newsGP – Japanese encephalitis brings Australia’s death toll to five


The latest confirmed death has prompted health authorities to remind GPs of their role in vaccination.

People in high-risk groups are advised to avoid exposure to mosquitoes and speak to their GP about vaccinations.

A man in his 60s who was diagnosed with Japanese encephalitis (JE) in early March died at Albury Base Hospital on Friday May 20, marking the second EJ death in the state, NSW Health confirmed.

This brings Australia’s death toll from the mosquito-borne virus to five, following the death of another New South Wales man in his 60s in February and deaths in Victoria, Queensland and Australia- Southern earlier this year.

Since May 18, the The Ministry of Health confirms there are 42 human cases of JE in Australia, with the majority (13) confirmed in New South Wales.

Victoria has 10 confirmed cases, South Australia four and Queensland two. Thirteen others in the four states are considered “probable cases” where the person has been epidemiologically linked and/or has symptoms of the disease and has suggestive laboratory evidence.

The current outbreak represents the first locally acquired cases detected on the Australian mainland since 1998 and was declared a Communicable Disease Incident of National Significance on March 4 by the Australian Government.

With the state’s second death and the growing outbreak, NSW Health is urging local healthcare providers to remain vigilant and promote vaccination of at-risk populations.

The risk of local infection is highest for:

  • people working and/or living near piggeries who have tested positive for JE
  • animal transport workers
  • veterinarians and students working with pigs
  • entomologists
  • laboratory workers handling EJ
  • those who engage in outdoor activities near mosquito populations, such as camping and fishing, especially near waterways.

GPs and other local healthcare providers are reminded to ensure that all people currently in ‘high risk of exposure’ categories have access to the vaccine.

There are two registered JE vaccines available in Australia, recommended for those most at risk of infection and not intended for the general population.

Imojev – a live attenuated JE vaccine given by subcutaneous injection with a primary treatment of one dose, registered for use in people aged ≥ 9 months.

  • – an inactivated JE vaccine given by intramuscular injection with a primary treatment of two doses, registered for use in people aged ≥ 18 years.

Previous advice from australian vaccination manual recommended routine JE vaccination only for laboratory workers who may be exposed to the virus, people traveling to endemic areas during the transmission season, and people who live or work on the outer islands of the Torres Strait .

Expanding the vaccination program to other at-risk groups, in addition to continued guidance from state and territory governments to avoid exposure to mosquitoes, has responded to calls from local governments and health specialists.

New South Wales virologist Professor Dominic Dwyer Told newsGP in March that extending the vaccine to people who work in piggeries would be a “logical starting point” and recommended that GPs remain alert to developments.

“There are huge amounts of water in the hinterland and that has been accompanied by high numbers of mosquitoes,” he said.

“So you have the mosquitoes, you have the pigs, which are like an amplifying host of JE, and then you have humans nearby.

‘[The] the general message is that people need to be aware that it exists; be aware of the disease, be aware of the risk and know what tests to do if [patients are] worried about it and know that there is a vaccine.

In March of this year, the federal government announced that it would invest in 130,000 additional vaccine doses in response to the JE outbreak that has spread through regional and remote areas of New South Wales, Victoria, Queensland and South Australia.

Current advice for GPs is that JE vaccination for non-high risk groups in the community is not recommended.

“Vaccines are available by order from the State Vaccine Center strictly for administration to patients in groups recommended by CDNA [Communicable Diseases Network Australia]’, NSW Health said.

Orders are limited to 10 doses of vaccine per clinic, with NSW clinics advised to contact their local public health office for larger orders.

Symptoms of JE include:

  • fever and headache with varying degrees of neck stiffness
  • disorientation
  • tremor
  • coma
  • seizures
  • paralysis.

“If patients have symptoms of encephalitis, include JE in your differential diagnosis if they live in or have visited rural areas, especially if they were near pig farms or report being bitten by mosquitoes,” recommends NSW Health.

Patients with suspected JE are advised to be referred to hospital for further management and investigation.

the australian vaccination manual has up-to-date recommendations on JE vaccine dosage and administration.

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