# An Overview of Japanese Encephalitis in Australia: Trends, Impact and Interventions
## 5 Future Implications and Concluding Remarks  
As mentioned above, although the risk of acquiring JE is low, the disease can be severe. Laboratory testing for JEV is complex due to the diversity of viral strains. The whole genomic sequences have identified five genotypes (GI, GII, GIII, GIV and GV) of JEV and the genetic diversity of JEV has remained high since 2000 [57]. Therefore, most cases are diagnosed by serology [11; 19], demonstrating that securing timely diagnosis and treatment is often challenging. Thus, prevention through increased JE vaccination coverage is key to reducing disease spread and represents a cost-effective health strategy expected to have a large impact on reducing the burden of JE on public and environmental health. High vaccination coverage in countries such as Japan, Taiwan and South Korea has demonstrated a successful reduction of JE burden to almost zero [58; 59], suggesting that while vaccination does not eliminate JEV, it can effectively reduce endemic JE transmission to humans. From 2010 to 2019, there was an overall decline in the mean number of JE deaths [37]. It is estimated that effective vaccination programmes have prevented approximately 315,000 cases and 115,000 deaths in the last ten years [37]. Despite these successes, there is still low vaccination coverage in many countries with a persistently high JE burden, including Bangladesh, Indonesia, Pakistan and the Philippines, due to the absence of a national vaccination programme [37]. Therefore, the extent of JE vaccination coverage can be seen to vary a great deal in many Asian countries with high JEV transmission [37]. Moreover, there is often an age-specific difference in vaccination coverage within the same country [37]. As such, JE remains a major cause of morbidity and mortality throughout Asia, particularly South and East Asia. Considering the size of current at-risk JE populations [37], increased JE vaccination coverage is needed. Increased funding to support large-scale vaccine programmes is required for low-income countries with high JE burden to achieve long-term elimination. Indeed, increased funding for JEV vaccination in recent years, including through support from Gavi, the Vaccine Alliance beginning in 2013, provides an opportunity to extend the successes experienced in higher-income countries to other countries that still experience a significant JE disease burden. While vaccination is a key indicator, ongoing JEV surveillance remains a challenge. Travellers living outside of JE high-risk countries are more vulnerable to acquiring JE and the severe symptoms of the disease due to a lack of understanding of the need for vaccination in these regions [41]. Hence, travellers from low-risk countries should be informed of the potential risks of acquiring JE when visiting regions where the virus is endemic and should be offered vaccinations. Differences in risk profiles according to the itinerary and season of travel should also be disclosed. From a public health perspective, managing JE in the context of the COVID-19 pandemic in Australia in 2022 represented a communication challenge, with mosquito monitoring and animal diagnostic surveillance forming the bulk of the health system response to JE [11], as opposed to the mass vaccination campaigns and targeted use of anti-viral therapies used in the nation's COVID-19 response [60]. The two available vaccines for JEV retained strict eligibility criteria throughout most of Australia during the recent outbreak, due to limited supply, with those most at risk being prioritised for vaccination, including those living in flood-affected areas, people employed on pig farms, and individuals working to remove stagnant waters following floods [61]. However, these vaccines have not become available to children as young as 2 months old, even if the people they live with meet one of these criteria [34].