# An Overview of Japanese Encephalitis in Australia: Trends, Impact and Interventions
## 4 Management Strategies for Curb JEV Infection  
Despite being one of the leading causes of encephalitis disorders, particularly in the Asia-Pacific region, there is still no cure for JE due to the lack of effective anti-viral therapy [17]. Current treatments do not reverse the permanent neurological damage caused by the infection; rather, they only provide patients with relief from some of the symptoms. These are usually limited to intravenous fluids (i.e., saline) and drugs (e.g., immunoglobulins, interferon alpha-2 and dexamethasone) that reduce inflammation, seizures, behavioural changes and/or psychotic episodes [15; 19]. A high level of care provided by medical staff or personal carers may be required by patients who are either bedridden or otherwise incapatated and unable to perform routine daily activities independently [16]. For an incurable condition, such as JE, preventative measures are of critical importance to halt the spread of this potentially life-threatening zoonotic disease. Chemical control of mosquitoes using larvicides containing bacterial toxins or insect growth regulators, adulticides such as fogging or surface application of a synthetic pyrethroid, and surface films or oils may be considered to reduce mosquito populations in high-risk areas [49]. However, these chemicals are also toxic to other land and marine wildlife and their efficacy declines within a week. Therefore, the use of these substances should be minimised where possible, and instead, regular surveillance of mosquito breeding grounds must be carried out. In 2022, the rapid JEV spread in eastern Australia across Queensland, NSW, Victoria, South Australia, and the Northern Territory strongly suggests that the natural transmission of the virus had been present for several months or years prior to being detected by the current surveillance systems. Therefore, additional animal surveillance protocols such as testing backyard pigs and their wastewater for the presence of viruses and newer mosquito sampling should be put in place for early detection systems in the future [50]. Future surveillance should not only incorporate the use of sentinel chicken flocks but also increase mosquito collections for virus isolation. It should also be targeted at wetlands where Ardeid bird feed and in areas of feral pig abundance [51]. Health campaigns, with the support of local councils, can also be developed to raise public awareness of JE and educate individuals and agricultural communities located in high-risk zones on the significance of taking precautions to avoid mosquito bites. These measures include reducing time spent outdoors, especially between dusk and dawn, wearing protective clothing, applying repellents containing permethrin or N,N-Diethyl-meta-toluamide, and sleeping within mosquito nets or in air-conditioned spaces [15]. Vaccination programmes are also available for people living in endemic areas, travellers who are likely to live in these areas during the transmission season for a month or more, or those who plan to spend significant time outdoors in rural or agricultural locations [15]. Residents from certain countries (e.g., United States of America) who plan to live in Asia for 6-12 months are also offered a JE vaccine as they may travel outside of urban areas for work or leisure [52]. Inactivated vaccines (e.g., JESpect, also known as Ixiaro(r)) have been developed by infecting Vero cells with the SA14-14-2 viral strain. The virus pool is collected, purified with protamine sulphate, and then inactivated with formaldehyde [53]. For this vaccine, two intramuscular doses must be administered 28 days apart [16]. Booster doses can be supplied a year after the second dose and are recommended for people at risk of infection with JEV. Live attenuated vaccines, such as Imojev(r), require only a single subcutaneous dose, but are not appropriate for people who are immunocompromised, pregnant or younger than nine months of age [52].