office

Department of Health – Center for Health Development - CAR

Communication Plan
Japanese Encephalitis Vaccine Introduction
(Region I, Region II, Region III and CAR )
Program Objective

95% JE vaccination coverage among children

9 months to <5 years old in Region I/Region II/
Region III/CAR
Overall behavioural objective

All parents and caregivers of children 9 months to <5

years old in Region I /Region II /Region III/CAR
submit their children to JE vaccination by March
2019
Target Audiences and Strategies
Parents and Caregivers

Issues and Barriers:

• Unaware of JE and its risk for children and young adults
• Fear of vaccination due to the dengue vaccine issue
• Notion that the JE vaccine is an entirely “new” vaccine
Target Audiences and Strategies
Parents and Caregivers
Desired behavior: Communication objective:  

All parents and caregivers By February 2019, at least 90% of parents and
of children 9 months to <5 caregivers with children 9 months to <5 years old in
years old in Regions Region I/ Region II/ Region III/CAR are aware of basic
1/Region II/Region information on JE
III/CAR submit their
children to JE vaccination By February 2019, at least 90% of parents and
by March 2019 caregivers with children 9 months to <5 years old in
Region I/ Region II/Region III/ CAR recall that
- vaccination is the best preventive measure against JE
- the JE vaccine is safe
- a JE vaccination campaign is taking place in their community
Target Audiences and Strategies
Parents and Caregivers
Strategies/Activities Materials
• Massive information campaign via multiple  TV and radio public service
communication platforms (television, print, announcements (PSAs)
radio, social media)  Print PSAs
- Visibility through IEC  Streamers
materials;    Flyers
• Community assemblies   Social media cards
• AVPs on-ground: at health centers and  
community areas
Target Audiences and Strategies
Health Workers

Issues and Barriers:

• unaware that JE is endemic in the Philippines, including
their respective regions
• Unprepared to sufficiently answer questions about the JE
vaccine
Target Audiences and Strategies
Health Workers
Desired behavior: Communication objective:  

Health workers actively By February 2019, 100% of frontline

promote JE vaccination and health workers deliver correct
sufficiently respond to information on JE and the JE vaccine to
questions of parents and parents and caregivers
caregivers
Target Audiences and Strategies
Health Workers
Strategies/Activities Materials
• Training of health workers on basics of JE • Presentations
and JE vaccination • Job aide on messaging
and FAQs
• Standard messaging by health workers  
during service delivery
Target Audiences and Strategies
Media

Issues and Barriers:

• Unaware of JE and its risk for children and young adults
• Association of the JE vaccine with the dengue vaccine issue
• Notion that the JE vaccine is an entirely “new” vaccine
Target Audiences and Strategies
Media

Desired behavior: Communication objective:  

Media consistently From February to March 2019, 100% of

disseminate correct identified media outlets disseminate
information on JE and on the
correct information on JE and the JE
JE vaccine
  vaccine
Media encourage parents
and caregivers to have their
eligible children vaccinated
Target Audiences and Strategies
Media
Strategies/Activities Materials
include Japanese Encephalitis vaccine in or press • Broadcaster’s manual
conferences • FAQs on JE and the JE
vaccine
Conduct a media forum focusing on Japanese • Press release
Encephalitis
 
Schedule media interviews in television and radio
with local networks with the topic of Japanese
Encephalitis
Target Audiences and Strategies
Local Leaders

Issues and Barriers:

• Unaware that JE is endemic in the Philippines, including their
respective communities
• Hesitant to support due to fear of association with the dengue
vaccine issue
Target Audiences and Strategies
Local Leaders

Desired behavior: Communication objective:  

• By February 2019, at least 85% of

Local leaders champion JE local chief executives (mayors and
vaccination in their governors) publicly expressed support
respective communities on the JE vaccination campaign

• By February 2019, at least 85% of

purok leaders champion immunization
in their respective communities
Target Audiences and Strategies
Local Leaders
Strategies/Activities Materials
• Reenergize/equip local leaders as • FAQs on JE and the JE
champions for immunization vaccine
• Sample talking points
• Communicate with LCEs through dialogues
 
Target Audiences and Strategies
Partners

Issues and Barriers:

• Unaware that JE is endemic in the Philippines, including their
respective communities
• Hesitant to support due to fear of association with the dengue
vaccine issue
Target Audiences and Strategies
Partners

Desired behavior: Communication objective:  

More stakeholders are By February 2019, all identified

tapped in support of the professional groups express support
campaign to promote for JE vaccination (e.g., issuance of
Japanese Encephalitis statement of support)
vaccination
Target Audiences and Strategies
Partners
Strategies/Activities Materials

• Stakeholders’ forum (orienting on JE and • FAQs on JE and the JE

vaccine; presentation of materials) vaccine
• Soft Copies of IEC
materials
 
 Key Messages
Key Ang Japanese Encephalitis (JE) ay malubha at nakamamatay na
Message sakit na higit na mapanganib sa kabataan.
#1
Supporting Ang JE ay pamamaga ng utak dulot ng JE virus na nakukuha sa kagat ng lamok
Message #1
na Culex.
 
Maaari magresulta ang JE sa pagkamatay o panghabang-buhay na epekto sa
katawan at pag-iisip gaya ng pagkaparalisa, pagkapipi, o pagkabaliw

Supporting Laganap ang JE sa buong bansa, kabilang na dito ang Region I/Region II/CAR.
Message #2

Supporting Ayon sa tala ng DOH, siyam sa bawat 10 kaso ng JE ay mga kabataang 15 taong
Message #3 gulang pababa.
 Key Messages
Key
Message Pagbabakuna ang pinakamainam na proteksyon laban sa JE
#2
Supporting  Epektibo ang bakuna laban sa JE. Mahigit sa 300 na milyong kabataan na
Message #1
sa Asya ang napoprotektahan ng bakuna laban sa JE.
Supporting  Ligtas ang bakuna laban sa JE. Bilang WHO-pre-qualified vaccine, dumaan
Message #2
ito sa matinding pagsusuri para matiyak na ito ay ligtas at epektibo. 
Supporting Maaring makaranas ang ilang bata ng karaniwang side effects ng
Message #3 pagbabakuna, gaya ng pamamaga at pamumula ng pinag-ineksyunan,
pamamantal, o di kataasang lagnat. Ang side effects na ito ay kadalasang
hindi tumatagal nang higit sa dalawang araw.
 Key Messages
Key Magkakaroon ng libreng pagbabakuna ang DOH laban sa JE
Message ngayong Pebrero hanggang Marso 2019.
#3
Supporting  Abangan ang mga health worker sa inyong lugar para sa pagbabakuna ng
Message #1
mga batang 9 na buwan hanggang hindi pa umabot sa 5 taong gulang ng
bakuna laban sa JE.

Supporting Nandito ang DOH para sa inyong mga katanungan tungkol sa

Message #2
pagbabakuna.  
Supporting Kapag may napansing kakaiba, agad kumunsulta sa pinakamalapit na
Message #3 Health Center.
NIP CHD CAR CONTACT DETAILS:
Ms. JOYCELYN Z. RILLORTA, NIP Regional Program
Coordinator: 09175585141/ 09275687318
OPLAN CULEX CHD CAR HOTLINE: 09471959845
NIP EMAIL ADDRESS: nipdohcar@gmail.com
NIP FACEBOOK ACCOUNT: Nip Doh Car

Department of Health – Center for Health Development - CAR

Thank you!