Volume 83, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The incidence rate of Japanese encephalitis (JE) in the People's Republic of China has decreased substantially with the wide use of JE vaccine, but the accuracy of JE reporting is uncertain. We established active surveillance for acute meningitis and encephalitis syndrome (AMES) in four prefectures in China during 2006–2008 and performed JE laboratory testing on AMES cases identified from six sentinel hospitals in each prefecture. We estimated JE incidence for each prefecture by applying age-adjusted and season-adjusted JE positivity rates from sentinel hospitals to the total AMES resident cases. We identified 4,513 AMES cases, including 3,561 (79%) among residents of four prefectures. Among 2,294 AMES cases from sentinel hospitals, we identified 213 (9.2%) laboratory-confirmed JE cases. Adjusted estimates of JE incidence per 100,000 persons ranged from 0.08 in Shijiazhuang to 1.58 in Guigang. Active surveillance and laboratory confirmation provides a better estimate of the actual JE disease burden and should be used to further refine JE prevention strategies.


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  1. Fischer M, Hills S, Staples E, Johnson B, Yaich M, Solomon T, Scheld WM, Hammer SM, Hughes JM, , 2008. Japanese encephalitis prevention and control: advances, challenges, and new initiatives. , eds. Emerging Infections 8. Washington, DC: American Society for Microbiology Press, 93124.[Crossref]
  2. WHO, 2006. Japanese encephalitis vaccines. Wkly Epidemiol Rec 81: 331340.
  3. Li Y, Yin Z, Li J, Ning X, Wang X, Li L, Liang X, , 2007. Epidemiological characteristic analysis of Japanese encephalitis in China during 2004–2006 [in Chinese]. Chin J Vaccines Immunization 13: 825829.
  4. Wang H, Li Y, Liang X, Liang G, , 2009. Japanese encephalitis in mainland China. Jpn J Infect Dis 62: 331336.
  5. Ji W, Sun M, Zeng Y, Zhang H, , 2008. The epidemiological characteristic analysis of Japanese encephalitis in Beijing during 2000–2007 [in Chinese]. Chin J Prev Med 9: 10701072.
  6. Song Q, Wang D, Jiang W, Zhou J, Hu J, , 2008. Study on cases surveillance of Japanese encephalitis in Guizhou Province [in Chinese]. Chin J Vector Bio Control 19: 333335.[Crossref]
  7. Wang LH, Fu SH, Wang HY, Liang XF, Cheng JX, Jing HM, Cai GL, Li XW, Ze WY, Lv XJ, Wang HQ, Zhang DL, Feng Y, Yin ZD, Sun XH, Shui TJ, Li MH, Li YX, Liang GD, , 2007. Japanese encephalitis outbreak, Yuncheng, China, 2006. Emerg Infect Dis 13: 11231125.[Crossref]
  8. Yu W, Shui T, Li L, Liang X, , 2006. Analysis on epidemiological characteristics and control measures of measles in China during 2004–2006 [in Chinese]. Chin J Vaccines Immunization 12: 337341.
  9. Molyneux E, Riordan FA, Walsh A, , 2006. Acute bacterial meningitis in children presenting to the Royal Liverpool Children's Hospital, Liverpool, UK and the Queen Elizabeth Central Hospital in Blantyre, Malawi: a world of difference. Ann Trop Paediatr 26: 2937.[Crossref]
  10. Srey VH, Sadones H, Ong S, Mam M, Yim C, Sor S, Grosjean P, Reynes JM, Grosjean P, Reynes JM, , 2002. Etiology of encephalitis syndrome among hospitalized children and adults in Takeo, Cambodia, 1999–2000. Am J Trop Med Hyg 66: 200207.
  11. Ding D, Hong Z, Zhao SJ, Clemens JD, Zhou B, Wang B, Huang MS, Zeng J, Guo QH, Liu W, Tao FB, Xu ZY, , 2007. Long-term disability from acute childhood Japanese encephalitis in Shanghai, China. Am J Trop Med Hyg 77: 528533.
  12. Wang X, Lu Y, Zhang Y, Chen Y, Liang X, , 2004. Dynamic tendency of Japanese B encephalitis in China [in Chinese]. Chin J Vaccines Immunization 10: 302304.
  13. Liu W, Clemens JD, Yang JY, Xu ZY, , 2006. Immunization against Japanese encephalitis in China: a policy analysis. Vaccine 24: 51785182.[Crossref]
  14. Ding D, Kilgore PE, Clemens JD, Wei L, Zhi-Yi X, , 2003. Cost-effectiveness of routine immunization to control Japanese encephalitis in Shanghai, China. Bull World Health Organ 81: 334342.
  15. Zhang S, Yin Z, Suraratdecha C, Hills S, Liu X, Li Y, Xia X, Liang G, Liang X, , 2008. Analysis on data from the clinical acute viral encephalitis surveillance system in three prefectures in Shaanxi during 2005–2006 [in Chinese]. Chin J Epidemiol 29: 895898.
  16. Solomon T, Vaughn DW, , 2002. Pathogenesis and clinical features of Japanese encephalitis and West Nile virus infections. Curr Top Microbiol Immunol 267: 171194.
  17. Burke DS, Nisalak A, Ussery MA, Laorakpongse T, Chantavibul S, , 1985. Kinetics of IgM and IgG responses to Japanese encephalitis virus in human serum and cerebrospinal fluid. J Infect Dis 151: 10931099.[Crossref]
  18. Kuwayama M, Ito M, Takao S, Shimazu Y, Fukuda S, Miyazaki K, Kurane I, Takasaki T, , 2005. Japanese encephalitis virus in meningitis patients, Japan. Emerg Infect Dis 11: 471473.
  19. Fan WF, Yu SR, Cosgriff TM, , 1989. The reemergence of dengue in China. Rev Infect Dis 11 (Suppl 4): S847S853.[Crossref]
  20. Zuo L, Shu LP, , 2004. Isolation, identification, and phylogenetic analysis of a dengue virus strain from Aedes albopictus collected in Mawei town in Guizhou Province, China. Chin Med J (Engl) 117: 18471849.
  21. Solomon T, Dung NM, Vaughn DW, Kneen R, Thao LT, Raengsakulrach B, Loan HT, Day NP, Farrar J, Myint KS, Warrell MJ, James WS, Nisalak A, White NJ, , 2000. Neurological manifestations of dengue infection. Lancet 355: 10531059.[Crossref]
  22. Jacobson JA, Hills SL, Winkler JL, Mammen M, Thaisomboonsuk B, Marfin AA, Gibbons RV, , 2007. Evaluation of three immunoglobulin M antibody capture enzyme-linked immunosorbent assays for diagnosis of Japanese encephalitis. Am J Trop Med Hyg 77: 164168.
  23. Ravi V, Robinson JS, Russell BJ, Desai A, Ramamurty N, Featherstone D, Johnson BW, , 2009. Evaluation of IgM antibody capture enzyme-linked immunosorbent assay kits for detection of IgM against Japanese encephalitis virus in cerebrospinal fluid samples. Am J Trop Med Hyg 81: 11441150.[Crossref]

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  • Received : 10 Dec 2009
  • Accepted : 23 Jun 2010

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