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Review
. 2014 Aug 14;8(8):e3015.
doi: 10.1371/journal.pntd.0003015. eCollection 2014 Aug.

Vaccine strategies for the control and prevention of Japanese encephalitis in Mainland China, 1951-2011

Xiaoyan Gao  1 , Xiaolong Li  1 , Minghua Li  1 , Shihong Fu  1 , Huanyu Wang  1 , Zhi Lu  1 , Yuxi Cao  1 , Ying He  1 , Wuyang Zhu  1 , Tingting Zhang  1 , Ernest A Gould  2 , Guodong Liang  1
Affiliations
Review

Vaccine strategies for the control and prevention of Japanese encephalitis in Mainland China, 1951-2011

Xiaoyan Gao et al. PLoS Negl Trop Dis. .

Abstract

Japanese encephalitis (JE) is arguably one of the most serious viral encephalitis diseases worldwide. China has a long history of high prevalence of Japanese encephalitis, with thousands of cases reported annually and incidence rates often exceeding 15/100,000. In global terms, the scale of outbreaks and high incidence of these pandemics has almost been unique, placing a heavy burden on the Chinese health authorities. However, the introduction of vaccines, developed in China, combined with an intensive vaccination program initiated during the 1970s, as well as other public health interventions, has dramatically decreased the incidence from 20.92/100,000 in 1971, to 0.12/100,000 in 2011. Moreover, in less readily accessible areas of China, changes to agricultural practices designed to reduce chances of mosquito bites as well as mosquito population densities have also been proven effective in reducing local JE incidence. This unprecedented public health achievement has saved many lives and provided valuable experience that could be directly applicable to the control of vector-borne diseases around the world. Here, we review and discuss strategies for promotion and expansion of vaccination programs to reduce the incidence of JE even further, for the benefit of health authorities throughout Asia and, potentially, worldwide.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The role of immunization in JE control and prevention in China.
The thumbnail in the upper right corner is cited from reference . The bar indicates JE case numbers. formula image The JE pandemic in China peaked during 1965–1977. formula image JE incidence decreased significantly after the local government covered a large proportion of immunization costs. formula image In 2008, the JE vaccine was included in the EPI by the central government, and JE immunization became free throughout China. Subsequently, JE has been controlled and the incidence remains at a low level. formula image The arrow indicates the introduction of the P3 inactivated JE vaccine in 1968. formula image The arrow indicates the point at which the SA 14-14-2 live-attenuated JE vaccine was licensed for use in China in 1988.
Figure 2
Figure 2. Incidence of JE in China.
(a) In 1971, during the JE pandemic, the 11 provinces where JE incidence was higher than the national average (20.92/100,000) were mainly distributed in the coastal areas of eastern China. The colors red, yellow, and light green in panel “a” indicate provinces with incidence higher than 20.00/100,000, 10.01–20/100,000 and lower than 10.00/100,000, respectively. (b) In 2006, the necessary local governments provided a large proportion of immunization costs, and JE incidence rates in economically developed regions of eastern China were far lower than the national average (0.58/100,000). The colors red, yellow, and light green in panel “b” indicate provinces with incidence higher than 0.60/100,000, 0.11–0.60/100,000, and lower than 0.10/100,000, respectively. The grid shadow showed 16 provinces that had implemented JE immunization programs by 2006. (c) In 2011, after the JE vaccine was included in the EPI, Sichuan, Yunnan, Guizhou, and other underdeveloped areas in southwest China still had JE incidence rates higher than the national average (0.12/100,000). The colors red, yellow, and light green in panel “c” indicate provinces with incidence higher than 0.20/100,000, 0.11–0.20/100,000 and lower than 0.10/100,000, respectively. The blank areas in panels “a,” “b,” and “c” represent Xinjiang, Tibet, and Qinghai, respectively, which are considered JE-free areas. The data of JE cases in Taiwan (blank) are not included in the statistics. Abbreviations: HLJ: Heilongjiang; JL: Jilin; LN: Liaoning; NMG: Inner Mongolia; BJ: Beijing; TJ: Tianjin; HB: Hebei: HN: Henan; SD: Shandong; SX: Shanxi; SaX: Shaanxi; NX: Ningxia; GS: Gansu; QH: Qinghai; XJ: Xinjiang; XZ: Tibet; SC: Sichuan; CQ: Chongqing; YN: Yunnan; GZ: Guizhou; GX: Guangxi; GD: Guangdong; GX: Guangxi; HaiN: Hainan; HuN: Hunan; HuB: Hubei; JX: Jiangxi; JS: Jiangsu; ZJ: Zhejiang; AH: Anhui; FJ: Fujian; SH: Shanghai; TW: Taiwan.
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Grants and funding

This work is supported by grants from National Natural Science Foundation of China (81290342), The Ministry of Science and Technology, China (2011CB504702), Development Grant of State Key Laboratory for Infectious Disease Prevention and Control (2014SKLID103), EU 7th Framework Projects SILVER (260644) and PREDEMICS (278433). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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