Japanese Encephalitis Vaccine: ACIP Provisional Recommendations

ACIP Provisional Recommendations for the Use of Japanese Encephalitis Vaccine
Date of ACIP vote: June 24, 2009
Date of posting of provisional recommendations: July 14, 2009

On June 24, 2009, the ACIP voted on revised recommendations for the use of Japanese encephalitis (JE) vaccine in travelers and laboratory workers. The new provisional recommendations are as follows:

*Recommendations for the prevention of JE among travelers
Travelers to JE endemic countries should be advised of the risks of JE disease and the importance of personal protective measures to reduce the risk of mosquito bites. For some travelers who will be in a high risk setting based on location, duration, season, and activities, JE vaccine may further reduce the risk of infection.
Personal protective measures
All travelers should take precautions to avoid mosquito bites to reduce the risk of JE and other vector-borne infectious diseases. These precautions include using insect repellent, permethrin-impregnated clothing, and bed nets, and staying in screened or air conditioned rooms. Additional information on protection against mosquitoes and other arthropods can be found at http://wwwn.cdc.gov/travel/yellowbook/ch2/insects-arthropods.aspx.

*Recommendations for the use of JE vaccine
JE vaccine is recommended for travelers who plan to spend a month or longer in endemic areas during the Japanese encephalitis virus (JEV) transmission season. This includes longer-term travelers, recurrent travelers, or expatriates who will be based in urban areas but are likely to visit endemic rural or agricultural areas during a high risk period of JEV transmission.

JE vaccine should be considered for the following:
•
Short-term travelers (<1 month) to endemic areas during the JEV transmission season if they plan to travel outside of an urban area and have an increased risk of JEV exposure. Examples of higher risk activities or itineraries include: 1) Spending substantial time outdoors in rural or agricultural areas, especially during the evening or night; 2) Participating in extensive outdoor activities (e.g., camping, hiking, trekking, biking, fishing, hunting, or farming); and 3) Staying in accommodations without air conditioning, screens, or bed nets.
•
Travelers to an area with an ongoing JE outbreak.
•
Travelers to endemic areas who are uncertain of specific destinations, activities, or duration of travel.
JE vaccine is not recommended for short-term travelers whose visit will be restricted to urban areas or times outside of a well-defined JEV transmission season.

Information on expected JEV transmission by country can be obtained from CDC at http://wwwn.cdc.gov/travel/yellowBookCh4-JapaneseEncephalitis.aspx. These data should be interpreted cautiously since JEV transmission activity varies within countries and from year to year.

Recommendations for the use of JE vaccine in laboratory workers
JE vaccine is recommended for laboratory personnel who work with live, wild-type JEV strains. Vaccinated, at-risk laboratory personnel should receive appropriate booster doses of JE vaccine or be evaluated regularly for JEV-specific neutralizing antibodies to assure adequate titers.

This document can be found at:
http://www.cdc.gov/vaccines/recs/provisional/downloads/je-july2009-508.pdf