The burden of Japanese encephalitis, the catch-up vaccination campaign, and health service providers' perceptions in Myanmar: 2012-2017

Aung Ye Naung Win; Khin Thet Wai; Anthony D Harries; Nang Thu Thu Kyaw; Tin Oo; Wint Phyo Than; Htar Htar Lin; Zaw Lin

doi:10.1186/s41182-020-00200-3

The burden of Japanese encephalitis, the catch-up vaccination campaign, and health service providers' perceptions in Myanmar: 2012-2017

Trop Med Health. 2020 Mar 5:48:13. doi: 10.1186/s41182-020-00200-3. eCollection 2020.

Authors

Aung Ye Naung Win¹, Khin Thet Wai¹, Anthony D Harries^{2

3}, Nang Thu Thu Kyaw², Tin Oo¹, Wint Phyo Than⁴, Htar Htar Lin⁵, Zaw Lin⁶

Affiliations

¹ 1Epidemiology Research Division, Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka Road, Dagon Township, Yangon, 11191 Myanmar.
² 2International Union against Tuberculosis and Lung Disease, Paris, France.
³ 3London School of Hygiene and Tropical Medicine, London, UK.
⁴ 4Vector Borne Disease Control Program, Ministry of Health and Sports, Naypyitaw, Myanmar.
⁵ 5Expanded Program on Immunization, Ministry of Health and Sports, Naypyitaw, Myanmar.
⁶ 6WHO South East Asia Regional Office, New Delhi, India.

Abstract

Background: Myanmar is endemic for Japanese encephalitis (JE) and has experienced several outbreaks in recent years. The vector-borne disease control (VBDC) program has collected hospital-based surveillance data since 1974. There is an urgent need to collate, analyze, and interpret the most recent information. The study aimed to describe (i) hospital-based JE cases and deaths between 2012 and 2017, (ii) a catch-up vaccination campaign in children in 2017, and (iii) health service provider perceptions about JE in one township in 2018.

Methods: This was a cross-sectional study of cases, deaths, and catch-up childhood vaccinations using secondary data from program records and a survey database of health service provider perceptions.

Results: Between 2012 and 2017, there were 872 JE cases and 79 deaths with a case fatality rate of 91 per 1000; 2016 was the year with most cases and deaths. Most cases (n = 324) and deaths (n = 37) occurred in children aged 5-9 years. Large case numbers were reported in delta and lowland regions (n = 550) and during the wet season (n = 580). The highest case fatality rates were observed in the hills and coastal regions (120 and 112 per 1000, respectively). Nationwide coverage of the catch-up JE vaccination campaign among 13.7 million eligible children was 92%, with coverage lower in the hills and coastal regions (84%) compared with delta and lowland regions and plains (94%). More vaccinations (65%) occurred through school-based campaigns with the remainder (35%) vaccinated through community-based campaigns. Structured interviews in one township showed that service providers (n = 47) had good perceptions about various aspects of JE, although perceived benefits of specific vector control measures were poor: spraying/fumigation (38%), garbage removal (36%), larvicide use (36%), and drainage of standing/stagnant water (32%).

Conclusion: The catch-up vaccination campaign was a successful response to high JE case numbers and deaths in children. However, ongoing surveillance for JE needs to continue and be strengthened to ensure comprehensive reporting of all cases, more knowledge is needed on disability in JE survivors, and all attempts must be made to ensure high percentage coverage of vaccination through routine and catch-up campaigns.

Keywords: Catch-up vaccination campaign; Children; Death; Health service provider perceptions; Japanese encephalitis; Myanmar; SORT IT.