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Laboratory-based Japanese Encephalitis Surveillance in Nepal and the Implications for a National Immunization Strategy

We report on two years of Japanese encephalitis (JE) surveillance in Nepal and the implications for a national immunization strategy. From May 2004 to April 2006, 4,652 patients with encephalitis were evaluated. A serum or cerebrospinal fluid specimen was collected from 3198 (69%) patients of which 1,035 (32%) were positive by Japanese encephalitis IgM ELISA. Most cases (N = 951, 92%) were from the 24 Terai districts (i.e., southern plains, 12.3 million persons) with the majority (N =616, 65%) from four western Terai districts (population =1.8 million). The case fatality ratio was 14.7% and 6.3% and the proportion of cases under 15 years old was 52% and 62% in the four western and 20 non-western Terai districts, respectively. Japanese encephalitis immunization targeting residents one year of age and older in the western districts and one through 14 years old in the non-western Terai districts may have reduced Japanese encephalitis cases by 84% and deaths by 92%, nationally.

Received June 6, 2007. Accepted for publication January 29, 2008.

Acknowledgments: The authors thank the Surveillance Medical Officers of the WHO in Nepal for their efforts to develop JE surveillance during difficult times. We also thank Mahendra Bahadur Bista, the Director General and Director of the Epidemiology and Disease Control Division, Shyam Raj Upreti, Chief of the National Immunization Program, and Mr. Shyam P Khanal, Medical Technologist, National Public Health Laboratory of Nepal for their cooperation.

Disclaimer: The opinions and assertions contained herein are not to be construed as official or as reflecting the views of the U.S. government or the U.S. Department of Defense.

Financial support: Financial support was provided by the United States Agency for International Development.

^* Address correspondence to Thomas F. Wierzba, US NAMRU2, 4540 Phnom Penh Place, Dulles, VA 20189. E-mail: wierzba{at}namru2.org.kh

Authors’ addresses: Thomas F. Wierzba, U.S. Naval Medical Research Unit No. 2, 4540 Phnom Penh Place, Dulles, VA 20189, Tel: 855-23-884228 (Phnom Penh), Fax: 855-23-883-561, E-mail: wierzba{at}namru2.org.kh. Prakash Ghimire and Tika R. Sedai, Program for Immunization Preventable Diseases, World Health Organization, P.O. Box 108, UN House, Pulchowk, Lalitpur, Kathmandu, Nepal; Sarala Malla, National Public Health Laboratory, Department of Health Services, Ministry of Health and Population, Teku, Kathmandu, Nepal. Manas Kumar Banerjee, Epidemiology and Disease Control Division, Department of Health Services, Ministry of Health and Population, Teku, Kathmandu, Nepal. Sanjaya Shrestha and Robert V. Gibbons, U.S. Army Medical Component, Armed Forces Research Institute of Medical Sciences (USAMC-AFRIMS) APO AP 96546, USA. Basudha Khanal, B. P. Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal.