National Strategy JE 2023-2027

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HALAMAN JUDUL
STRATEGI NASIONAL PENANGGULANGAN JAPANESE ENCEPHALITIS
2023—2027
1
PREFACE
All praise be to God Almighty, who has given His grace and guidance so that the book
National Strategy for Japanese Encephalitis (JE) 2023—2027 can be published.
Japanese Encephalitis (JE) is a virus infection that attacks the central nervous
system, transmitted through mosquito bites (mosquito-borne viral disease). The
case fatality rate (CFR) of this disease is relatively high at 16-30%, with 36% of
survivors have permanent disabilities, especially children under 15 years old. The
high mortality and disability rates will lead to the loss of potential human resources
for the country’s development.
The Ministry of Health is the lead sector in the implementation and achievement of
the Sustainable Development Goals (SDGs) for Health with the vision of "Ensuring a
Healthy Life and Improving the Welfare of All People of All Ages." As a leading sector,
the Ministry of Health needs the support and participation of various parties,
including the government sector, the business sector, non-governmental
organizations (NGOs), universities, and the community. This support and
participation are parts of the contribution and dedication of all parties imbued with
the values and spirit of mutual cooperation.
In line with the health transformation pillar, which is also a form of translating
national health system reform, this National Strategies to Countermeasure JE is
expected to provide guidelines for JE preventive measures at the national and
regional levels.
On this occasion, I would like to thank all parties who have contributed to the
preparation of this document. It is hoped that this book can provide a strong
foundation for uniting all parties to work together in JE prevention.
Jakarta, 19 June 2023

Director General of P2P
Dr. dr. Maxi Rein Rondonuwu, DHSM, MARS
ii
FOREWORD
Japanese Encephalitis (JE) is an endemic disease that spreads in many Asian regions
and is estimated to account for about 17% of the estimated global burden of
infectious diseases. As a vector-borne disease, JE prevention requires collaborative
actions from various sectors, particularly those of human, animal and environmental
health.
This National Strategies document consists of six chapters, namely Introduction;

Situation Analysis, Challenges and Strategic Issues; Objectives and Targets;
Strategies and Interventions; Budget and Financing; Implementation and Targets
and appendices to support the chapters’ contents.
The process of developing the National Strategies to Countermeasure JE involves

various interrelated programs and sectors. Thus, in addition to reflecting that JE
management is multi-program and multi-sectoral, its implementation must be
integrated, comprehensive, and sustainable.
We would like to express our gratitude to those who have contributed to the
composing process of this National Strategies to Countermeasure Japanese
Encephalitis of 2023—2027. We hope this document will prove valuable to prevent
JE in Indonesia.
Jakarta, 19 June 2023

Director of P2PM
dr. Imran Pambudi, MPHM
iii
AUTHORS AND CONTRIBUTORS
Directors:
Dr. dr. Maxi Rein Rondonuwu DHSM., General of Disease Prevention and
MARS Control
dr. Imran Pambudi, MPHM Director of Infectious Disease
Prevention and Control
Coordinator:
dr. Asik Surya, M.P.P.M Coordinator of Arbovirus Working
Team
Editor:
Dr. Agus Handito, S.K.M., M.Epid Arbovirus Working Team
Authors:
Prof. Dr. dr. Elisabeth Siti Herini, Universitas Gadjah Mada
Sp.A(K)
dr. Agung Triono, Sp.A(K) Universitas Gadjah Mada
dr. Denny W Sigarlaki, M.Sc Sp. A(K) Universitas Gadjah Mada
dr. Dian K Nurputra M.Sc, PhD, Sp.A Universitas Gadjah Mada
dr. Marissa Leviani Hadiyanto Universitas Gadjah Mada
dr. Veronica Wulan Wijayanti Universitas Gadjah Mada
Deni Harbianto, SE, M.EK Universitas Gadjah Mada
dr. Riris Andono Ahmad, MPH, PhD Universitas Gadjah Mada
Contributors:
dr. Asik Surya, MPPM Arbovirus Working Team
Dr. Agus Handito, SKM, M. Epid Arbovirus Working Team
dr. Iriani Samad,M.Sc Arbovirus Working Team
dr. Fadjar Silalahi Arbovirus Working Team
dr. Dyana Gunawan Arbovirus Working Team
iv
Agus Sugiarto SKM, M.Kes Arbovirus Working Team
Erliana Setiani, SKM, MPH Arbovirus Working Team
Nurlina, SKM, MKKK Arbovirus Working Team
Jeffrynsen Immanuel Hand Tondang, Arbovirus Working Team
SKM
Burhannudin Thohir, SKM Arbovirus Working Team
Desfalina Aryani, SKM Arbovirus Working Team
Anzala Khoirun Nisa, SKM Arbovirus Working Team
Yudi Gunanto. Arbovirus Working Team
Prof. dr. Adi Utarini, M.Sc, MPH, PhD Universitas Gadjah Mada
Dr. Soewarta Kosen,MD,MPH The National Institute of Health
Research and Development
Indah Susanti Donimando, S.Si., Apt. Directorate General of
Pharmaceuticals and Medical Devices
Ministry of Health
Hashta Meyta, S.Si, Apt, M.Sc, PH Directorate of Immunization
Management Ministry of
Health
dr. I Md Gede Dwi L Utama, Sp. A (K) Indonesian Pediatric Association Bali
Province
dr. I Gusti Ayu Raka Susanti Bali Provincial Health Office
Tanti Iswati Biofarma
Prof. Dr. dr. Sri Rezeki H, Sp.A(K) Indonesia Technical Advisory Group
on Immunization
Tri Wibowo Ambar Gardjito, PhD Center for Research and Development
of Disease Vectors
and Reservoirs of Salatiga
Drh. Syafrison, M.Si. Ministry of Agriculture
v
dr. Bagus Febrianto, M.Sc Center for Research and Development
of Disease Vectors
and Reservoirs of Salatiga
Yullita Evarini Yuzwar, MARS Prevention and Control of Infectious
Diseases - Zoonosis Working Team of
Ministry of Health
Dwi Amalia, MPH Center for Environmental Health
Engineering of Disease Prevention and
Control of Yogyakarta
dr. Imelda, MPH Director of Public Health Governance,
Ministry of Health
Prof. Dr. Aryati, dr., MS, Sp.PK(K) Universitas Airlangga
drg. Esther Raflesya Bellsayda Directorate of Health Security System
Disease Prevention and Control,
Ministry of Health
Andrey Prayoga PT. Zamasco Mitra Solusindo
dr. Triya Novita Dinihari Head of Ministry of Health
Surveillance Working Team
Aang Abu Azhar, S.Kom, M.Kes Data and Information Cente, Ministry
of Health
Dewi N Aisyah, SKM, M.Sc, DIC, PhD Epidemiologist of Digital
Transformation Office, Ministry of
Health
dr. Anak Agung Sagung Sawitri, MPH Universitas Udayana
Inti Wikanestri, SKM, MPA Ministry of National Development
Planning
Yulitasari, S.Si. Ministry of Villages, Disadvantaged
Regions, and Transmigration
Budiono Subambang, ST, MPM Ministry of Home Affairs
vi
Dr. dr. Rita Kusriastuti, M.Sc Head of Indonesian Parasitic Disease
Eradication Association
Prof. Dr. Mohamad Sudomo, PhD Head of Experts Committee
I Wayan Sugihana A, SKM, MPH Bali Provincial Health Office
Dr. dr.Tri Yunis Miko Wahyono, M.Sc Universitas Indonesia
Andri Setyo D N, S.Kep, Ners, MPH Yogyakarta Provincial Health Office
Darmawali Handoko, M.Epid Center for Environmental Health
Dr. dr. Nelly Amalia R Sp. A(K), M.Kes Universitas Padjajaran
Dr. dr. IGN. Made Suwarba Sp. A(K) Universitas Udayana
Dr. dr. H. Indriyono Tantoro, DTM&H Indonesian Epidemiologist Association
Prof. dr. Sunartini Hapsara, Sp.A(K), Universitas Gadjah Mada
PhD
Darmawali Handoko, M.Epid Center for Environmental Health
Agung Ludiro Yogyakarta Provincial Agriculture
Office
Ir. Erlina R. Salmun, M.Kes Kupang Provincial Health Office
dr. Hermi Indita Malewa, SpA Johannes Hospital, Kupang
drh. Melky Angsar East Nusa Tenggara Provincial
Agriculture Office
dr. Regina Maya Manubulu Sp. A Johannes Hospital
Ruth Diana Laiskodat, S.Si, Apt, MM Kupang Provincial Health Office
dr. Erna Yulianti West Kalimantan Provincial Health
Office
dr. Muchamad Budi N M. Kes Sp. A Indonesian Pediatric Association of
West Kalimantan Province
vii
Dr. dr. Irene, MKM Center for Environmental Health
Control of Jakarta
Drh. Banter Wahyudi Department of Plantation and Animal
Husbandry of West Kalimantan
Province
Nuryana, S. Si., M.H. Apt. West Kalimantan Provincial Health
Office
Erliansyah S. Si, M.A.A West Kalimantan Provincial Health
Office
Nurlia S. Kep Ns West Kalimantan Provincial Health
Office
Head of Health Resilience System and Health Resources Policy Center
Director of Environmental Health, Directorate General of Public Health, Ministry of
Health
Director of Referral Health Services, Directorate General of Health Services, Ministry
of Health
Director of Health Promotion and Community Empowerment, Ministry of Health
Director of Pharmaceutical and Medical Device Resilience, Directorate General of
Pharmaceuticals and Medical Devices
Acting. Head of the Center for Research and Development of Disease Vectors and
Reservoirs, Ministry of Health
Head of Center for Environmental Health Engineering and Disease Control of Jakarta
Head of Center for Environmental Health Engineering of Disease Prevention and
Control of Jakarta
Control of Surabaya
viii
Control of Banjarbaru
Control of Medan
Control of Batam
Control of Palembang
Control of Manado
Control of Makassar
Control of Ambon
Head of the Public Health Laboratory Working Team, Directorate of Public Health
Governance, Directorate General of Public Health
Head of the Additional and Special Immunization Working Team, Directorate of
Immunization Management, Directorate General of Disease Prevention and
Control Services
Head of the Vector and Disease-Carrying Animals Working Team, Directorate of
Health Surveillance and Quarantine, Directorate General of Disease Prevention
and Control
Head of Surveillance Working Team, Directorate of Surveillance and Health
Quarantine, Directorate General of Disease Prevention and Control
Head of Emerging Infections Working Team, Directorate of Health Surveillance and
Quarantine, Directorate General of Disease Prevention and Control
Head of the Health Laboratory Working Team, Directorate of Health Surveillance
and Quarantine, Directorate General of Disease Prevention and Control
ix
Head of the Zoonoses and Venomous Animal Bites and Poisonous Plant Working
Team, Directorate of Infectious Disease Prevention and Control, Directorate
General of Disease Prevention and Control
Head of Program and Information Unit for Disease Prevention and Control
Head of Law, Organization and Public Relations of the Directorate General of
Disease Prevention and Control
Project Management Officer for Arboviruses
Center for Health Systems and Strategies
Digital transformation Office
Director of Synchronization of Regional Government Affairs III, Directorate General
of Bina BANGDA, Ministry of Home Affairs
Director of Community Health and Nutrition, Ministry of National Development
Planning
Director of Animal Health, Ministry of Agriculture
Director of Veterinary Public Health, Ministry of Agriculture
Director of Species & Genetic Biodiversity Conservation, Ministry of Environment
and Forestry
Deputy for Climatology Unit, Meteorological, Climatological, and Geophysical
Agency
Assistant Deputy for Disease Control & Management, Deputy for Coordination of
Health Quality Improvement and Population Development (Deputy III),
Coordinating Ministry for Human Development and Culture
Head of DKI Jakarta Provincial Health Office
Head of West Java Provincial Health Office
Head of Central Java Provincial Health Office
Head of the Special Region of Yogyakarta Health Office
Head of Bali Provincial Health Office
Head of West Nusa Tenggara Provincial Health Office
Head of East Nusa Tenggara Provincial Health Office
x
Head of North Sulawesi Provincial Health Office
Head of Riau Islands Provincial Health Office
Head of North Sumatra Provincial Health Office
Head of West Kalimantan Provincial Health Office
Director of Dr. Cipto Mangunkusumo Hospital, Jakarta
Director of Dr. Hasan Sadikin Hospital, Bandung, West Java
Director of Dr. Sardjito Hospital, Yogyakarta
Director of Dr. Kariadi Hospital, Semarang
Director of Dr. Pirngadi Hospital, Medan
Director of Prof. Dr.R.D Kandou Hospital, Manado
Director of Dr.Soedarso Hospital, Pontianak
Director of West Nusa Tenggara Provincial Hospital, Mataram
Director of Prof. Dr. W.Z Johannes Hospital, Kupang
Director of Prof. dr.I.G.N.G. Ngoerah Hospital, Denpasar Bali
Director of Embung Fatimah Hospital, Batam
Head of Bali Provincial Health Laboratory
Head of DKI Jakarta Provincial Animal Husbandry Office
Head of West Java Provincial Animal Husbandry Office
Head of Central Java Provincial Animal Husbandry Office
Head of Special Region of Yogyakarta Animal Husbandry Office
Head of North Sumatra Provincial Animal Husbandry Office
Head of Riau Islands Provincial Animal Husbandry Office
Head of West Kalimantan Provincial Animal Husbandry Office
Head of North Sulawesi Provincial Animal Husbandry Office
Head of Bali Provincial Animal Husbandry Office
Head of West Nusa Tenggara Provincial Animal Husbandry Office
Head of East Nusa Tenggara Provincial Animal Husbandry Office
Director of PT. Biofarma
Indonesian Pediatrics Society
xi
Indonesia Technical Advisory Group on Immunization
Indonesian Association of Environmental Health Experts
Illustrator & Designer

dr. Veronica Wulan Wijayanti Universitas Gadjah Mada
xii
TABLE OF CONTENTS
PREFACE ...........................................................................................................ii
FOREWORD .....................................................................................................iii
AUTHORS AND CONTRIBUTORS ...................................................................... iv
TABLE OF CONTENTS ..................................................................................... xiii
LIST OF ABBREVIATIONS ................................................................................ xv
GLOSSARY OF TERMS ..................................................................................... xx
LIST OF TABLES ............................................................................................. xxii
LIST OF IMAGES AND PHOTOS .................................................................... xxiii
EXECUTIVE SUMMARY ................................................................................ xxiv
CHAPTER I. INTRODUCTION ............................................................................ 1
1.1 Global Commitment to Countermeasure Japanese Encephalitis ............ 1
1.2 National Commitment to Countermeasure Japanese Encephalitis ......... 4
1.3 The Process of Developing National Strategies ........................................ 6
CHAPTER II. SITUATION ANALYSIS, CHALLENGES AND STRATEGIC ISS ......... 11
2.1 Situation Analysis .................................................................................... 11
2.2 Challenges ............................................................................................... 13
2.3 Strategic Issues ....................................................................................... 16
CHAPTER III. OBJECTIVES, INDICATORS, AND TARGETS ................................ 19
3.1 Objectives of the 2023—2027 JE Countermeasure Program ................. 19
3.2. Key Targets of the 2023—2027 JE Countermeasure program ............... 20
3.3 Additional Target of JE Countermeasure 2023—2027................................... 21
CHAPTER IV. STRATEGY AND INTERVENTIONS ............................................. 25
xiii
4.1 Strategy 1. Strengthening the surveillance system, JE laboratory
network, and developing a comprehensive JE information system
(SIARVI) ................................................................................................... 26
4.2 Strategy 2. JE Immunization Expansion .................................................. 31
4.3 Strategy 3. Effective, Safe, and Sustainable Control of Vectors and
Reservoirs ............................................................................................... 33
4.4 Strategy 4. Increasing Commitment, Coordination, Consolidation,
Participation, and Sustainable Financing at Various Government Levels
(Central, Provincial, Regency/Municipality , and Village) in JE
Surveillance Activities ............................................................................. 35
4.5 Strategy 5. Developming of Innovation and Research that Support JE
Countermeasure Program ...................................................................... 37
CHAPTER V. BUDGET AND FINANCING ......................................................... 41
1.1 Budget Requirements ............................................................................. 41
1.2 Funding Sources and Financing Gaps ..................................................... 43
CHAPTER VI. IMPLEMENTATION AND TARGETS .......................................... 47
6.1 Implementation ...................................................................................... 47
6.2 Monitoring and Evaluation ..................................................................... 48
6.3 The Roles of Policymakers ...................................................................... 51
BIBLIOGRAPHY .............................................................................................. 56
APPENDICES .................................................................................................. 59
Appendix 1. Breakdown of intervention cost requirements per strategy ..... 59
Appendix 2. SWOT of JE countermeasure program in Indonesia ................. 66
Appendix 3. Target and Supplemental Indicator .......................................... 70
Appendix 4. Aim and Implementation Target of the JE Control Program
Interventions ................................................................................................. 74
Appendix 5. Literature Review ...................................................................... 80
Appendix 6. History of JE Surveillance in Indonesia ...................................... 94
Appendix 7. WHO-based Surveillance Performance Indicators for JE .......... 96
xiv
LIST OF ABBREVIATIONS
3M : menguras, menutup, mendaur ulang
(draining, covering, recycling)
AES : acute encephalitis syndrome
ADINKES : Asosiasi Dinas Kesehatan Seluruh Indonesia
(Association of Indonesian Health Offices)
APBD : anggaran pendapatan dan belanja daerah
(Local government budget)
APBN : anggaran pendapatan dan belanja negara
(State budget)
ATLM : ahli teknologi laboratorium medik
(medical laboratory technologist)
BAPPENAS : Badan Perencanaan Pembangunan Nasional
(National Development Planning Agency)
B2P2V : Balai Besar Litbang Vektor dan Reservoir Penyakit
(Center for Research and Development of Disease Vectors
and Reservoirs)
B/BTKLPP : Balai/ Besar Teknik Kesehatan Lingkungan Pencegahan
dan Pengendalian Penyakit
(Center for Environmental Health Engineering of Disease
Prevention and Control)
BKPK : Badan Kebijakan Pembangunan Kesehatan
(Health Development Policy Agency)
BPOM : Badan Pengawas Obat dan Makanan
(Indonesian Food and Drug Authority)
BRIN : Badan Riset dan Inovasi Nasional
(National Research and Innovation Agency)
xv
CDC : Centers for Disease Control and Prevention
CFR : case fatality rate
CT SCAN : computerized tomography scan
CSS : cairan serebro spinal
(Cerebrospinal fluid)
Ditjen P2P : Direktorat Jenderal Pencegahan dan Pengendalian
Penyakit
(Directorate General of Disease Prevention and Control)
Dit. P2PM : Direktorat Pencegahan dan Pengendalian Penyakit
Menular
(Directorate of Infectious Disease Prevention and Control)
ELISA : enzyme linked immuno sorbent assay
IDAI : Ikatan Dokter Anak Indonesia
(Indonesian Pediatric Society)
IDI : Ikatan Dokter Indonesia
(Indonesian Medical Association)
ITAGI : Indonesian Technical Advisory Group on Immunization
JE : Japanese Encephalitis
Kemendagri : Kementerian Dalam Negri
(Ministry of Home Affairs)
Kemenkes : Kementerian Kesehatan
(Ministry of Health)
Kemendikbud : Kementerian Pendidikan dan Kebudayaan
(Ministry of Education and Culture)
Kemendes PDTT : Kementerian Desa, Pembangunan Daerah Tertinggal, dan
Transmigrasi
(Ministry of Villages, Development of Disadvantaged
Regions, and Transmigration)
Kementan : Kementerian Pertanian
xvi
(Ministry of Agriculture)
Kemen-LH : Kementerian Lingkungan Hidup
(Ministry of Environment)
Kementerian : Kementerian Pekerjaan Umum dan Perumahan Rakyat
PUPR (Ministry of Public Works and Housing)
Kemenko-PMK : Kementerian Koordinator Bidang Pembangunan Manusia
dan Kebudayaan
(Coordinating Ministry for Human Development and
Cultural Affairs)
Kemenparekraf : Kementerian Pariwisata dan Ekonomi Kreatif
(Ministry of Tourism and Creative Economy)
Kominfo : Kementerian Komunikasi dan Informatika Republik
Indonesia
(Ministry of Communications and Informatics)
KIPI : kejadian ikutan paska-imunisasi
(post-immunization adverse events)
KLB : kejadian luar biasa
(extraordinary events)
Labkesda : Laboratorium Kesehatan Daerah
(Regional Health Laboratory)
LSM : Lembaga Swadaya Masyarakat
(Non-Governmental Organization or NGO)
MRI : magnetic resonance imaging
mNGS : metagenomics next-generation sequencing
NTDs : neglected tropical diseases
OJT : on the job training
P2P : Pencegahan dan Pengendalian Penyakit
(Disease Prevention and Control)
P2PM : Pencegahan dan Pengendalian Penyakit Menular
xvii
(Prevention and Control of Infectious Diseases)
P2PTVZ : Pencegahan dan Pengendalian Penyakit Tular Vektor dan
Zoonotik
(Prevention and Control of Vector-Borne and Zoonotic
Diseases)
PBTDK : Puslitbang Biomedis dan Teknologi Dasar Kesehatan
(Research and Development Center for Biomedics and
Basic
Health Technology)
PD3I : penyakit yang dapat dicegah dengan imunisasi
(immunization-preventable diseases)
PERSI : Perhimpunan Rumah Sakit Seluruh Indonesia
(Hospital Association of Indonesia)
PKK : Pemberdayaan Kesejahteraan Keluarga
(Family Welfare Empowerment)
PPI : pencegahan dan pengendalian infeksi
(Infection Prevention and Control)
PSN : pemberantasan sarang nyamuk
(Mosquito Nest Eradication or MNE)
PUPR : pekerjaan umum dan penataan ruang
(Public works and spatial planning)
RAP : rencana aksi program (program action plans)
Rikhus Vektora : riset khusus vektor dan reservoir
(vector and reservoir specialized research)
JMN : rencana pembangunan jangka menengah nasional
(national medium-term development plan)
RT-PCR : reverse transcription polymerase chain reaction
SIARVI : sistem informasi Arboviruses
(arbovirus information system)
xviii
SKDR : sistem kewaspadaan dini dan respons
(Early Warning Alert and Response or EWARS)
SWOT : strength, weakness, opportunity, threat
UCI : universal child immunization
WHO : World Health Organization
xix
GLOSSARY OF TERMS
Extraordinary : The onset or increase in the incidence of epidemiologically
occurrence meaningful morbidity and/or mortality in an area within a
certain period of time, and is a situation that can lead to
an outbreak.
Regional : Governor, regent or mayor, and regional apparatus as
Government elements of regional government
Central : The President of the Republic of Indonesia who holds the
Government governmental power as referred to in the 1945
Constitution of the Republic of Indonesia.
Countermeasures : Actions that prioritize promotive and preventive aspects
aimed at reducing and eliminating morbidity and
mortality, as well as limiting a disease transmission and
spread to prevent cross-regions and cross-countries
escalation which potentially lead to extraordinary
events/outbreaks.
Epidemiologic : A series of activities held to identify the cause and
Investigation characteristics, source, mode of transmission, and factors
that affect the onset of a disease or other health problem,
xx
which are carried out to confirm the extraordinary
occurrence or its aftermath/outbreak.
PSN : Efforts to control JE vector made by the community
through draining, covering, and recycling.
xxi
LIST OF TABLES
Table 1. Key Indicator Target ........................................................................ 20

Table 2. 2023—2027 Budget Planning for JE National Strategy ................... 42
Table 3. Funding Sources and Financing Gaps ............................................. 44
Table 4. The Roles of Cross-program ............................................................ 51
Table 5. The Roles of Cross-Sectors .............................................................. 52
Table 6. Breakdown of JE National Strategy Intervention Cost Planning
2023—2027 ................................................................................................... 59
Table 7. SWOT of JE countermeasure in Indonesia ...................................... 66
Table 8. Target and Supplemental Indicator of JE 2023—2027 National
Strategy ......................................................................................................... 70
Table 9. Aim and Implementation Target ..................................................... 74
Table 10. Vector types and distribution of JE vectors in Indonesia .............. 82
Table 11. JE Vector Habitats ......................................................................... 83
Table 12. JE vectors biting preference .......................................................... 83
Table 13. History of JE Surveillance and Sentinel Hospital in Indonesia ...... 94
Table 14. Performance indicators based on WHO ....................................... 96
xxii
LIST OF IMAGES AND PHOTOS
Figure 1. Countries or Endemic Regions of JE in Asia Pacific .......................... 2
Figure 2. The Process of Developing the JE National Strategies of 2023—
2027 ................................................................................................................ 7
Figure 3. The procedure of the JE surveillance system in Indonesia ............ 15
Figure 4. Budget Planning ............................................................................. 43
Figure 5. Funding Sources and Gaps of JE National Strategies ..................... 44
Photo source 1. Center for Tropical medicine, Universitas Gadjah Mada

Photo source 2. Research by Center for Research and Development of
Disease Vectors and Reservoirs, Ministry of health (2013)
MOSQUITOES IN JAVA: Morphology, Systematics, Ecology,
and their roles and Disease Transmitting Vector
Photo source 3. Provincial Health Office of Bali
Photo source 4. Food, Animal Husbandry, and Animal Health Office of West
Kalimantan
Photo source 5. Special Research on Disease Vector and Reservoir 2016
xxiii
EXECUTIVE SUMMARY
Objective: Increasing the capacity of the Japanese Encephalitis control program in
Indonesia in 2027
Indicators and Targets:
Indicator Main Means of Baseline Target

2023 2024 2025 2026 2027
Verifying indicator indicator
Increased
reporting of Laboratory
confirmed JE cases based 12 13 14 15 16
11 16
nationally surveillance (75%) (80%) (90%) (95%) (100%)
(provinces) reports
Coverage of
vulnerable
populations
protected by
Survey 1 8 2 3 4 6 8
vaccination
nationally
(provinces)
Regions that
Improvement of
carry out
vector and
vector and 12 13 14 15 16
reservoir control in 11 16
reservoir (75%) (80%) (90%) (95%) (100%)
endemic areas
control
(provinces)
Five Strategies
xxiv
An illustration JE child patient receiving a supportive therapy 1
xxv
CHAPTER I. INTRODUCTION
1.1 Global Commitment to Countermeasure Japanese

Encephalitis
Japanese Encephalitis (JE) virus is the most common cause of viral

encephalitis in Asia. A total of 24 countries in the Southeast Asia
and Western Pacific region are at risk of JE transmission;
approximately 3 billion people are at risk of JE infection with a
mortality rate of 20-30% [World Health Organization (WHO),
2019]. A systematic review reported a global burden of 100,308 JE
infections in 2015, resulting in 25,125 deaths (Quan et al., 2020).
Neurological sequelae are reported in 30-50% of cases and
predominantly affect children <15 years (Li et al., 2016; World
Health Organization, 2019). In the Southeast Asia region, 10 out
of 11 countries are categorized as JE endemic except Maldives
(Figure 1).
Japanese Encephalitis can develop into extraordinary occurrence

every 2-15 years, with transmission increasing during the rainy
season when the vector population grows along with the virus
spread associated with agricultural irrigation systems (World
Health Organization, 2019). On April 28, 2022, Australia officially
reported a JE outbreak with 37 JE cases (25 laboratory confirmed
and 12 probable cases) found as of December 31, 2021. WHO
recommended the following steps to respond to the outbreak: (1)
vector control; (2) use of personal protective equipment against
1
mosquito bites; (3) strengthening surveillance; and (4) vaccination for all age groups
at risk of JE (“Japanese Encephalitis - Australia,” 2022).
Figure 1. Countries or Endemic Regions of JE in Asia Pacific
As a form of global commitment to the JE control roadmap, WHO has formulated the
Global Strategy on Comprehensive Vaccine- Preventable Disease Surveillance 2021-
2030 (WHO, 2020) which recommends JE surveillance to be carried out on a case-
based sentinel basis with laboratory confirmation for each case. The overall
objectives of the global strategy on comprehensive surveillance are as follows:
1. To develop a trained workforce with core surveillance competencies,
including in data analysis and interpretation.
2. To strengthen and broaden the public health laboratory network.
3. To develop a sustainable and interoperable information system of vaccine-
preventable disease surveillance to support comprehensive data
collection, analysis, sharing, and use.
2
4. To conduct applied research to enhance and monitor the quality of
surveillance systems and their ability to adapt to new data demands,
such as for new vaccines.
5. To promote sustainable financing and increase domestic
government support for core surveillance activities.
WHO makes a number of commitments to accelerate JE control as stated in the

South-East Asia regional vaccine action plan 2022-2030 (WHO, 2017), namely:
1. To reduce overall mortality and morbidity from vaccine-preventable
diseases.
2. To eliminate and control diseases that can be prevented by vaccination.
3. To increase access to vaccination for all at-risk populations with
new and existing vaccines.
Japanese Encephalitis is one of the major vector-borne diseases in humans

and accounts for approximately 17% of the estimated global burden of
infectious diseases. WHO recommends the following national and regional
vector control strategic plans in each country to align with the global vector
control response (“Global vector control response 2017–2030”):
1. Strengthening multi-sectoral action, collaboration, and engagement in
vector control.
2. Developing effective national planning on community involvement and
mobilization in vector control
3. Strengthening vector surveillance and integrating it with health
information systems to guide vector control.
4. Establishing national targets to protect at-risk populations with
synchronized vector control across vector-borne diseases.
Controlling JE requires collaborative efforts from multiple sectors, primarily human,

animal, and environmental health. In the One Health Joint Action Plan 2022-2026, JE
3
contributes to a high social and economic burden, prompting the development of six
independent action pathways that collectively contribute to achieving sustainable
health and food systems, reducing global health threats, and improving ecosystem
management (“One health joint plan of action 2022‒2026”). The six pathways are as
follows:
1. Enhance One Health capacity to strengthen health systems.
2. Reduce the risk of zoonotic diseases that emerge from epidemics and
pandemics
3. Control and eradicate endemic zoonotic diseases, neglected tropical

diseases, and vector-borne diseases.
4. Strengthen food safety risk assessment and management.
5. Overcoming antimicrobial resistance.
6. Integrating the environment into One Health.
1.2 National Commitment to Countermeasure Japanese Encephalitis
Japanese Encephalitis is a zoonotic disease which the virus is transmitted through

mosquito bites (especially Culex species); with pigs, cows, goats, chickens, ducks,
horses, bats, and birds living in swamps as the amplifying hosts (reservoirs); and
humans as the final hosts of this virus infection (Diptyanusa et al., 2021). The spread
of the JE virus in Indonesia was first discovered in Lombok in 1960. The virus was first
isolated in 1972 from Culex tritaeniorhychus mosquitoes in Bekasi, West Java, and
Kapuk, West Jakarta. Since then, Indonesia had been declared as an endemic country
for JE transmission. Sporadic cases were also reported in Bali, West Kalimantan, and
several cities in Java.
The 2020-2024 National Medium-Term Development Plan (hereinafter referred to

as RPJMN) was created to improve health services towards universal health scope
4
which consists of 5 policy directions, with 1 of which being the Improvement of
Infectious Diseases Control. The 2020-2024 RPJMN Policy Strategies also attach
particular importance to emerging diseases, which potentially cause outbreaks
(including JE), and to strengthening real-time surveillance. In the 2020-2024
Program Action Plan (hereinafter referred to as RAP) of the Directorate General of
Disease Prevention and Management (hereinafter referred to as P2P), zoonotic
diseases (including JE) are one of the public health threats; zoonotic diseases cause
about 70% of infectious diseases. The prevention and control implementation of
zoonotic vector-borne diseases is one of many steps taken by the Directorate
General of P2P. The strategy for handling zoonotic diseases requires cross-sectoral
involvement with a one health approach (humans, animals, environment) which
includes: prevention and mitigation, improving detection/diagnosis capabilities,
strengthening the national laboratory system and surveillance, and improving case
response capabilities (including facilities, infrastructure, and competent human
resources) (Directorate General of P2P, 2020; Ministry of Health, 2020). According
to the Decree of the Minister of Agriculture No: 237/Kpts/PK.400/M/3/2019, JE is
one of the 15 priority zoonoses that require control in Indonesia.
JE surveillance has been carried out since 2014 under the Arboviruses Working Team
of the Directorate of Prevention and Control of Infectious Diseases (hereinafter
referred to as P2PM), the Ministry of Health of the Republic of Indonesia, using
laboratory-based surveillance methods to confirm a diagnosis. This activity involves
the Provincial Health Office, Regency/Municipality Health Office, Central General
Hospital, Regional General Hospital, Private Hospital, Center for Environmental
Health Engineering of Disease Prevention and Control (B/BTKLPP) as the examining
laboratory in its working area, Biomedicine Research and Development Center, and
Basic Health Technology (PBTDK) of the Ministry of Health as a reference laboratory.
The JE surveillance system covers 11 provinces in Indonesia. Bali, West Kalimantan,
and Yogyakarta Special Region have implemented surveillance in all districts/cities;
5
while North Sumatra, Riau Islands, DKI Jakarta, West Java, Central Java, North
Sulawesi, West Nusa Tenggara, and East Nusa Tenggara have carried out a sentinel
system.
Japanese Encephalitis is one of many diseases that is preventable through

immunization. Based on the 2020-2024 RAP of the Directorate General of P2P, the
introduction of the JE vaccine as a new vaccine needs to be consistently enhanced.
The Decree of the Minister of Health of the Republic of Indonesia No:
01.07/Menkes/117/2017 stated that the implementation of JE immunization
campaign and introduction began in 2018 in Bali, one of the endemic areas in
Indonesia, by targeting children aged 9 months to less than 15 years for 1 time
(Kemenkes RI, 2017; WHO, 2018). In 2023, the JE immunization campaign and
implementation programs are planned to be carried out in West Kalimantan.
1.3 The Process of Developing National Strategies
The National JE Countermeasure Strategies 2023—2027 were developed by a team

of authors and guided by the supervising team, that is the Directorate General of
Disease Prevention and Control (P2P), Ministry of Health of the Republic of
Indonesia through a series of activities (Figure 2).
Preparatory meetings, consensus, and discussions involved various programs and

sectors. In addition, a desk review and literature study were conducted to collect
documents or literature related to global strategies, national strategies in various
countries, JE-related research results, as well as important regulations and
documents on JE programs in Indonesia as a reference to develop the national
strategies.
6
The results of the preparatory meetings, desk review, and literature study were
further investigated in a discussion with the Ministry of Health’s supervising team and
experts, and followed by two series of workshops to discuss each chapter in the
National Strategies document. Internal discussions with the writing team were held
regularly to review and revise the National Strategies document. Finalization and
dissemination meetings were held to gain final input from all stakeholders in the JE
countermeasure program, which ended with the launching of the JE countermeasure
strategy document.
Figure 2. The Process of Developing the JE National Strategies of 2023—2027
The National Strategies document consists of six (6) chapters, namely Introduction
(Chapter 1); Situation Analysis, Challenges and Strategic Issues (Chapter 2);
Objectives and Targets (Chapter 3); Strategies and Interventions (Chapter 4); Budget
and Financing (Chapter 5); Implementation and Targets (Chapter 6), and appendices
to support the chapter content. Chapter 1 discusses global and national
commitments to countermeasure JE and the process of developing national
strategies. Chapter 2 analyzes the current situation and challenges in counter-
7
measuring JE and the strategic issues. Chapter 3 describes the objectives of the
program and the performance indicators. The financing sources for the program
budget are outlined in Chapter 5. Lastly, Chapter 6 covers the implementation,
monitoring, and roles of various sectors and programs. The appendices contain
detailed intervention costs required for each strategy, analyses of strength,
weakness, opportunity, and threat (SWOT), additional targets and indicators,
targets and objectives of the implementation, literature review, history of JE
surveillance in Indonesia, and performance indicators that refer to WHO.
8
Vector sampling in a rice field2
9
JE immunization in Bali in 20183
10
CHAPTER II. SITUATION ANALYSIS,
CHALLENGES AND STRATEGIC ISS
2.1 Situation Analysis
The situation analysis aims to describe the current situation of JE

control in Indonesia, including the burden of JE, as well as challenges
in prevention, diagnosis, treatment activities, national policies,
surveillance programs, research, and innovation, and identify
existing strategic issues. The situation analysis results will form the
basis of the JE SWOT and the establishment of the National Strategy
for JE control in Indonesia.
2.1.1 JE Cases in Indonesia
Japanese Encephalitis is a health issue in Indonesia as it is one of the

most common causes of inflammatory brain disease (Kementerian
Kesehatan Republik Indonesia, 2017). Situation analysis in Indonesia
is challenging due to the absence of complete data on JE cases from
all the regions. Based on the Ministry of Health's technical
surveillance report, JE deaths in 11 provinces in 2020-2021 were not
reported, which requires integrated recording and reporting,
including death cases. To date, the reported incidence of suspected
JE cases in Indonesia is around 178 cases in 2020 and 164 cases in
2021 (Substansi Arboviruses Direktorat Pencegahan dan
Pengendalian Penyakit Menular, 2022). There were reports from
sentinel hospitals in Bali, NTT, and West Kalimantan of JE case
fatality, but these cases were neither reported nor recorded in the
surveillance system.
11
A study in Bali reported a JE case fatality rate of 9.5% (6 out of 63 patients) and a
disability rate of 36% (23 out of 63 patients) in children aged 0-11 years old during
2001-2003 (Liu et al., 2010). The risk of JE mortality and morbidity may change along
with the changes in population characteristics, strengthened surveillance, expanded
immunization coverage, and improved quality of health services.
Based on the sentinel surveillance system in 11 provinces in Indonesia in 2014-2021,

we found 8, 40, 43, 15, 6, 10, 12, and 13 JE cases each year, respectively (Substansi
Arboviruses Direktorat Pencegahan dan Pengendalian Penyakit Menular,
Kementerian Kesehatan Republik Indonesia, 2022). Sentinel surveillance results in
2016 found 43 cases (13%) positive for JE out of 326 Acute Encephalitis Syndrome
(AES) cases reported (Kementerian Kesehatan Republik Indonesia, 2018). In 2015, JE
surveillance in Bali resulted in 282 AES cases, 17% of which were confirmed JE,
resulting in an estimated JE incidence rate of 1.2/100,000 population/year, with 92%
affecting children under 15 years old (Kari I.K., et al. 2022). The incidence of JE in
Indonesia cannot be calculated accurately for the following reasons. (1) Surveillance
of JE cases has not been conducted in all regions of Indonesia, so it cannot describe
the incidence of JE throughout Indonesia. (2) Actual incidence rates for JE in most
rural areas of Indonesia are currently unavailable. (3) Clinical symptoms of JE are
difficult to distinguish from those of AES or other intracranial infections and are
dependent on serologic testing, leading to frequent misdiagnosis. (4) Symptomatic
JE cases treated at health facilities only account for <1% of cases. This leads to many
unreported JE cases. (5) The emergence of the Covid-19 pandemic in early 2020 has
disrupted the concentration of the government, the Indonesian Ministry of Health,
and health workers in the surveillance of JE cases.
12
2.2 Challenges
2.2.1 JE Prevention
a. Vector control
JE vector control in Indonesia is not well established. This is due to the high
variation in mosquito species, breeding habitats, biting preferences, resting
behavior, and insecticide resistance status. The control program for JE virus-
carrying mosquitoes can be integrated with the mosquito nest eradication
program (PSN).
b. Reservoir Control
Based on the Minister of Agriculture decree No 237/ Kpts/ PK.400/ M/ 3/ 2019,
JE disease is included in the 15 priority zoonoses, but so far, there is no technical
guidance for special control and eradication programs for JE reservoirs. The
Indonesian Department of Agriculture and Food Security has implemented
good farming practice certification for medium and large-scale farms, but the
management of low and medium-scale farms is poorly organized.
c. Environmental management
Keeping the residential and farm environment clean is one of the efforts to
prevent JE. To date, there is no specific regulation on environmental
management to prevent JE, such as the cleanliness and smooth flow of sewers,
the minimum distance of livestock pens to residents' homes, and the
cleanliness of livestock pens.
d. Immunization
Immunization is one of the most effective forms of JE disease control, but until
2023, Bali is the only Province that has been conducting routine immunization
for JE since 2018. The delay in the JE immunization distribution in Indonesia is
due to the Covid-19 pandemic. JE immunization coverage in Bali in 2018 was
101% (Anak Agung Sagung Sawitri et al., 2018). The implementation of JE
immunization in Bali faces several challenges, including the rejection of
13
vaccines by a group of people related to halal issues in the JE vaccine, time
constraints to access JE vaccination services, and lack of vaccine stocks during
the Covid-19 pandemic in 2020-2022.
2.2.2 Case Management

Japanese Encephalitis case management is prioritized by giving supportive
management to prevent more severe sequelae complications, given that there is no
definitive therapy for JE. Due to the severity of the sequelae, both primary and
secondary prevention management through immunization programs becomes the
priority. There are several obstacles in the field in confirming the diagnosis of JE;
clinical symptoms and laboratory results in JE patients which are not specific and
cannot be distinguished from other etiologies of viral encephalitis. The laboratory
network for JE IgM dot enzyme immunoassay examination is still limited to several
Centers for Environmental Health, Disease Control and Prevention (B/BTKLPP) that
have been designated to conduct serological examinations related to JE surveillance.
The key to successful JE management is the prevention of JE disease. Although the

number of JE cases with severe clinical manifestations is low, there are still reports
of deaths in some districts/municipalities and the sequelae are severe and require
long-term treatment at a high cost.
Evaluation of the factors contributing to the causes of death from JE needs to be

improved, in terms of public awareness, access to health services, and health service
providers. The results of this evaluation are essential for planning the necessary
efforts to prevent JE deaths. Hospital clinical audits can be conducted to improve
the quality of service in hospitals.
2.2.3 The society

The society (the wider community, civil society organizations, community leaders,
religious leaders, and cultural leaders) has not actively prevented and controlled JE.
14
Lack of dissemination and public knowledge about the dangers of JE disease is the
cause of their lack of participation.
2.2.4 JE Surveillance System

The implementation of JE surveillance that has been implemented in Indonesia until
2021 involves 11 provinces with 60 sentinel hospitals. The system used is a
laboratory-based case surveillance system to confirm the diagnosis of JE. The
implementation of surveillance is still facing several challenges, such as poor
reporting of AES cases at sentinel hospitals, obstacles in sending samples to the
laboratory, and JE testing reagents are not available in some B/BTKLPP. Other
obstacles faced are the absence of performance indicators and target indicators of
JE surveillance implementations and the cessation of the JE surveillance system at
the beginning of the Covid-19 pandemic. Figure 3 displays the procedure of the JE
surveillance system in Indonesia.
Figure 3. The procedure of the JE surveillance system in Indonesia
2.2.5 Policy and Program Management

Japanese Encephalitis controls and countermeasures are the responsibility of both
health and non-health sectors, but an adequate response has not been received,
15
and it has not been considered a priority at the national and regional levels. In the
RPJMN 2020-2024 and RAP 2020-2024, the Directorate General of P2P does not
have a specific strategy for JE control. In the 2020-2024 RPJMN Policy Strategy, JE
control is part of disease-control that potentially causes outbreaks and is included
in strengthening real-time surveillance. In the 2020-2024 RAP of the Directorate
General of P2P, JE control is included in the program to prevent and control zoonotic
vector-borne diseases. It is reflected in the poor management and budget support
for JE prevention and control. The allocation of funds entirely comes from the
central government. The Indonesian Ministry of Agriculture has not allocated a
particular budget for JE vector and reservoir control programs even though JE is
ranked 6th out of 15 priority zoonoses in Indonesia. In general, advocacy and
supervision of the continuity of the JE surveillance program have not been
adequately implemented.
2.2.6 Innovation Research and Information Systems

Japanese Encephalitis is an endemic disease in many Asian countries, including
Indonesia. However, research on JE has not been conducted in Indonesia.
Implementation, adoption, and dissemination of previous research results have not
been utilized for actualization and routine decision-making. The current JE
information system is not integrated in terms of data collection, analysis, and use of
program data. The JE Arbovirus Information System (SIARVI) is still under
development, so JE surveillance data is still collected manually. The reporting of
surveillance data is hampered by the low number of AES cases reported, late
reporting, and feedback.
2.3 Strategic Issues

The following are five strategic issues.
16
1. Surveillance, strengthening laboratory networks and developing a JE
information system (SIARVI).
2. Implementing JE immunization as an effective prevention.
3. Vector and reservoir control.
4. Sustainably financing and strengthening the government involvement
(central and local) in order to support the sustainability of laboratory-
based surveillance programs and continuity of vaccine services.
5. Developing and utilizing research and innovation.
17
Sampling of reservoir animals in West Kalimantan in 2023 4
18
CHAPTER III. OBJECTIVES, INDICATORS,
AND TARGETS
3.1 Objectives of the 2023—2027 JE Countermeasure Program

Main Objective
The main objective of the JE countermeasure program is to increase
the capacity of the Japanese Encephalitis control program in
Indonesia by 2027.
Additional Objectives
Specifically, the 2023—2027 JE countermeasure program aims to
strengthen the following JE control programs at the national and
regional levels.
1. Strengthening of surveillance system including laboratory
network, early detection, diagnosis and supervision, and
information system development (SIARVI).
2. Expanding immunization related to immunization criteria and
strategies to determine areas of introduction and sustainable
immunization.
3. Effective, safe and sustainable vector and reservoir control.
4. Strengthening of government commitment.
5. Developing innovation and research related to JE surveillance and
countermeasure systems.
19
3.2. Key Targets of the 2023—2027 JE Countermeasure program
The main indicator targets of the 2023—2027 JE countermeasure program are as follows.
1. Increasing reporting of confirmed JE cases nationwide in 16 provinces by 2027.
2. Coverage of vulnerable populations protected by vaccination in 8 provinces by 2027.
3. Increasing vector and reservoir control efforts in 16 provinces by 2027.
Table 1. Key Indicator Target
Verification Indicator Indicator

No Key Indicator 2023 2024 2025 2026 2027
method Baseline Target
The increase of confirmed
JE case reports Laboratory-based
1. 11 16 12 (75%) 13 (80%) 14 (90%) 15 (95%) 16 (100%)
nationwide (provinces) surveillance report
Coverage of vulnerable
populations protected by
2. vaccination nationwide Survey 1 8 2 3 4 6 8
(provinces)
The improvement of
vector and reservoir Conducted by the
3. 11 16 12 (75%) 13 (80%) 14 (90%) 15 (95%) 16 (100%)
control in endemic areas region
(province)
20
3.3 Additional Target of JE Countermeasure 2023—2027
1. The compliance rate of JE case reporting The number of AES cases reported
increases every year, which is > 2/100,000 population.
3.3.1 The Improvement of Surveillance Capacity

1. JE case reporting compliance rate reaches 80% by 2027.
2. The number of hospitals with adequate encephalitis clinical management capacity
reaches 80% by 2027.
3. The number of provinces using SIARVI platform for JE reporting reaches 100% by
2027.
4. SIARVI completion rate reaches 80% by 2027.
5. The increase of health workers capacity in order to update knowledge of JE
surveillance and management in 16 provinces by 2027.
3.3.2 The Improvement of Vector and Reservoir Control
1. Community, cross-program, and cross-sector participation are indicated through
behavioral surveys and involvement from the group team once until 2027.
3.3.3 The Improvement of Government, Cross-program and Cross-sector
Commitment
1. The increasing budget allocation for JE control from 0.025% to 0.03% compared to
the overall Ministry of Health budget in 2027.
2. Implementation of JE-related policies at cross-sectoral level through one evaluation
survey of the policy implementation by 2027.
3.3.4 The Improvement of Research and Innovation Capacity
1. Research prioritization for JE control through one Delphi survey by 2023.
2. Increasing number of research on JE control by 2 studies per year.
Notes:
Details of additional indicators and targets can be found in Appendix 3.
21
JE reservoir animals1
22
B/BTKLPP Office DIY1
Gedung B/BTKLPP DIY1
23
Light trap installation for mosquito vectors 2
24
CHAPTER IV. STRATEGY AND
INTERVENTIONS
In 2023—2027, the JE control program in Indonesia will be

implemented with five strategies, all of which have high leverage in
achieving program targets and indicators. The five strategies are as
follows.
Strategy 1. Strengthening the surveillance system, JE laboratory

network, and developing a comprehensive JE information
system.
Strategy 2. Expanding the JE immunization coverage.
Strategy 3. Effective, safe, and sustainable vector and reservoir

controls.
Strategy 4. Increasing the commitment, coordination, consolidation,

participation, and sustainable financing at various levels
of government (central, province, regency/municipality,
and village) in JE surveillance activities.
Strategy 5. Developing innovations and research that support JE

countermeasure programs.
25
4.1 Strategy 1. Strengthening the surveillance system, JE laboratory network,
and developing a comprehensive JE information system (SIARVI)
Objective
To comprehensively improve the surveillance system and laboratory network.
Justification
The current JE surveillance system is not optimal due to the following factors. (1)
the quantity and quality of sentinel surveillance which have not been running well
in several provinces designated as sentinel areas. (2) time, geographical area, and
cost constraints for sending samples from sentinel hospitals to B/BTKLPP. (3)
dissemination of JE surveillance that has not been evenly distributed to all health
workers, hospital leaders, and local health offices. (4) no integrated reporting
system. (5) indicators related to the surveillance system already exist, but have not
been implemented properly. (6) implementation and reporting of surveillance
results currently done manually by Sentinel Hospital and B/BTKLPP. In order to
support the expansion of surveillance to other provinces in Indonesia, a centralized
system capable of collecting, analyzing, and utilizing data is needed in the
Arboviruses Information System (SIARVI).
The above factors have caused the number of reported JE cases from the
surveillance system unable to reach the estimated actual case number and unable
to do follow-up reporting by the local health office on-time.
Intervention Description
To achieve this objective, several interventions were developed, namely

surveillance-strengthening interventions and laboratory network-strengthening
interventions.
26
The surveillance-strengthening interventions are as follows. (1) expanding the
sentinel surveillance area to other provinces and adding sentinel network hospitals
in each regency/municipality. (2) improving the quality of sentinel surveillance,
standardization, integration, and creation of JE surveillance master data. (3)
strengthening human resource competencies related to JE surveillance, early
detection, and JE vigilance. (4) developing and socializing of surveillance guidebooks
that can be used as a reference by health workers, hospital leaders, DHOs, and other
cross-sectors involved. (5) developing and integrating of surveillance into SIARVI.
Laboratory network strengthening interventions are as follows. (6) preparing the

facilities and infrastructure needed for the expansion of JE network laboratories. (7)
establishing the system or procedure from sample collection, delivery, serological
examination process, to reporting serological results to local hospitals and DHOs. (8)
Identify local government funding sources to support the Regional Medical
Laboratory (Labkesda) in conducting JE serological tests.
The description of the intervention is as follows.
1. Expanding the sentinel surveillance area to other provinces and adding sentinel
network hospitals in each Regency/Municipality.
Expansion of the sentinel surveillance area can be done through the following
intervention efforts. (1) Establish new sentinel areas based on sentinel surveillance
site selection criteria, such as (a) provinces with a quiet large population or which
are reported to have a high incidence of AES. (b) central/regional public hospitals
and/or private hospitals that have human resources and supporting health service
facilities of surveillance. (c) areas that will receive expanded JE immunization. (2)
Develop a roadmap for the next few years regarding which areas will be designated
to carry out JE sentinel surveillance.
27
2. Improving the quality of sentinel surveillance, standardization, integration and
creation of JE surveillance data master.
The improvement of sentinel surveillance quality can be realized through the

following methods. (1) Establish a JE surveillance team and data coordinator at each
sentinel hospital. (2) Increase the commitment and regularity of sample submissions
by sentinel hospitals and the local health office by using local budget allocations
(APBD) or state budget allocations (APBN). (3) Develop operational definitions,
diagnosis codification, and standardization of health data. (4) Develop flowcharts
and guidelines for standardization, integration, and creation of JE data master. (5)
Conduct training and dissemination of surveillance techniques to all JE surveillance
teams in each Sentinel Hospital. (6) Conduct routine monitoring and evaluation of
surveillance implementation every quarter related to completeness of reporting,
regularity of reporting, and procedure of sending samples to reporting serological
results in each sentinel area.
3. Strengthening the competence of human resources related to JE surveillance,

early detection, and JE vigilance.
Intervention efforts undertaken to strengthen JE early detection and vigilance are

as follows. (1) Improve the early detection capability of AES cases. (2) Conduct
dissemination and training related to operational definitions, diagnosis codification,
health data standardization, and technology-based JE surveillance reporting flow
through workshops. (3) Complete the national JE infection reporting system.
including reporting activities for various clinical manifestations of JE, involvement of
all hospital in reporting suspected AES or JE, increased compliance with the
implementation of reporting suspected/diagnosed AES within 24 hours after
serological results are released. (4) Follow up the reporting of each JE case, both
suspected AES, probable JE and confirmed JE with epidemiological investigations to
confirm the incidence of local transmission. (5) Strengthen monitoring and
28
evaluation of the JE surveillance system by increasing the capacity of hospitals in
conducting case analysis and follow-up through meetings, on the job training (OJT),
and developing a tiered feedback system from the central, provincial, and
Regency/municipality levels to the health facility level on a regular basis. (6)
Optimizing the integration of all screening systems owned by the Indonesian
Ministry of Health such as the Early Alertness Response System (SKDR).
4. Developing and disseminating surveillance technical manuals (including JE case

management).
Efforts to develop a JE surveillance technical manual are as follows. (1) Form a JE

surveillance technical manual drafting team (including JE case management). (2)
Involve cross-program and cross-sectoral in the preparation of the JE surveillance
technical guidelines. (3) Conduct routine dissemination every year on the
importance of JE surveillance and update the surveillance technical guidelines every
two years to all health workers, hospital leaders, and DHOs through coordination
meetings or workshops.
5. Developing and integrating surveillance into SIARVI
To support a sustainable JE surveillance system, an integrated system is required

through the following efforts. (1) Identify technological capabilities at various levels
of health facilities to enable integrated surveillance data collection. (2) Continuously
evaluate and test the use of SIARVI. (3) Integrate surveillance data for planning,
monitoring, evaluation, and management of JE response into the SATUSEHAT
application system (development of PEDULI LINDUNGI application). and (4) Establish
a hotline for SIARVI.
29
6. Preparing facilities and infrastructure needs for the expansion of the JE network
laboratory.
Efforts that will be made are as follows. (1) Coordination with B/BTKLPP and the
Health Development Policy Agency (BKPK) to determine what facilities and
infrastructure are needed for the detection of JE IgM capture enzyme linked
immuno sorbent assay (ELISA). (2) The commitment of the central government and
local governments in ensuring the availability of facilities and infrastructure for JE
ELISA testing. (3) Expansion of JE network laboratories to various Regional medical
laboratory started with training for Regional medical laboratory human resources
by the nearest B/BTKLPP about the procedure of receiving, examining, and reporting
samples. (4) Increased commitment and role of the BKPK in conducting evaluation
of JE serological examination to B/BTKLPP and Regional medical laboratory. (5)
Improvement of the reagent import system to allow easy entry into Indonesia. (6)
Innovation in making independent reagents in Indonesia.
7. Establishing a system or procedure from sample delivery, serological

examination process, to reporting serological results to the local hospitals and
DHOs.
Efforts that will be made are as follows. (1) Developing a team and arrange Standard
Operating Procedures for collecting and managing JE specimens at each sentinel
hospital. (2) Collecting AES specimens according to surveillance technical guidelines.
(3) Sample delivery is carried out in accordance with the surveillance technical
manual. (4) Immediate reconfirmation of Dengue IgM in serum with positive JE
results.
30
8. Identifying local government funding sources to support Regional medical
laboratory in conducting JE serological tests.
Efforts to be made are as follows. (1) Performing cross-sectors coordination (e.g.

Ministry of Home Affairs. Ministry of Village, Development of Disadvantaged
Regions and Transmigration; Ministry of Public Works and Housing; Ministry of
Environment and Forestry; etc.), cross-programs, and multi-stakeholders in the
preparation of plans and budgets from various funding sources in the central
government, local governments, village governments, private sector, philanthropy,
and other parties. (2) Affirm the commitment of stakeholders in providing support
for the ability of regional medical laboratory in the form of providing facilities and
infrastructure as well as increasing the capacity of human resources in JE serological
testing.
4.2 Strategy 2. JE Immunization Expansion
Objective
The goal of this strategy is to expand JE immunization in Indonesia.
Justification
Immunization is one of the most effective measures of JE disease control. Since

2018, Bali Province has conducted routine immunization for JE.
In the expansion of JE immunization, the following interventions are carried out. (1)
expanding the areas of JE immunization and its dissemination in JE endemic areas in
the next five years. (2) increasing the role of cross-sectors and programs in
31
supporting the expansion of JE immunization. (3) Improving the quality of
immunization in areas that have carried out routine immunization for JE.
1. Expanding the areas of JE immunization and the dissemination in JE endemic

areas in the next five years
The interventions that will be carried out are as follows. (1) planning JE campaign
and immunization activities in West Kalimantan in 2023, Special Region of
Yogyakarta in 2024, followed by other endemic areas, such as North Sulawesi, East
Nusa Tenggara, West Nusa Tenggara, DKI Jakarta, and Riau Islands through
coordination with the central government and local health offices. (2) Preparing the
availability of human resources, facilities and infrastructure in health facilities to
carry out JE campaigns and immunization. (3) Collaborating with professional
organizations in providing immunization services.
2. Increasing the role of cross-sector and cross-program in supporting the

expansion of JE immunization.
Intervention efforts that will be carried out are as follows. (1) developing the IEC
media, budgeting support through non-physical special allocation funds for health
operational assistance (BOK), and public health promotion. (2) APBD support in the
implementation of non-physical special allocation funds for immunization BOK. (3)
Strengthening the integration of immunization programs and other health
intervention programs. (4) Ensuring vaccine availability, distribution, and logistics.
3. Improving the quality of immunization in areas that have conducted routine

immunization for JE.
Intervention efforts that will be carried out are as follows. (1) Increasing
immunization coverage through increased outdoor activities and monitoring to
achieve Universal Child Immunization (UCI) in all districts/cities to the village level.
(2) Improving the quality of immunization through cold chain improvement. (3)
32
Monitoring and evaluation every two years on the implementation of routine
immunization for JE and capacity building of immunization human resources. (4)
Ensuring the availability of vaccine stocks and vaccine funding at the regional and
central levels.
4.3 Strategy 3. Effective, Safe, and Sustainable Control of Vectors and Reservoirs
Objective
The objective of this strategy is to conduct vector and reservoir control that is
effective, safe, and sustainable, and can be implemented by cross-sectors, cross-
programs, and communities.
Justification
Currently, cross-sector, cross-program, and community are not maximized in vector

and reservoir control activities, especially JE disease. This strategy is needed to
increase community participation and related institutions to overcome local
transmission and handle extraordinary events.
To achieve these objectives, the following four intervention areas were developed.
(1) Building cross-sector and cross-program commitment in supporting JE vector and
reservoir control. (2) Vector control management. (3) Building community,
educational institution and workplace participation in JE vector and reservoir
control activities. (4) Vector and reservoir surveillance.
1. Building cross-sector and cross-program commitment in supporting JE vector and

reservoir control.
Efforts required are as follows. (1) Using a one health approach between the human
health, animal health and forestry environment sectors in JE control efforts.. (2)
33
conducting dissemination, monitoring and evaluation every year on the
implementation of JE vector and reservoir control by cross-sectors and cross-
programs. (3) developing a technical manual for control and surveillance of JE
vectors and reservoirs involving cross-sectors and cross-programs. (4) improving the
capacity of health workers in empowering communities to implement PSN-3M Plus,
cleanliness of livestock/pet pens through workshops or OJT. (5) building the
involvement of the agriculture and livestock sector in reservoir control, such as
vector and reservoir surveillance, registration of livestock businesses, implementing
and obtaining good farming practice certification, and periodic monitoring of
agricultural/livestock activities in areas near residential areas.
2. Vector control management
There are two intervention efforts that will be carried out as follows (1) ensuring the
availability of facilities and infrastructure for vector and reservoir management in
the regions (larvicides, insecticides, other supporting tools, and livestock farming
arrangements). (2) environmental management in controlling vector habitats
through integration of the health, agriculture, and environment-forestry sectors.
3. Increasing the participation of communities, educational institutions, and

workplaces in JE vector and reservoir control activities.
Implementation of guidelines in vector and reservoir control is not only applied in

the community, but also in strategic places, such as educational institutions and
workplaces. Intervention efforts that will be carried out are as follows. (1) improving
community understanding and practice of the 3M-Plus PSN and cleanliness of
livestock/pet pens by socializing in community forums driven by community health
centers, as well as local animal husbandry and agriculture offices. (2) encouraging
the participation of community health center, educational institutions, and
34
workplaces through PSN activities and the establishment of Jumantik (mosquito
larvae controllers).
4. Strengthening vector and reservoir surveillance systems.
To strengthen the mosquito vector and reservoir surveillance system for pigs, cattle,
buffaloes, goats, dogs, and poultry, the following intervention efforts are carried
out. (1) integrating case surveillance (human AES reports) with virus surveillance in
vectors and reservoirs that can be conducted by BTKL/B/BTKLPP and the local
agriculture and livestock sector. (2) increasing the capacity of environmental health
officers and/or their designees in implementing and reporting vector and reservoir
control activities in the vector and reservoir surveillance system through workshops
or OJT on vector control. (3) improving the knowledge of health cadres and
communities in reporting control activities in the JE vector and reservoir surveillance
system.
4.4 Strategy 4. Increasing Commitment, Coordination, Consolidation,

Participation, and Sustainable Financing at Various Government Levels
(Central, Provincial, Regency/Municipality, and Village) in JE Surveillance
Activities
Objectives
The objectives of this strategy are as follows; (1) strengthening the commitment,
coordination, consolidation, and participation of the central, provincial,
regency/municipality, and village governments in strengthening policies and
management of JE prevention and control programs; (2) increasing the contribution
of sustainable financing from the central, provincial, regency/municipality, and
village governments for JE prevention and control.
35
Justification
The commitment of central and local governments in policy implementation still

varies. Local Government Budget and State Budget financing for JE prevention and
control programs are still limited. Cross-government coordination and consolidation
are needed in financing and funding JE prevention and control programs.
Intervention Descriptions
To develop commitment, participation, and sustainable financing by the

government, the following interventions were undertaken; (1) strengthening the
commitment of the central and local governments in policy making, regulation, and
program management with health system support. (2) Improved collaboration and
coordination between the government and cross-program, cross-sectoral, and
partnerships. (3) Increased financing through communication and advocacy.
1. Strengthening the commitment of central and local governments in policy-

making, regulation, and program management with health system support.
Efforts made are as follows. (1) developing a strategic plan to action plans at the
regional level for JE control as a basis for strengthening policies, designing program
action plans, preparing central and regional budgets, and improving surveillance
standards and quality, through coordination meetings. (2) integrating and
strengthening JE control programs in the authorities and regulations prepared by
the central, provincial, regency/municipality, and village governments.
2. Improved collaboration, consolidation and coordination between cross-

government, cross-program, cross-sectoral and partners.
The efforts made are as follows. (1) identifying and mapping the contributions of
stakeholders from the central and local governments (cross-program and cross-
sector such as Ministry of Agriculture, Ministry of Home Affairs, Ministry of Villages,
36
National Research and Innovation Agency (Badan Riset dan Inovasi Nasional (BRIN)),
Non-Governmental Organizations (NGOs), researchers, and others). (2) encouraging
and ensure regional contributions through internalization of JE prevention and
control into regional development and financial planning documents. (3)
communicating and coordinating the strengths, weaknesses, opportunities, and
challenges of the JE prevention program.
3. Increased sustainable financing through communication and advocacy.
Efforts made are as follows. (1) coordinating the central government, local
governments, cross-programs, and cross-sectors to integrate JE into priority
programs, (2) communicating and advocate with the central government, local
governments, cross-programs, and cross-sectors (such as the National Development
Planning Agency (Badan Perencanaan Pembangunan Nasional (Bappenas)),
Coordinating Ministry for Human Development and Culture (Kementerian
Koordinator Bidang Pembangunan Manusia dan Kebudayaan (Kemenko PMK)),
Ministry of Agriculture, Ministry of Home Affairs, Ministry of Villages, and others) in
the preparation of plans and budgets. (3) conducting education, dissemination, and
campaigns for JE prevention and control programs to community leaders, religious
leaders, and the wider community to increase awareness.
4.5 Strategy 5. Developming of Innovation and Research that Support JE

Countermeasure Program
Objectives
(1) Developing JE studies, inventions, innovations, and research. (2) increasing the
adoption of studies, inventions, innovations, and research results for quality
37
monitoring of JE surveillance systems. (3) developing research on JE vector and
reservoir control. (4) developing research on JE immunization.
Justification
The development of innovations and research to monitor the quality of the

surveillance system requires strengthening and integration between surveillance of
AES cases, vectors, and reservoirs. Adopting and disseminating the results of studies,
inventions, innovations, and research on JE have not been optimal in strengthening
policies and programs. Research on coverage, effectiveness, post-immunization
adverse events (AEFIs), and problems from the implementation of JE immunization
is still limited.
Intervention Descriptions
Development of the Innovation and Research system to monitor the quality of the
surveillance system is carried out as follows. (1) developing research networks
related to JE. (2) creating priority research related to JE. (3) increasing the capacity
to implement innovation and research related to JE.
1. Developing research networks related to JE
Efforts made are as follows. (1) strengthening collaboration and encourage the
development of JE research innovations with research institutions, universities, and
other institutions. (2) advocating government and private institutions to support
funding for the development of JE inventions, innovations and research (BRIN,
MoEC, MoA, other government institutions, private sector and philanthropy).
2. Establishing priority research related to JE
The efforts made are as follows. (1) conducting a Delphi survey to determine priority
research related to strengthening surveillance of AES cases, vectors, reservoirs, and
38
immunization. (2) determining priority research implementers involving research
institutions, universities, and other institutions.
3. Increasing the capacity to implement innovation and research related to JE.
Efforts made are as follows, (1) disseminating priority research to research

institutions, universities, and other institutions. (2) conducting training for
researchers to conduct JE research. (3) increasing dissemination and publication of
JE inventions, innovations, and research results.
39
JE Vaccine 3
40
CHAPTER V. BUDGET AND FINANCING
1.1 Budget Requirements
The total budget requirement for the JE control program in Indonesia for the five-
year period (2023—2027) is IDR 415,377,000,000.00. The budget requirement for
the JE response program is calculated using a costing approach per activity and
strategy for each intervention. The budget calculation in the medium-term
projection of JE program budgeting (2023—2027) takes into account the medium-
term design of national health programs and international roadmaps related to JE
control.
The total budget requirement for the JE control program in Indonesia for the five-
year period (2023—2027) is IDR 415,377,000,000.00. The budget requirement for
the JE response program is calculated using a costing approach per activity and
strategy for each intervention. The budget calculation in the medium-term
projection of JE program budgeting (2023—2027) takes into account the medium-
term design of national health programs and international roadmaps related to JE
control.
Table 2 and Figure 4 show the estimated budget requirements needed over the
next five years for each strategy.
41
Table 2. 2023—2027 Budget Planning for JE National Strategy
Year (in million rupiah)

Total 2023—
Strategies and Interventions 2023 2024 2025 2026 2027
2027
Strategy 1. Strengthening surveillance system, JE 11,542 13,800 15,798 25,375 28,901 95,416
laboratory network, and developing
comprehensive JE information system
Strategy 2. JE Immunization Expansion 27,366 48,247 55,303 61,564 65,603 258,083
Strategy 3. Effective, safe and sustainable vector and 1,710 2,489 5,749 9,345 10,883 30,176
reservoir control
Strategy 4. Improvement of commitment, coordination, 1,361 2,752 3,130 3,540 3,982 14,764
consolidation, participation, and sustainable
financing at various levels of government
(central, provincial, district/municipal, and
village) in JE surveillance activities
Strategy 5. Developing of innovation and research that 2,400 3,045 3,418 3,820 4,254 16,937
supports JE prevention programs
TOTAL 44,378 70,333 83,398 103,644 113,624 415,377
42
Rp120,000
IDR 120,000
Strategy
Strategi 1 Strengthening
5. Pengembangan inovasi dan
risetsurveillance system,
yang mendukung JE
program
laboratory network,
penanggulangan JE and
developing comprehensive JE
information system
Rp100,000
IDR 100,000
Strategi 4. Peningkatan
Strategy komitmen,
2 JE Immunization
koordinasi, konsolidasi,
Expansion
partisipasi, dan pembiayaan
berkelanjutan di berbagai tingkat
Rp80,000
IDR 80,000 pemerintah (pusat, provinsi, kabupaten/
kota, dan desa) dalam aktivitas
surveilans JE
In a million rupiah
Strategy
Strategi 3 Effective,
3. Pengendalian safedan
vektor and
sustainable
reservoir vector
yang efektif, anddan
aman,
Rp60,000
IDR 60,000 berkesinambungan
reservoir control
Strategi 2. Perluasan Imunisasi JE

Strategy 4 Improvement of
Rp40,000
IDR 40,000 commitment, coordination,
consolidation, participation,
and sustainable financing at
various levels of government
in JE surveillance activities
Rp20,000
IDR 20,000 Strategy
Strategi 5 Developing
1. Penguatan of
sistem surveilans,
innovation
jejaring and JE,
laboratorium research
dan that
pengembangan
supports JEsistem informasi JE
prevention
secara komprehensif
programs
Rp-
2023 2024 2025 2026 2027
Figure 4. Budget Planning
1.2 Funding Sources and Financing Gaps
Identification of funding sources is carried out by referring to laws and regulations

related to the duties and functions of the institution, as well as looking at the results
of collective agreements in accordance with stakeholder analysis mapping. Table 3
and Figure 5 show the estimated funding sources for the JE prevention program in
the next five years.
The years 2023 and 2024 are the first period of implementation of the strategy and
activities of the countermeasure JE; government funding priorities have not yet
shown a significant proportion. Most funding comes from the central government.
The year 2025 is a transitional year in which funding responsibility must begin to be
43
transferred from the central government to local governments
(provincial/regency/municipality) and village governments. This is in line with the
principle of decentralization/regional autonomy.
Table 3. Funding Sources and Financing Gaps
Year (in million rupiah)
Total 2023
Strategies and Interventions 2023 2024 2025 2026 2027
-2027
National Government
4,438 8,440 12,510 15,547 18,180 59,114
Local Government
3,550 6,330 8,340 11,401 13,635 43,256
Other National Funding Source
888 2,110 3,336 5,182 6,817 18,333
Grants and Partner Acceptance
2,219 2,110 3,336 4,146 4,545 16,356
Gap
33,284 51,343 55,876 67,369 70,447 278,319
TOTAL
44,378 70,333 83,398 103,644 113,624 415,377
100%
Acceptance
Kesenjangan
90%
Gap
80%
Grants
Hibah dan and
70%
Penerimaan
Partner Mitra
60%
50% Other Pendanaan
Sumber National
Nasional Lain-lain
Funding Source
40%
30% Local
Pemerintah Daerah
20% Government
10% National Pusat
Pemerintah
0% Government
2023 2024 2025 2026 2027
Figure 5. Funding Sources and Gaps of JE National Strategies
In the next five years, the largest source of funding for the JE program in Indonesia
will still be allocations from State Budget and will still increase in proportion to the
44
government's obligation to improve the general health status of the community and
local governments (provinces, districts, cities, and village governments) to
participate in the implementation of health programs based on decentralization. By
2023, the contribution of the central government will be 5%, while the contribution
of local governments (provinces, districts/municipalities) is only estimated at 1%.
The expectation is that by the end of the national strategy period in 2027, financing
from the regions (provinces, districts/municipalities, and village governments) will
increase in proportion to 15%. Allocation of funding sources from the central
government at the end of the national strategy period will still be needed to increase
the coverage of the JE response strategy with a proportion of funding of 30%.
Another potential that is expected to support the achievement of the program is the
increase in funding sourced from development partner grants, foreign aid, as well
as the participation of the private sector and philanthropy (2% in 2023 increasing to
5% in 2027). Donor grants and the role of private funding are expected to help
strengthen the program in terms of capacity building, innovation research, research,
and health promotion in a broad sense.
45
Meeting in Bali in 20221
Pertemuan kunjungan ke Bali tahun 20221
46
CHAPTER VI. IMPLEMENTATION AND TARGET
6.1 Implementation
The implementation of The JE control program in Indonesia in the
period 2023—2027 refers to the targets and target indicators that
have been set in the 2020-2024 Health Sector RPJMN and the 2020-
2024 RAP of the Directorate General of P2P as the basis for the
National Strategy for the JE Control Program 2023—2027. In
implementing this strategy, a monitoring and evaluation system is
needed as well as estimates of budget requirements and funding
sources.
Successful implementation of this strategic plan requires

leadership, commitment and concerted efforts from the central and
local governments down to the village level, as well as the
contribution of cross-sectoral and cross-program roles at that level.
Therefore, these national strategies will serve as an advocacy and
communication document for various stakeholders, and is expected
to be further developed in order to develop regional strategies for
JE prevention and control programs and active regional action plans
so that the desired results can be achieved.
47
6.2 Monitoring and Evaluation
Implementation of the strategic plan requires a periodic and systematic monitoring
and evaluation system. The targets and achievements of annual outcome indicators
for each strategy and intervention in the JE prevention program are elaborated in
Appendix 4.
Monitoring and evaluation aim to determine the status of implementation of the

national JE prevention strategy using agreed indicators from various available data
sources, identify obstacles to the implementation of the strategy at all levels
(central, provincial, regency/municipality, village), and follow up on the
improvement plan that has been prepared. In addition, monitoring and evaluation
can also identify potential risks and efforts to reduce them when carrying out
activities throughout the strategy.
Monitoring the achievement of these outcome indicators is expected to be the basis

for annual planning and budgeting of JE response activities in each region (central,
provincial, regency/municipality, village), across programs and sectors.
48
Strategy 1
Strengthening Surveillance System, JE Laboratory Network, and
Development of Comprehensive JE Information System
40% 100%
Percentage of provinces that became sentinel Percentage of logistics needs,
areas, namely 16 out of 38 provinces in facilities and infrastructure for the
Indonesia and 100 hospitals. expansion of laboratory networks
2 2
Two training activities on sentinel surveillance, At least 2 meetings (coordination and
codification, standardization, integration, and evaluation of sample processing
creation of JE surveillance master data system) conducted per year
1 25%
One early awareness dissemination activity per Percentage of local governments
year for 16 provinces supporting regional medical
laboratory's capability in JE
serological testing
2 1
Renewal of 2 books (guidelines and technical One SIARVI-JE improvement and
surveillance instructions) every 2 years development activity per year
Strategy 2
Expansion of JE Immunization until 2027
50% 95%
Percentage of JE immunization expansion JE immunization coverage in areas
areas, namely 8 out of 16 provinces that where routine immunization has been
have conducted sentinel surveillance. conducted
2
Two cross-sector and cross-program coordination activities to support the expansion of JE
immunization
49
Strategy 3
Effective, Safe and Sustainable Vector and Reservoir Control until 2027
One activity to formulate an intersectoral memorandum of understanding (MoU)

supporting reservoir vector control in the first year, followed by one MoU dissemination
activity for each of the second to fifth years.
1 One time dissemination activity of SOP for reservoir vector control per year
One dissemination and outreach activity to communities, institutions and workplaces
regarding vector and reservoir control per year
One reservoir vector control supervision and strengthening activity per year
Strategy 4
Increasing Commitment, Participation, and Sustainable Financing at
Various Government Levels (Central, Provincial, Regency/Municipality
, and Village) in Surveillance Activities until 2027
One activity to strengthen the commitment of central and local governments per year
1 One activity to increase government collaboration with cross-program, cross-sectoral,

and partnerships per year
One coordination activity for financing capacity building per year
Strategy 5
Development of Innovation and Research that supports the JE
prevention program until 2027
One JE assessment, invention, innovation and research needs identification meeting per
1 year
One JE countermeasure implementation and strengthening activity per year
50
6.3 The Roles of Policymakers
6.3.1 The Roles of Cross-program in JE Control in Indonesia
Table 4. The Roles of Cross-program
Unit/Unit Programme Role
Directorate of Prevention • Increasing promotive and preventive efforts through the

and Control of Infectious acculturation of the 1 House 1 Jumantik Movement
Diseases (Arboviruses (G1R1J) through increased education to the community,
Working Team) multi-sectors, and increased surveillance.
• Developing a national real time reporting system through
SIARVI.
• Influencing relevant stakeholders to obtain support for JE
control policies.
Directorate of Health • Empowering communities to be active in supporting
Promotion and Community behavioral and environmental changes as well as
Empowerment maintaining and improving health for JE control.
• Composing materials in the communication, information,
and education media for the JE control program and
distributing them to the regions.
• Providing information to the public about early signs and
symptoms of JE.
• Socializing to the public regarding JE control.
Provincial and District Health • Conducting JE control at the provincial level and endemic
Offices (P2 Arboviruses and districts/municipalities by intensifying JE prevention and
Health Promotion) control in all regions through increasing the role of
community health center, regency/municipality Health
Office-Provincial Health Office.
• Increasing the capacity of health workers in primary and
referral service facilities in early detection and
management of patients with JE.
• Conducting monitoring and evaluation of JE control at the
referral health service level.
51
6.3.2 The Roles of Cross-Sectors in JE Response in Indonesia
Table 5. The Roles of Cross-Sectors
Ministry/Institution Role
Ministry of Village, • Formulating and leading the implementation of policies

Development of in the field of fostering the management of basic social
Disadvantaged Regions and services, developing village economic enterprises,
Transmigration utilizing natural resources and appropriate technology
for the development of village infrastructure, so as to
improve JE control efforts.
• Providing recommendations to the Ministry of Health
and other relevant ministries regarding the
opportunities and challenges of JE control efforts in
health care villages (use of village funds).
• Facilitating ministries/non-ministerial institutions,
provincial governments and regency/municipality
governments to actively participate in JE control efforts
in Health Care Villages.
Ministry of Home Affairs • Formulating policies and facilitation of JE

countermeasures, as well as monitoring and evaluation
in utilization planning and spatial management control
of local government areas that support self-reliance
efforts in the JE elimination program in every
development planning in all provinces and
districts/cities.
Coordinating Ministry for • Advocating and collaborating between cross-programs
Human Development and and cross-sectors (across ministries).
Cultural Affairs • Coordinating and synchronizing the formulation,
determination, and implementation as well as
controlling the implementation of policies in
ministries/institutions related to improving the quality of
health service delivery and health programs.
Ministry of Education and • Developing healthy school areas (free of larvae) from the
Culture central to regency/municipality level as a school health
effort (UKS).
• Encouraging the UKS program for screening and early
detection of seizures in school children from elementary
to senior high school..
Ministry of Communications • Assisting the development of technology and

and Informatics digitalization in the health sector, especially in JE control.
52
Ministry of Tourism and • Formulating technical policies and integrating JE control

Creative Economy programs such as health promotion related to supporting
Indonesia's health tourism program.
National Development • Contributing to the preparation of themes, targets, policy

Planning Agency directions, and health development priorities, especially
in JE control.
• Coordinating and synchronizing the implementation of
planning and budgeting policies for the national JE
control strategy.
• Providing assistance and strengthening to
Ministries/Institutions and local governments related to
the JE control program.
• Intensive coordination with Ministries/Institutions
regarding public consultation and strengthening the role
as Coordinating Ministry in the JE control program.
• Coordination across development actors with
Ministries/Institutions, local governments, and
academics, along with field visits; and
• Involvement of development actors and becoming a
focal point for JE control coordination.
Village Government • Integrating JE control activities into Desa Peduli

Kesehatan in endemic areas; managing the meeting,
recognizing and documenting P2 JE best practices in
villages; and reporting P2 JE activities in Desa Peduli
Kesehatan.
Universities, Academia, • Formulating, developing, and enriching research and

Researchers, and Research technology utilization to support the success of the JE
Institutions control program.
Association of Indonesia • Improving communication between members,

Local Health Offices government, private sector and community in
implementing Regional Autonomy/Decentralization on
JE control.
• Developing capacity and improving the competence of
members in carrying out their duties and functions in the
health sector, especially in controlling JE.
• Supporting the government in the development of public
health efforts, individuals and community
empowerment in controlling JE.
53
Professional associations • Supporting the process of strengthening and developing

(Indonesian Medical the human resource capacity of health workers, in terms
Association, Indonesian of policy management, technical guidance and technical
Pediatric Association, implementation, so that the government can provide
Indonesian Hospital quality health services in the JE control program.
Association, Indonesian
Psychological Association)
National-Local Non- • Coordinating, integrating, and collaborating with the

Governmental Organization government and private sector in JE control efforts
through early detection, case finding, surveillance,
prevention, treatment, training, dissemination research
and development.
Family Welfare • Conducting counseling and mobilizing the community in

Empowerment (PKK) at each Dasa Wisma group to conduct out 3M plus
national-regional Mosquito Attack Eradication.
(village/sub-district) level
Local Government (Provincial Province

and Regency/Municipality ) • Creating and implementing JE control policies in
provincial endemic areas in accordance with national
policies.
• Cooperating and forming networks with relevant
stakeholders.
• Conducting technical guidance and monitoring and
evaluation of the implementation of the JE control
program to districts/cities through the Health Office,
Hospitals, Puskesmas, and other health service facilities.
• Providing the necessary resources.
• Providing and developing communication, information,
and education media for JE control programs.
• Improving cross-program and cross-sector coordination
at the endemic area level.
• Carrying out advocacy and dissemination of JE control
programs to stakeholders in districts/cities and related
cross-sectors,
• Improving the technical capacity of human resources in
JE control
• Conducting research and development related to JE.
54
Regency
• Developing and implementing JE control policies in
endemic districts/cities in accordance with national and
provincial policies.
• Improving the ability of health center and hospital
personnel.
• Providing the necessary resources.
• Providing and developing communication, information,
and education media for the JE control program.
• Carrying out advocacy and dissemination of the JE
control program to relevant stakeholders and cross-
sectors.
• Conducting technical guidance, monitoring, and
evaluation of control implementation to community
health centers.
Sub-district/village officials • Providing support, coordination, integration, and

collaboration with community health center and village
community organizations for JE control.
Traditional leaders and • Seeking the aspirations of indigenous communities and

institution in the village participating in formulating P2 JE policies in their
respective regions.
Media • Providing support for the implementation of a national-

scale dissemination strategy in stages from central to
regional levels in an effort to accelerate the success of
advocacy and education to the community for successful
JE control.
55
BIBLIOGRAPHY
Bharucha T, Sengvilaipaseuth O, Seephonelee M, Vongsouvath M, Vongsouvath M,
et al. 2018. Detection of Japanese Encephalitis Virus RNA in Human Throat
Samples in Laos - A Pilot study. Sci Rep 8, 8018.
https://doi.org/10.1038/s41598-018-26333-4
Chanama S, Sukprasert W, Sa-Ngasang A, A-nuegoonpipat A, Sangkitporn S, et al.
2005. Detection of Japanese Encephalitis (JE) virus-specific IgM in
cerebrospinal fluid and serum samples from JE patients. Japanese journal of
infectious diseases 58, 294–6.
Cheng Y, Minh NT, Minh QT, Khandelwal S, Clapham HE. 2022. Estimates of Japanese
Encephalitis mortality and morbidity: A systematic review and modeling
analysis. PLOS Neglected Tropical Diseases 16, e0010361.
https://doi.org/10.1371/journal.pntd.0010361
Diptyanusa A, Herini ES, Indarjulianto S, Satoto TBT. 2021. The detection of
Japanese encephalitis virus in Megachiropteran bats in West Kalimantan,
Indonesia: A potential enzootic transmission pattern in the absence of pig
holdings. Int J Parasitol Parasites Wildl.14:280-286.
https://doi.org/10.1016%2Fj.ijppaw.2021.03.009
Ekawasti F, Martindah E. 2017. Vector Control of Zoonotic Arbovirus Disease in
Indonesia. WARTAZOA. Indonesian Bulletin of Animal and Veterinary
Sciences 26, 151–162. https://doi.org/10.14334/wartazoa.v26i4.1402
Global vector control response 2017–2030 [WWW Document], n.d. URL
https://www.who.int/publications-detail-redirect/9789241512978
(accessed 3.30.23).
IDAI | Jadwal Imunisasi IDAI 2020 [WWW Document], n.d. URL
https://www.idai.or.id/tentang-idai/pernyataan-idai/jadwal-imunisasi-idai-
2020 (accessed 5.26.22).
Japanese Encephalitis - Australia [WWW Document], 2022. URL
https://www.who.int/emergencies/disease-outbreak-news/item/2022-
DON365 (accessed 8.6.22).
Japanese Encephalitis Vaccines: WHO position paper [WWW Document], n.d. URL
https://www.who.int/publications-detail-redirect/who-wer9009-69-88
(accessed 12.20.22).
Kari IK, Suwarba IGN,Sutriani D, Syarief I, Lestari R, et. al. Buku Ajar Neurologi Anak
Edisi 1, 1st ed, 1. Badan penerbit Ikatan Dokter Anak Indonesia, Jakarta.
Kemenkes Canangkan Imunisasi Cegah Radang Otak Japanese Enchepalitis (JE) – P2P
Kemenkes RI, 2018. URL http://p2p.kemkes.go.id/kemenkes-canangkan-
imunisasi-cegah-radang-otak-japanese-enchepalitis-JE/ (accessed 7.5.22).
Kementerian Kesehatan Republik Indonesia, 2018. Kementerian Kesehatan Republik
Indonesia [WWW Document]. Mengenal Penyakit Radang Otak Japanese
Enchepalitis. URL
56
https://www.kemkes.go.id/article/view/18030500001/mengenal-
penyakit-radang-otak-japanese-enchepalitis.html (accessed 11.5.22).
Kementerian Kesehatan Republik Indonesia, 2017. Pedoman Pencegahan dan
Pengendalian Japanese Encephalitis, 616.832 Ind P. ed, 616.832 Ind P.
Kementerian Kesehatan Republik Indonesia.
Khan SA, Choudhury P, Kakati S, Doley R, Barman MP, et al. 2021. Effectiveness of a
single dose of Japanese encephalitis vaccine among adults, Assam, India,
2012-2018. Vaccine 39, 4973–4978.
https://doi.org/10.1016/j.vaccine.2021.07.041
Koh YL, Tan BH, Loh JJP, Ooi EE, SU SY, et al. 2006. Japanese Encephalitis, Singapore.
Emerg Infect Dis 12, 525–526. https://doi.org/10.3201/eid1203.051251
Kosen S, Khoe LC, Indriasih E, Tarigan I, Iriawan RW, et al. 2022. Expanding japanese
encephalitis vaccination to selected endemic indonesia provinces: A cost-
effectiveness analysis. Vaccine: X 11, 100179.
https://doi.org/10.1016/j.jvacx.2022.100179
Li X, Cui S, Gao X, Wang H, Song M, et al. 2016. The Spatio-temporal Distribution of
Japanese Encephalitis Cases in Different Age Groups in Mainland China,
2004 – 2014. PLoS Negl Trop Dis 10, e0004611.
https://doi.org/10.1371/journal.pntd.0004611
Li X, Li J, Wu G, Wang M, Jing Z. 2022. Detection of Japanese Encephalitis by
Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid: A Case
Report and Literature Review. Front Cell Neurosci 16, 856512.
https://doi.org/10.3389/fncel.2022.856512
Liu W, Ding D, Clemens JD, Yen N, Poit V, et al. 2010. Measuring Japanese
Encephalitis (JE) Disease Burden in Asia. Springer, New York, NY, pp. 1391–
1399. https://doi.org/10.1007/978-0-387-78665-0_80
Nurzaeni KM, Hestiningsih R, Sutiningsih D, Kusariana N. 2021. Bionomik Vektor
Japanese Encephalitis Di Wilayah Kerja Pos Lintas Batas Darat Negara
(Plbdn) Motaain. Jurnal Kesehatan Masyarakat 9, 281–286.
One health joint plan of action (2022‒2026): working together for the health of
humans, animals, plants and the environment [WWW Document], n.d. URL
https://www.who.int/publications-detail-redirect/9789240059139
(accessed 3.30.23).
Quan TM, Thao TTN, Duy NM, Nhat TM, Clapham H. 2020. Estimates of the global
burden of Japanese encephalitis and the impact of vaccination from 2000-
2015. eLife 9, e51027. https://doi.org/10.7554/eLife.51027
Ringkasan Singkat Hasil Rikhus Vektora 2016 [WWW Document], n.d. URL
http://www.b2p2v.litbang.kemkes.go.id/mobile/berita/baca/60/Ringkasan
-Singkat-Hasil-Rikhus-Vektora-2016 (accessed 1.11.23).
Sawitri AAS, Yuliyatni PCD, Ariawan IMD, Sari KAK. 2018. Coverage Evaluation Of
Japanese Encephalitis Supplementary Immunization Activities (JE SIA) In Bali
Island 2018.
57
Simon LV, Sandhu DS, Goyal A, Kruse B, 2022. Japanese Encephalitis, StatPearls
[Internet]. StatPearls Publishing.
Solomon T, Thao LTT, Dung NM, Kneen R, Hung NT, et al. 1998. Rapid Diagnosis of
Japanese Encephalitis by Using an Immunoglobulin M Dot Enzyme
Immunoassay. J Clin Microbiol 36, 2030–2034.
Substansi Arboviruses Direktorat Pencegahan dan Pengendalian Penyakit Menular,
2022. Laporan Teknis Surveilans Japanese Encephalitis Tahun 2020-2021, 1.
Symptoms & Treatment | Japanese Encephalitis | CDC [WWW Document], 2019.
URL https://www.cdc.gov/japaneseencephalitis/symptoms/index.html
(accessed 8.17.22).
WHO, 2020. Global strategy for comprehensive Vaccine-Preventable Disease (VPD)
surveillance [WWW Document]. URL
https://www.who.int/publications/m/item/global-strategy-for-
comprehensive-vaccine-preventable-disease-(vpd)-surveillance (accessed
10.19.22).
WHO, 2017. South-East Asia regional vaccine action plan 2016-2020 [WWW
Document]. URL https://apps.who.int/iris/handle/10665/272397 (accessed
10.19.22).
World Health Organization, 2019. Japanese encephalitis.
World Health Organization, 2018. WHO Vaccine-Preventable Diseases Surveillance
Standards for Japanese Encephalitis.
58
APPENDICES
Appendix 1. Breakdown of intervention cost requirements per strategy
Table 6. Breakdown of JE National Strategy Intervention Cost Planning 2023—2027
Strategy and Objective and Activity Total Cost

Key Activity
Intervention Unit Baseline 2023 2024 2025 2026 2027
Strategy 1. Strengthening Surveillance System, JE Laboratory Network, and Development of Comprehensive JE Information System
Subtotal of Strategy 1 11,541,500,000 13,800,150,000 15,797,722,500 25,375,140,000 28,901,092,106
1.1 Expanding 1. Working visit Vertical hospitals, 1,080,000,000 1,307,250,000 1,554,525,000 3,646,518,750 4,229,961,750
sentinel areas 2. Online and offline Ministry of Health,
and adding surveillance model training Provincial
network hospitals Governments, 756,000,000 915,075000 1,088,167,500 2,552,563,125 2,960,973,225
Regency/Municipality
Governments
Improving the 1. Surveillance training Vertical hospitals, 2,276,000,000 2,847,075,000 3,204,967,500 4,867,813,125 5,489,226,225
1.2 quantity and 2. Development of Ministry of Health,
quality of integrated JE surveillance Provincial
sentinel SI in SIARVI Governments,
surveillance, Regency/Municipality
codification, Governments
2,332,000,000 2,854,950,000 3,331,755,000 6,887,868,750 7,934,824,800
standardization,
integration, and
creation of JE
surveillance
master data
1.3 Strengthening JE 1. Regular dissemination Ministry of Health,
180,000,000 204,750,000 231,525,000 260,465,625 291,721.,500
early awareness and webinars Provincial
2. SIARVI and SKDR Governments,
450,000,000 511,875,000 578,812,500 651,164,063 729,303,750
Integration Regency/Municipality
59
3. Technical and Governments,
implementation guidelines Integration of SIARVI
252,000,000 286,650,000 324,135,000 364,651,875 408,410,100
for PE during Extraordinary and Health Services,
Occurrences Animal Husbandry
4. Training offices, Public Health
Centers, Regional
Medical Laboratories,
Centers for
504,000,000 573,300,000 648,270,000 729,303,750 816,820,200
Environmental Health
Engineering, and
Disease Control at
every level.
1.4 Production and 1. Production and Ministry of Health,
dissemination of publication of a Ministry of Health's
surveillance companion book to the Vertical Central
600,000,000 682,500,000 771,750,000 868,218,750 972,405,000
guidebooks National Strategy book General Hospitals,
(surveillance technical Provincial
guidebook) Governments,
2. Dissemination of Regency/Municipality
online/offline technical Governments, Health 360,000,000 409,500,000 463,050,000 520,931,250 583,443,000
guidelines book Offices, Animal
3. Technical support Husbandry offices,
Public Health Centers,
Regional Medical
Laboratories,
186,000,000 211,575,000 239,242,500 269,147,813 301,445,550
and Disease Control
Engineering Centers at
every level
1.5. Preparing kit 1. Coordination meetings Provincial
504,000,000 573,300,000 648,270,000 729,303,750 816,820,200
needs, facilities and appointments Governments,
and 2. Laboratory readiness Regency/Municipality
504,000,000 573,300,000 648,270,000 729,303,750 816,820,200
infrastructure for evaluation Governments, Health
the expansion of 3. Database of organizers Offices, Animal
the JE network at the Husbandry Offices,
laboratory Regency/Municipality Public Health Centers, 600,000,000 682,500,000 771,750,000 868,218,750 972,405,000
/Provincial level Regional Medical
Laboratories,
60
and Disease Control
Engineering Centers at
every level
1.6. Establishing a system or flow from the Regency/Municipality
collection, delivery of samples, serological Government, Health
examination process, to reporting serological Office, Center for
199,500,000 253,575,000 277,830,000 303,876,563 331,833,206
results to the hospital and local health Environmental Health
department. and Disease Control
Techniques
1.7. Development of 1. Capacity building Community health
Arboviruses centers, hospitals,
information Regency and 380,000,000 483,000,000 529,200,000 578,812,500 632,063,250
system (SiARVi)) municipality health
offices
1.8. Identify local 1. Coordination meeting Provincial 126,000,000 143,325,000 162,067,500 182,325,938 204,205,050
government 2. Finalization of policy Government,
funding sources and MoU Regency/Municipality
to support Local Government, Health
Health Office, Animal
Laboratory Husbandry Office, 252,000,000 286,650,000 324,135,000 364,651,875 408,410,100
capabilities in JE Community Health
serological Center
testing
Strategy 2. Expansion of JE Immunization

Subtotal of Strategy 2 27,366,000,000 48,247,350,000 55,302,900,000 61,563,947.,50 65,602,748,288
2.1. Expanding JE 1. Dissemination Ministry of Health, 200,000,000 315,000,000 441,000,000 694,575,000 972,405,000
immunization 2. Training of vaccine Ministry of Health’s 250,000,000 393,750,000 551,250,000 868,218,750 1,215,506,250
areas and introducers and Vertical Central
introducing vaccinators General Hospital,
immunization in 3. Immunization Provincial 26,070,000,000 46,140,000,000 52,260,000,000 56,820,000,000 58,740.000,000
JE endemic areas implementation Government,
in the next 5 4. Monitoring of Post- Regency/Municipality 84,000,000 132,300,000 185,220,000 291,721,500 408,410,100
years. Immunization Adverse Government, Health
Events Office, Animal
5. Report Husbandry Office, 48,000,000 75,600,000 105,840,000 166,698,000 233,377,200
Community Health
61
Center, Integrated
Service Post,
Professional
Association
(Indonesian Doctors
Association,
Indonesian Pediatric
Association)
2.2. Increasing the 1. National Coordination Central Government 168,000,000 264,600,000 370,440,000 583,443,000 816,820,200
role of cross- Meeting (Ministry of Health,
sectors and 2. Regional Coordination Ministry of Home 168,000,000 264,600,000 370,440,000 583,443,000 816,820,200
programs in Meeting Affairs, Provincial
supporting the 3. MoU Drafting Government, 168,000,000 264,600,000 370,440,000 583,443,000 816,820,200
expansion of JE 4. Making Implementation Regency/Municipality 84,000,000 132,300,000 185,220,000 291,721,500 408,410,100
immunization Guidelines for technical Government, Health
guidelines Office, Professional
Association
(Indonesian Doctors
Association,
Association), regional
leadership
coordination forum
2.3. Improving the 1. Dissemination and Central Government 42,000,000 88,200,000 92,610,000 97,240,500 102,102,525
quality of Training (Ministry of Health,
immunization in 2. National and regional Ministry of Home 42,000,000 88,200,000 92,610,000 97,240,500 102,102,525
areas where meetings to evaluate Affairs, Provincial
routine JE scope Government,
immunization has 3. Regional meeting to Regency/Municipality 42,000,000 88,200,000 77,830,000 486,202,500 969,973,988
been conducted evaluate scope Government, Health
Office, Professional
Association
(Indonesian Doctors
Association,
Association), regional
leadership
coordination forum
62
Strategy 3. Effective, Safe, and Sustainable Vector and Reservoir Control
3.1. Strengthening of 1. Working visit Provincial 480,000,000 546,000,000 617,400,000 694,575,000 777,924,000
vector and 2. Online and offline Government, 600,000,000 682,500,000 771,750,000 868,218,750 972,405,000
reservoir surveillance model training Regency/Municipality
surveillance Government, Health
systems Office,
Livestock/Agriculture
Office
3.2. Building cross- 1. Coordination meeting Central Government 50,000,000 52,500,000 360,000,000 642,600,000 754,110,000
sector, cross- 2. SOP Drafting (Ministry of Health, 50,000,000 157,500,000 - -
program Ministry of Home -
commitment in 3. Formulation of Affairs, Ministry of 100,000,000 - -
supporting vector intersectoral MoUs Agriculture, Ministry - -
and reservoir 4. Formulation of of Education), 52,500,000 - -
control Ministerial Regulations Provincial - -
Government,
Government, Health
Office, Animal
Husbandry/Agricultur
e Office
3.3. Increasing 1. Coordination meeting Central Government 100,000,000 105,000,000 2,000,000,000 3,570,000,000 4,189,500,000
participation of 2. SOP Drafting (Ministry of Health, 100,000,000 315,000,000 - - -
communities, 3. Formulation of Ministry of Home 100,000,000 - - - -
educational intersectoral MoUs Affairs, Ministry of
institutions and 4. Formulation of Agriculture, Ministry - 105,000,000 - - -
workplaces in JE Ministerial Regulations of Education),
vector and 5. Dissemination and Provincial - 210,000,000 - - -
reservoir control Outreach Government,
activities. Regency/Municipality
Government, Health
Office, Animal
e Office, Education
Office
63
3.4. Vector and 1. SOP Drafting Provincial 50,000,000 157,500,000 2,000,000,000 3,570,000,000 4,189,500,000
reservoir control 2. Training and Government, 80,000,000 - - - -
management Implementation Regency/Municipality
3. Creating and compiling Government, Health - 105,000,000 - - -
an integrated vector Office,
information system Regency/Municipality
Animal
e Office, relevant
Technical
Implementation Units
under the health
office and livestock
and agriculture office.
Strategy 4. Increasing Commitment, Coordination, Consolidation, Participation, and Sustainable Financing at Various Government Levels (Central, Provincial,
Regency/Municipality , and Village) in JE Surveillance Activities
4.1. Strengthening 1. Coordination meeting Central Government, 1,260,000,000 1,323,000,000 1,504,912,500 1,701,708,750 1,914,422,344
the commitment Provincial
of central and Government,
local Regency/Municipality
governments in Government, Village
policy making, Government
regulation, and
program
management
with health
system support
4.2. Improving 1. Coordination meeting Central Government, 100,800,000 105,840,000 120,393,000 136,136,700 153,153,788
collaboration and Provincial
coordination Government,
between Regency/Municipality
government and Government, Village
cross-program, Government, Private
cross-sectoral, Sector and NGOs
and partnerships
4.3. Financing 1. Coordination meeting Central Government, 1,323,000,000 1,504,912,500 1,701,708,750 1,914,422,344
enhancement Provincial -
64
through Government,
communication Regency/Municipality
and advocacy Government, Village
Government, Private
Sector and NGOs
Strategy 5. Developing Innovations and Research that Support JE Countermeasure Program
5.1. Identifying JE 1. Operational Activities Central government, 525,000,000 551,250,000 578,812,500 607,753,125
studies, Academics -
inventions,
innovations and
research needs
5.2. Implementing 1. Operational Activities Provincial health 2,400,000,000 2,520,000,000 2,866,500,000 3,241,350,000 3,646,518,750
and office, District health
strengthening the office
evaluation of JE
surveillance
system in early
detection and
control of JE
disease.
TOTAL 44,378,300,000 70,332,840,000 83,397,740,500 103,644,197,700 113,623,549,744
65
Appendix 2. SWOT of JE countermeasure program in Indonesia
Table 7. SWOT of JE countermeasure in Indonesia
S W O T
JE Surveillance system and laboratory network
There is a sentinel surveillance system Surveillance remains limited (remain Updating surveillance guidelines and Surveillance system was suspended during the
in 11 provinces involving B/BTKLPP and sentinel), resulting in underreporting of dissemination of surveillance techniques to pandemic
BKPK Acute Encephalitis Syndrome (AES) cases. health workers, hospital boards, respective
Health Office, and other cross-sectors
There has been dissemination and There is no decree from the Director of the Providing opportunities to improve data- The allocation of APBN and APBD funds for JE
selection of surveillance teams in each hospital / Ministry of Health to the JE integrated reporting systems (e.g. SIARVI, disease is limited.
hospital. surveillance team in each Sentinel hospital SATU DATA)
regarding the duties and responsibilities of
each unit so medical staff are less able to
understand/are less aware of how to identify
JE suspects through AES surveillance.
There is already a standardized flow of The data collected is incomplete, making it Many hospitals are willing to become JE There is no integrated information system to
examination, examination methods and difficult to analyze, feedback and evaluate. sentinel hospital access JE surveillance data in Indonesia.
specimen storage contained in the
surveillance guidebook but it has not
been routinely updated.
External Quality Monitoring has been Local hospital laboratories do not have the Increasing the capacity of laboratories that Some people are unwilling to undergo laboratory
running well BKPK / Research and laboratory capabilities to support JE can examine JE specimens (District/Provincial tests related to JE surveillance, due to lack of
Development Center, human resources diagnosis (both availability of human level health centers can be equipped to knowledge of the disease.
have been trained, kits and procedures resources, materials, and equipment as well conduct JE examinations), involving
used are standardized. as budget) laboratories in hospitals.
Serologic examination results are long due to JE reagents and kits are purchased jointly for Rapid rotation of surveillance officers in
waiting for the number of samples to meet the entire network of JE laboratories to get provinces/regencies/cities causes surveillance to
the quota so that many cases are late for wholesale prices. be neglected.
epidemiological investigation.
66
S W O T
Lack of information on the referral pathway JE testing reagents are expensive and difficult to
for JE laboratory examination when AES obtain, so the risk of vacancies is high.
cases are found in non-sentinel health
centers/ hospitals.
JE Information System
Routine surveillance reporting has been There is no integrated information system SIARVI JE is being developed Ability to implement SIARVI in real-time
done manually for data collection, analysis, and use of
program data.
HR training Data collection is still done manually The advancement of technology and social Access to the internet is limited in certain areas.
media development
Support from IDAI and PAPDI Limited information on JE discovery Financing in the utilization of information systems
Establishment of SIARVI Delay in data entry by the person in charge Human resource capacity in operating the
information system
Sentinel hospitals already have an
integrated hospital information system
(internal)
JE Immunization
Expansion of JE campaigns and routine The immunization program cannot be Global initiatives (WHO) that include There is a risk of vaccine shortages due to
immunization to other endemic areas expanded to all regions in Indonesia due to vaccines as a JE prevention strategy and challenges in importing JE vaccines, long
has been planned by the Ministry of insufficient JE epidemiological data in each. support JE immunization in Indonesia transportation distances, and shifts in national
Health. priorities.
Campaigns and routine immunizations Dependence on import to provide JE vaccine Public acceptance that vaccines are an There are issues (hoaxes) in the community
have been carried out in Bali since 2018 effective preventive measure against disease regarding the halal status of the JE vaccine.
so that it can become a pilot area for
other regions
JE vaccine recommendation in the IDAI There is no specific policy underlying JE Local government enthusiasm in supporting There are no pharmaceutical companies in
immunization schedule in 2020 and JE immunization immunization expansion Indonesia capable of producing JE vaccines.
vaccine distribution permit by BPOM
67
S W O T
Lack of guidance on effective and proper Adequate human resources at community
vaccine distribution and storage systems in health centre to conduct campaigns and
the regions routine JE immunization
Vector and Reservoir Control
Capacity of entomologists at the center Absence of vector-reservoir surveillance and Research from various institutions or Vector and reservoir control is less of a priority for
is available vector-reservoir control universities on JE vectors and reservoirs MOA, as it does not pose a threat to livestock.
There is entomology training although Uneven availability of entomologists at the Increased cross-sector, cross-program, and JE has many vectors and reservoirs, making it
only at the center and some regions regional level, several regions do not yet government commitment to vector and difficult to control.
have active entomologists reservoir control
No cross-sectoral cooperation (such as Lack of public knowledge to keep the

Department of Animal Husbandry) exists in environment and livestock pens clean
controlling JE reservoir vectors.
Lack of knowledge of local officers and the

community about the importance of vector
and reservoir control
Commitment and Sustainable Financing at Various Government Levels

There is support from the central Limited budget allocation from APBN and One health concept for the integration of There are several health problems apart from JE
government (Ministry of Health) APBD for JE program cross-program and cross-sector involvement that have not been resolved and continue to be
for health transformation prioritized.
Designing a strategic plan for JE control No budget allocation from the local Education and mobilization of community
government participation
Support from international development
partners (WHO) and the private sector
68
S W O T
Innovation and Research
The number of studies that have been Not much research has been done on JE in Research opportunities for higher dose IVIG Treatment is symptomatic and supportive. There
conducted in several countries that can Indonesia for JE therapy is no effective antiviral against JE virus.
be used as references
There is support from B2P2V Salatiga JE is currently not a prioritized program. Research staff available Inadequate funding
laboratories that can test for JE virus
serotypes and B/BTKLPP that can
perform JE serologic testing.
There has been research on JE There are some earlier JE study findings that Training for ATLM staff
innovations conducted in several have not been implemented.
regions in Indonesia.
Engagement with universities and other

government research institutions
Ministry of Health’s policy supports

innovation and research
69
Appendix 3. Target and Supplemental Indicator
Table 8. Target and Supplemental Indicator of JE 2023—2027 National Strategy
Specific Indicator Verification Indicator Target 2023 2024 2025 2026 2027 Assumption
objective method baseline Indicator
Improving surveillance and management capabilities for JE
1.1. Number of Surveillance 11 provinces 16 12 13 14 15 16
reported AES report provinces Province Provinces Provinces Provinces Province
cases increased s (75%) (80%) (90%) (95%) s (100%) There is a
1.2. JE case Clinical 60% 80% 60% 65% 70% 75% 80% sustained
reporting survey/audit commitment
compliance from medical
rate personnel,
1.3. Number of Having 62 hospital 100 60% 65% 70% 75% 80% health staff,
hospitals with pediatrician hospital and health
adequate who have facility
Encephalitis attended JE resources.
clinical surveillance
management dissemination
capacity
1.4. Number of SIARVI reports 0 100% 60% 70% 80% 90% 100% The workload
provinces using of program
SIARVI platform management
for JE reporting staff remains
manageable.
1.5. SIARVI SIARVI reports 0 80% 40% 50% 60% 70% 80%
completion rate
1.6. Increased Certified HR Participants, 100 % 12 13 14 15 16
capacity of training community community Province Provinces Provinces Provinces Province
health workers health health s (80%) (90%) (95%) s (100%)
70
in order to center center and 75%) 100%?
update workers, hospital in
knowledge of JE Regency/Mu 16
surveillance nicipality, provinces
and JE hospitals in (JE endemic
treatment 16 provinces areas)
(JE endemic
areas)
Expanding immunization coverage
2. Expansion of Immunization 1 province Bali, West Bali, Bali, West Bali, West Bali, West Bali, Availability of
national achievement Kalimantan, West Kalimantan, Kalimantan, Kalimanta West vaccines in the
immunization report DIY, DKI, Kaliman DIY DIY, DKI n, DIY, Kaliman market and a
coverage for JE. East Nusa tan regencies/ci 31 DKI, East tan, DIY, well-
Tenggara, 23 ties regencies/ci Nusa DKI, maintained
West Nusa regencie ties Tenggara, NTT, supply chain
Tenggara, s/cities West NTB,
NTB, Riau, Nusa Riau,
North Tenggara North
Sulawesi, 63 Sulawesi
90 regencies/ 90
regencies/c cities regencie
ities s/cities
Enhancing vector and reservoir control
3.1. Number of Program report 11 Provinces 16 12 13 14 15 16 commitment

provinces in provinces provinc provinces provinces provinces provinc and active
vulnerable es (80%) (90%) (95%) es participation
areas (75%) (100%) from cross-
conducting sectors and
71
regular vector communities
and reservoir remain high
control
3.2. Community, Behavior and 0 30% - - 30% - -
cross-program, engagement
and cross- survey from
sector rate Pokjanal (the
participation inIntegrated Care
vector and and
reservoir Development
control. Post
Operational
Working)
Increasing commitment from government, cross-program, and cross-sector collaboration
4.1. Increased Budget 0,025% 0,03% 0,025% 0,025% 0,026% 0,027% 0,03% Health policy
budget document In 11 priorities have
allocation provinces In 16 remained
specifically for provinces unchanged
JE control Socio-political
within the conditions in
national health the community
budget remain
4.2. Rate of cross- Policy 0 30% - - 30% - - favorable
sectoral implementation
implementation evaluation
of policies survey
related to JE
Strengthening research and innovation capacity
72
5.1. Availability of Research - 1 1 - - - - Access to
research priority sufficient
priorities for JE document funding is
control through Delphi available
survey Communication
5.2. Increase in the Research - 2 - 2 2 2 2 between
number of report/policy researchers
studies related brief and
to JE control policymakers
remain
effective
73
Appendix 4. Aim and Implementation Target of the JE Control Program Interventions
Table 9. Aim and Implementation Target
Strategy Key Activity Objectives and Program Unit Target
Baseline 2023 2024 2025 2026 2027
Strategy 1. Strengthening the JE surveillance and laboratory network.
a. Expanding sentinel areas • supervision • Public and private 12 provinces, 60 13 Provinces, 14 Provinces, 15 provinces, 16 provinces,
and adding network • Online and offline hospitals hospitals in 70 hospitals 80 hospitals 90 hospitals 100 hospitals
hospitals surveillance model training • Central, provincial, and endemic and
municipal government priority areas
b. Improving the quality of • Surveillance training and • Public and private 2x activity/year 2x activity/year 2x 2x 2x activity/year
sentinel surveillance, standardization hospitals (including activity/year activity/year
codification, • Central government, defining national
coordination meeting
standardization, integration,
and generation of JE • Developing an integrated JE provincial government, JE surveillance
surveillance master data surveillance information and municipal baseline
system within SIARVI government indicators)
c. Strengthening early • Periodic dissemination and • Central government 1x activity/year 1x activity/year 1x 1x 1x activity/year
vigilance for JE webinar (Ministry of Health), for 12 provinces for 13 provinces activity/year activity/year for 16 provinces
• SIARVI and SKDR integration provincial government, for 14 for 15
provinces provinces
• Technical and operational and municipal
guidelines for PE during government
outbreaks • Health Office
• Training healthcare workers • Department of Animal
on clinical management Husbandry
d. Developing and • Producing and publishing • Public and private • Production of dissemination • Updating Disseminatio • Updating the
disseminating a surveillance guidebooks hospital guidebook and of guidelines the n of updates guidebook and
• Primary Health Center
manual for JE, including case • Guidebook dissemination technical and technical guidebook to the technical
management guidelines • Regional Health manual guidelines for and guidebook guidelines
(online/offline)
Laboratory 13 provinces and technical Dissemination
74
Baseline 2023 2024 2025 2026 2027
• technical assistance • B/BTKLPP at every level • Dissemination technical guidelines for of information
for 12 guidelines 15 provinces to 16
provinces • Disseminati provinces
on of
information
to 14
provinces
e. Preparing logistical needs, • meetings • Regional Health 1x online 1x coordination 1x 1x 1x coordination
facilities, and infrastructure • Evaluation of laboratory Laboratory coordination meeting and 1x coordination coordination meeting and 1x
for expanding the JE readiness • B/BTKLPP at every level meeting and 1x readiness meeting and meeting and readiness
laboratory network online meeting to evaluation 1x readiness 1x readiness evaluation
• database of implementers
evaluate meeting in 13 evaluation evaluation meeting in 16
at the
readiness in 12 provinces meeting in 14 meeting in 15 provinces
Regency/Municipality/provi
provinces provinces provinces
ncial level.
f. Establishing a systematic • meetings • Central government 1x online 1x online 1x online 1x online 1x online
flow for sample collection, • Evaluation of laboratory (Ministry of Health), coordination coordination coordination coordination coordination
delivery, serological testing, readiness provincial government, meeting and 1x meeting and 1x meeting and meeting and meeting and 1x
and reporting of results to and municipal evaluation evaluation 1x evaluation 1x evaluation evaluation
• database of implementers
hospitals and local health government meeting for 12 meeting for 13 meeting for meeting for meeting for 16
at the
departments.
Regency/Municipality/provi • Health Office provinces, 60 provinces, 70 14 provinces, 15 provinces, provinces, 100
ncial level. • Department of Animal hospitals in hospitals 80 hospitals 90 hospitals hospitals
Husbandry endemic and
• Regional Health priority areas
Laboratory
• B/BTKLPP at every level
• Community health center
75
Baseline 2023 2024 2025 2026 2027
g. Developing an Arboviruses • Capacity building • Community health center, 12 Provinces, 1x 13 Provinces, 1x 14 Provinces, 15Provinces, 16 provinces,
information system (SiARVi) Hospital, Health Office in activity/year activity/year 1x 1x
every regency and activity/year activity/year
municipality
• Information technology
companies
h. Identifying local government • meeting • Provincial government, Financial support Financial Financial Financial Financial
funding sources to support • Finalizing policies and MoU and municipal from municipal support from support from support from support from
the ability of local health government governments in municipal municipal municipal municipal
laboratories to conduct JE • Health Office 12 provinces governments in governments governments governments in
serological testing. • Department of Animal 13 provinces in 14 in 15 16 provinces
Husbandry provinces provinces
• Community health center
Strategy 2. Expanding immunization coverage
a. Expanding JE • Dissemination • Central government Bali and West Expansion: Expansion: Expansion: Expansion:
immunization coverage • Training on vaccine (Ministry of Health), Kalimantan, Jogjakarta DKI Jakarta NTT and NTB Riau and North
and introducing introduction and vaccinator provincial government, Sulawesi
immunization in JE- training. and municipal 2x activity/year 2x activity/year 2x 2x 2x activity/year
endemic areas over the • Immunization government activity/year activity/year
next 5 years • Monitoring Vaccine Adverse • Health Office Immunization 1,338,000 3,484,000 3,788,000 2,178,000
Event Reporting • Community health center target: 1,738,000 children children children children
• Reporting • Integrated Health Posts children
• Developing implementation • IDAI (Indonesian Pediatric
guidelines and technical Society)
guidelines • IDI (Indonesian Medical
Association)
b. Enhancing the role of • National Coordination • Central government 2x activity/year in 2x activity/year 2x 2x 2x activity/year
cross-sector and cross- Meetings (Ministry of Health, 2 provinces in 3 provinces activity/year activity/year in 8 provinces
program collaborations in Ministry of Home Affairs), in 4 provinces in 6 provinces
76
Baseline 2023 2024 2025 2026 2027
supporting the expansion • Regional Coordination provincial government,
of JE immunization Meetings and municipal
• Establishing Memorandum government
of Understanding (MoU) • Health Office
• IDAI and IDI
c. Improving the quality of • Dissemination and training • Central government 1x activity/year in 2x activity/year 2x 2x 2x activity/year
immunization in areas • National and regional • Regency/Municipality 2 provinces that in 3 provinces activity/year activity/year in 8 provinces
with routine JE meetings to evaluate government have conducted in 4 provinces in 6 provinces
immunization, targeting a coverage • Health Office regular
coverage rate of over 95% • IDAI and IDI immunizations
Strategy 3. Effective, safe and sustainable vector and reservoir control
a. Building cross-sector • Meetings • Central government • Establishment 1x activity/year; 1x 1x 1x activity/year;
program commitment to • Designing intersectoral MoU (Ministry of Health, Ministry of intersectoral MoU activity/year; activity/year; MoU
support vector and • Designing ministerial of Home Affairs, Ministry of MoU dissemination MoU MoU dissemination in
reservoir control regulations Agriculture), provincial • Establishment in pilot area dissemination dissemination 15 provinces
government, and municipal of joint (Bali, West in 13 in 14
government ministerial Kalimantan, provinces provinces (online)
• Health Office regulations DIY) (online)
• Department of Agriculture (online)
• Ministry of Agriculture,
Ministry of Health, Ministry
of Home Affairs
b. Managing vector and • Dissemination of SOP • Provincial government, and • Establishment Disseminating Disseminatio Disseminatio Dissemination
reservoir control efforts • Training and municipal government of integrated SOPs and n and n and and Training at
effectively Implementation • Health Office surveillance drafting Training at all Training at all all levels of
• Developing and preparing • Department of Agriculture information Technical levels of levels of government in
an integrated vector at the Regency/Municipality system Guidelines for government government 15 Provinces
information system level • Establishment Training in Pilot in 13 in 14 1x activity/year
of SOPs and Areas (Bali, Provinces Provinces
77
Baseline 2023 2024 2025 2026 2027
• Health Department and joint ministerial West 1x 1x
Agriculture Department regulation on Kalimantan, activity/year activity/year
Technical Implementation vector control Yogyakarta)
Units
• Ministry of Agriculture,
Ministry of Health, Ministry
of Home Affairs
c. Increasing participation Dissemination and counselling • Central government Draft SOP on Disseminating Disseminatio Disseminatio Dissemination
of society, institutions, (Ministry of Health,, joint control SOPs and n and n and and Training at
education, and Ministry of Home Affairs, drafting Training at all Training at all all levels of
workplaces in vector Ministry of Agriculture, Technical levels of levels of government in
control activities and JE Ministry of Education and Guidelines for government government 15 Provinces
reservoir management. Culture) Training in Pilot in 13 in 14 1x activity/year
• Provincial government, and Areas (Bali, Provinces Provinces
municipal government West
• Health Office Kalimantan,
• Department of Agriculture Yogyakarta)
• Department of Education 1x 1x
1x activity/year activity/year activity/year
d. Strengthening the • Supervision • Provincial government, and 1x activity/year in 1x activity/year 1x 1x 1x activity/year
surveillance systems for • online and offline municipal government 12 provinces in 13 provinces activity/year activity/year
in 16 provinces
vectors and reservoirs. surveillance model training • Health Office in 14 in 15
• Department of Agriculture provinces provinces
Strategy 4. Increasing the Commitment, Coordination, Consolidation, Participation, and Sustainable Financing at Various Government Levels (Central, Province, Regency/Municipality , and
Village) in JE Surveillance Activities
a. Strengthening the Meeting • Central government, 12 provinces, 1 13 provinces, 1 14 provinces, 15 provinces, 16 provinces, 1
commitment of the provincial government, coordination coordination 1 1 coordination
central government and and municipal meeting/year meeting/year coordination coordination meeting/year
regions in policy-making, government, village meeting/year meeting/year
regulations, and program
78
Baseline 2023 2024 2025 2026 2027
management, supported
by the healthcare system
b. Improving collaboration Meeting • Central government, 12 provinces, 1 13 provinces, 1 14 provinces, 15 provinces, 16 provinces, 1
and coordination between provincial government, coordination coordination 1 1 coordination
government, cross- and municipal meeting/year meeting/year coordination coordination meeting/year
program, cross-sectoral government, village, meeting/year meeting/year
stakeholders, and private sector, and NGOs
partnerships
c. Increasing financing Capacity building • Central government, 12 provinces, 1 13 provinces, 1 14 provinces, 15 provinces, 16 provinces, 1
through communication provincial government, coordination coordination 1 1 coordination
and advocacy and municipal meeting/year meeting/year coordination coordination meeting/year
government, village, meeting/year meeting/year
private sector, and NGOs
Strategy 5. Developing innovation and research that support JE countermeasure programs
a. Identifying research Operational activities • Central government Not yet available Once a year Once a year Once a year Once a year
needs, inventions, • Researchers
innovations, and studies
related to JE
b. Implementing and Operational activities • Provincial Health 1 activity in 12 1 activity in 13 1 activity in 1 activity in 1 activity in 16
strengthening JE Department, provinces inviting provinces 14 provinces 15 provinces provinces
countermeasure Regency/Municipality Regency/Municip
Health Department ality sentinel
areas
Notes: In implementing the aforementioned strategies, efforts are made to integrate multiple strategies into a single meeting activity by
combining them.
79
Appendix 5. Literature Review
1. JE Countermeasure
JE countermeasures currently rely on immunization, environmental management,
and vector control, which require active community involvement.
a. Immunization
Immunization is an effective and reliable public health intervention in JE

countermeasures (Khan et al., 2021; Kosen et al., 2022). WHO recommends that JE
immunization should be integrated into national immunization schedules in all areas
where JE is recognized as a public health priority. Even if the number of confirmed
JE cases is low, immunization should be considered where there is a suitable
environment for JE transmission, such as the presence of animal reservoirs,
ecological conditions supportive of virus transmission, and proximity to other
countries or regions with known high rates of JE virus transmission. JE immunization
does not include herd immunity. Thus, achieving high vaccination coverage in
populations at risk of the disease is important. It will allow JE in humans to be
eliminated despite ongoing virus circulation in the animal cycle (“Japanese
Encephalitis Vaccines,” n.d.). The most effective immunization strategy in JE
endemic areas is through a one-time campaign in the primary target populations,
followed by introducing JE vaccine into routine immunization programs. This
approach has a greater public health impact as the campaign rapidly reduces disease
incidence in a broader age group than the susceptible age group (Kosen et al., 2022).
Globally, three types of vaccines have received WHO prequalification as stated

below (“Japanese Encephalitis Vaccines,” n.d.):
1. Inactivated Vero cell-derived vaccines ( JEEV®): consist of two doses
administered intramuscularly four weeks apart for >6 months of age or older.
The dose for those aged <3 years in 0.25 ml, and 0.5 ml for those aged ≥ 3 years.
80
2. Live attenuated vaccine (CD.JEVAX®): consists of 1 dose (0.5 ml) administered
subcutaneously from 8 months of age or older.
3. Live recombinant vaccines (IMOJEV®) : consists of 1 dose administered

subcutaneously at 9 months of age or older. A booster dose is recommended
12-24 months later for those <18 years of age.
The campaign and introduction of JE immunization is being implemented in

Indonesia following the Decree of the Minister of Health of the Republic of Indonesia
No: 01.07/Menkes/117/2017. In March 2018, the JE immunization campaign was
launched in Bali province, targeting children aged 9 months to under 15 years.
(“Kemenkes Canangkan Imunisasi Cegah Radang Otak Japanese Enchepalitis (JE) –
P2P Kemenkes RI,” 2018). The JE vaccine is administered through a subcutaneous
injection in single dose (0.5 ml). Two types of JE vaccine packaging are available:
single-dose vials containing 0.5 ml of vaccine and multi-dose vials with 4 doses of
0.5 ml each (Kementerian Kesehatan Republik Indonesia, 2017). WHO recommends
administering a single dose JE vaccine in endemic areas. Currently, JE immunization
has been integrated into the routine immunization program recommended by the
Indonesian Pediatric Association (IDAI) for endemic areas and for individuals who
will travel to endemic areas. (“IDAI | Jadwal Imunisasi IDAI 2020,” n.d.).
b. Environmental management
Keeping residential and livestock environments clean is an important JE
countermeasure. Residential neighborhoods should be free of breeding and resting
habitats for JE-transmitting mosquitoes. Cleanliness of waterways such as gutters
and sewers must be maintained so that they flow smoothly. Air circulation in the
house should be adequately maintained by opening windows during the day and
ensuring adequate lighting at night. It is recommended to avoid hanging clothes or
fabrics inside the house. In addition, the farm environment should be cleaned daily,
especially the stable area, which should be free from mosquito breeding habitats.
81
Animal pens should not be damp and dark, and puddles should be cleaned regularly
(Kementerian Kesehatan Republik Indonesia, 2017).
c. Vector control
JE vector control is carried out by considering the type of vector, breeding habitat,
biting preference, resting behavior, and vector resistance status to insecticides.
Vector Type
There are several genera of Culex, Anopheles and Armigares in Indonesia that act as
vectors of Japanese encephalitis (“Ringkasan Singkat Hasil Rikhus Vektora 2016,”
n.d.) (See Table 10)
Table 10. Vector types and distribution of JE vectors in Indonesia

Vector Sumatra Kalimantan Java Nusa Sulawesi Maluku Papua
Tenggara
Cx. Ö Ö Ö Ö Ö Ö
tritaeniorhynchus
Cx. gelidus Ö Ö Ö Ö Ö Ö Ö
Cx. vishnui Ö Ö Ö Ö Ö Ö Ö
Cx. quinquefasciatus Ö Ö Ö Ö Ö Ö Ö
Cx.fuscocephala Ö Ö Ö Ö Ö
Cx.bitaeniorhynchus Ö Ö Ö Ö Ö Ö Ö
Cx sitiens Ö Ö Ö Ö Ö
Cx infula Ö Ö Ö
An. vagus Ö Ö Ö Ö Ö Ö
An. annularis Ö Ö Ö Ö
An. kochi Ö Ö Ö Ö Ö Ö
Ar. subalbatus Ö Ö Ö Ö Ö Ö Ö
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Breeding habitat
In general, Culex larvae were found to live well in various types of water, both indoor
and outdoor, both clean water and water contaminated by household waste (See
Table 11)
Table 11. JE Vector Habitats

Vector Habitat
Cx.bitaeniorhynchus Pond, puddle with filamentous green algae
Cx. quinquefasciatus Clear or muddy water, contaminated water, freshwater, brackish water
(can survive in any habitat)
Cx. Tritaeniorhynchus, Cx. Gelidus, Rice fields, home gardens, shallow swamps, ponds, wells, ditches, and
Cx. vishnui clean or murky stagnant water devoid of grass, rice paddies, or other
aquatic vegetation
Cx sitiens Various habitat types in brackish water
An. vagus Puddles, ponds, containers, rice fields, ditches, footprint, car tire tracks
An. annularis Fish ponds, rice fields, streams from mountain springs
An. kochi Rice fields, footprints, buffalo pits, runnels
Ar. subalbatus Organic-rich water reservoirs, such as tree holes, rock holes, bamboo
strips, pandanus leaf axils, sago plants, pineapples, fallen leaves, etc
JE Vectors Biting Preference

Each JE vectors exhibit distinct biting preferences, such as zoophilic, anthropophilic,
zooanthropophilic, endophagic and exophagic (See Table 12). Some vectors prefer
to feed on animal blood (zoophilic), human blood (anthropophilic), or both
(zooanthropophilic). Furthermore, regarding the timing and location of mosquito
hunting, there are instances where mosquitoes exhibit a preference for biting
indoors (endophagic) or outdoors (exophagic).
Table 12. JE vectors biting preference

Vector Biting preference
Cx. Tritaeniorhynchus, Cx. Gelidus, Cx. Vishnui, >Zoophilic, exophagic
Cx.fuscocephala, An. Annularis, An. vagus

Cx.bitaeniorhynchus, Cx. Infula > zooanthropophilic, endophagic, and exophagic
Cx. Quinquefasciatus, armigares subalbatus > anthropophilic endophagic, and exophagic
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Vector Biting preference
An. vagus >Zoophulic, around 09.00-11.00 PM
An. annularis Zoophilic (many in cattle, buffalo pens), before
midnight
An. kochi Zoophilic, before 09.00 PM
Ar. subalbatus Anthropophilic, endophilic, night
Types of vector control

Vector control is mainly focused on breaking the vector life chain that can reduce or
suppress vector populations at a level that does not endanger public health
(Ekawasti and Martindah, 2017; Kementerian Kesehatan Republik Indonesia, 2017;
Nurzaeni et al., 2021).
Non-chemical control
- Eradicating Culex mosquito breeding sites such as managing water channels/
pots to prevent stagnation in residential areas and locations where pigs or
other large animals are reared; simultaneously cultivating rice to limit
mosquitoes’ density in rice fields; periodic drying of rice fields.
- Using mosquito nets to prevent contact between mosquitoes and humans.
- Using Ovitrap, a trap for mosquito egg that can be placed in residential and
farm area
- Using live organisms, such as sowing fish, and Bacillus thurigiensis, to control
larvae
- Setting barriers such as wire mesh to prevent mosquitoes from entering the
house
- Implementing mina padi (rice-fish system) and cattle barriers in rice fields
Chemical control
- Fogging in residential and farm areas
- Using insecticides such as larvicides, insecticide-treated bed nets, mosquito
repellents, and repellents in areas with high mosquito density.
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2. Diagnosis and Treatment
a. Diagnosis
Globally, WHO has included several descriptions of JE diagnosis and treatment in the
2018 JE surveillance standard book (World Health Organization, 2018). It also has
been discussed by the Centers for Disease Control and Prevention (CDC)
(“Symptoms & Treatment | Japanese Encephalitis | CDC,” 2019). However, there
are no specific guidelines on diagnosing and treating JE globally until 2022. In 2017,
the Ministry of Health in Indonesia released a guidebook on JE Prevention and
Control that explains the diagnosis and treatment of JE (Kementerian Kesehatan
Republik Indonesia, 2017)
Clinical manifestations of JE disease in humans vary, ranging from mild symptoms

like a common cold to severe symptoms and even death. The incubation period
averages 6 to 8 days but ,generally, ranges from 4 to 15 days. In the prodromal stage,
nonspecific symptoms such as malaise, anorexia, headache, fever, cough, runny
nose, nausea and vomiting can be found for 2-3 days. Symptoms then progress to
encephalitis, such as high fever, neck stiffness, signs of increased intracranial
pressure, and decreased consciousness to apathy. As the disease progresses,
patients may experience dystonia, choreoathetoid movements resembling the
extrapyramidal symptoms of Parkinson's disease. In severe cases, it can result in
sequelae, including paralysis, mental retardation, and decreased intelligence,
affecting approximately 40-75% of cases (Simon et al., 2022).
Hematological examination reveals anemia, mild leukocytosis with a leftward shift,

mild thrombocytopenia, and an elevated ESR. In cases where patients display
symptoms suggestive of encephalitis, further diagnostic tests such as neuroimaging
and lumbar puncture may be conducted. Magnetic resonance imaging (MRI) or
computed tomography scans (CT scans) of the head may show lesions in the bilateral
thalamus, basal ganglia, cerebellum, pons, and cortex. However, it is not specific to
85
JE. Analysis of cerebrospinal fluid (CSF) typically shows a clear, colorless, cell count
0-0. <100, mononuclear cell domination, elevated protein levels, normal glucose
levels, and positive Nonne and Pandy tests (Simon et al., 2022).
Individuals with clinical symptoms of encephalitis and residing in or recently

traveling to a JE-endemic area are considered suspect cases for JE. Laboratory tests
are necessary to confirm JE virus infection and rule out other causes of encephalitis
(World Health Organization, 2019). Flaviviruses circulating simultaneously in the
blood, such as dengue, West Nile virus, and post-vaccination JE and yellow fever,
can lead to cross-reactions with JE virus antibodies. Therefore, serologic tests with
high sensitivity and specificity are required to accurately detect JE. The standard
diagnostic test for JE is IgM capture by ELISA from serum or cerebrospinal fluid. Field
diagnosis can be done by IgM dot enzyme immunoassay for cerebrospinal fluid and
serum. Compared to ELISA this method has a sensitivity of 98.3% and specificity of
99.2% (Kementerian Kesehatan Republik Indonesia, 2017). Testing CSS samples is
preferred to minimize false positive rate from previous infections or vaccinations. JE
virus IgM antibodies are typically detectable within 3 to 8 days after disease onset
and persist for 30 to 90 days, although longer persistence has been observed. It is
important to note that positive IgM antibodies can sometimes indicate past
infections or vaccinations (World Health Organization, 2019). Other confirmatory
tests for JE include virus isolation and Reverse Transcription PCR amplification (RT-
PCR) to detect JE virus RNA.
b. Treatment
To date, there is no specific treatment available for JE. The treatment of JE primarily
focuses on symptomatic and supportive care, i.e. monitoring vital signs, managing
seizures, lowering intracranial pressure, and maintaining brain metabolic function.
If there are signs of shock (such as weak and rapid pulse or not palpable, drop in
blood pressure, cold acral, slow capillary refill time (≥3seconds), immediate
86
treatment is necessary with intravenous fluid administration of lactated Ringer's
solution or NaCl 0.9%. Children experiencing initial seizures are provided with anti-
seizure medications per the guidelines for managing acute seizures and status
epilepticus. Lowering intracranial pressure can be achieved by administering 20%
mannitol at a dose of 0.5-1 g / kgb IV in 30 minutes, which can be repeated every 4-
6 hours. Consciousness status should also be monitored during mannitol
administration. Maintaining brain metabolic function is done by giving fluids
containing 10% glucose so blood sugar levels become normal, typically ranging from
100-150 mg/dl. As a home remedy, 5% glucose fluid in 0.45% NaCl can be given.
Antibiotics are prescribed if secondary infections, such as pneumonia, urinary tract
infections, and decubitus, are present (Lopez et al., 2021). Currently, there are no
effective antivirals against the JE virus. In severe conditions, patients should be
admitted to the intensive care unit (Kementerian Kesehatan Republik Indonesia,
2017). There is no available data on the case of CFR in Indonesia, while Australia
reported CFR data of 30% and Singapore approximately 25% (“Japanese Encephalitis
- Australia,” 2022; Koh et al., 2006).
3. JE Surveillance and Response System
In general, JE surveillance includes both case surveillance and vector surveillance. JE

case surveillance begins with identifying AES patients who are then serologically
confirmed. Case-based surveillance is gradually starting to be carried out in sentinel
hospitals with an integrated surveillance system for diseases in hospitals (STP RS).
An outbreak of JE is identified if there is a least one case that has not been previously
reported in an area, a death caused by JE, or a two-fold increase in cases compared
to the previous period. Vector surveillance is conducted to identify vector breeding
habitats, vector species, vector density, blood-sucking behavior, and vector
susceptibility. Methods used for vector surveillance include capturing larvae and
adult mosquitoes, testing vector susceptibility to insecticides, and confirming
87
vectors through PCR techniques. However, vector surveillance has not yet been
implemented in Indonesia.
The JE surveillance implemented in Indonesia utilizes a laboratory-based case

surveillance system to diagnose JE and determine the etiology. The surveillance
process follows this: Sentinel hospitals collect serum and cerebrospinal fluid
samples from suspected JE patients, which are then sent to the local B/BTKLPP in
their respective areas. The samples are examined using the JE IgM capture ELISA
method. In the case of positive results for serum samples, further confirmation is
conducted using the Dengue ELISA method to exclude cross-reactivity. Serum
samples that test positive for dengue are recorded as JE negative but dengue
positive. All JE-positive results, equivocal results, and 10% of JE-negative results are
sent to the BKPK Ministry of Health for confirmation testing. In instances where a
local B/BTKLPP is unable to perform the JE IgM capture ELISA test, the samples are
sent to the BKPK Ministry of Health for analysis.
The following are some obstacles the JE case surveillance system must address. The
JE surveillance system was suspended due to Covid 19 response activities.
1. There are constraints in identifying JE cases within hospitals. Efforts are

required to strengthen the dissemination of JE surveillance among
network hospitals and expand the sentinel hospital.
2. The role of primary healthcare facilities in detecting cases with encephalitis
symptoms in their working areas and referring them to hospitals.
3. JE laboratory testing reagents are not frequently available.
4. Strengthening the network of JE testing laboratories by involving B/BTKLPP
and provincial health laboratories.
5. Development of JE Surveillance in other provinces in Indonesia.
6. No performance indicators and targets for JE surveillance in Indonesia.
88
As of 2023, the established JE laboratory network consists of seven B/BTKLPP
(B/BTKLPP Jakarta, DI Yogyakarta, Surabaya, Manado, Medan, Batam, and Banjar
Baru) and one national laboratory network (BKPK) responsible for conducting JE
surveillance laboratory tests throughout Indonesia.
4. Policy and Program Management

a. JE Countermeasure Policy
Several regulations and guidelines which have been issued include the RPJMN 2020-
2024, which emphasizes strategies for addressing emerging diseases, potential
outbreak-causing diseases (including JE), and strengthening real-time surveillance.
Regulation of the Minister of Health Number 21 of 2020 concerning the Ministry of
Health's Strategic Plan as outlined in the 2020-2024 RAP of the Directorate General
of P2P in the context of implementing the prevention and control of zoonotic vector-
borne diseases. Additionally, Regulation of the Minister of Health of the Republic of
Indonesia Number 45 of 2014 addresses the implementation of health surveillance,
while Regulation of the Minister of Health of the Republic of Indonesia Number 82
of 2014 pertains to communicable disease management. Guidelines for the
Prevention and Control of Japanese Encephalitis have also been established.
Furthermore, the Ministry of Health of the Republic of Indonesia's Decree No:
01.07/Menkes/117/2017 outlines the implementation of the Japanese Encephalitis
Immunization Campaign and Introduction in Bali Province.
The JE response strategy extends beyond the health sector and requires cross-
sectoral support. One of the ministries that participates in JE prevention is the
Ministry of Home Affairs, specifically through the Directorate General of Regional
Development, conducts synchronization and harmonization involving cross-
ministries and institutions to ensure that JE is integrated into regional development
plans and financial planning documents. The role of the Ministry of Home Affairs in
this regard is outlined in the regulation of Ministry of Home Affairs No: 90/2019 and
89
the decree of Ministry of Home Affairs No: 90/2019: 90/2019 and the decree of
Ministry of Home Affairs No: 050-5889 in 2021 which provide guidance to local
governments in preparing budget planning documents (RKPD/APBD) at the
provincial and district levels, incorporating appropriate nomenclature for JE
countermeasures. The nomenclature of government affairs in the health sector (02)
includes programs to fulfill individual and public health efforts (02. 02), management
of health services for infectious and non-communicable diseases (02.02.1.02.11)
and the distribution of medical devices, drugs, vaccines, food and beverages and
other health facilities (02.02.1.01.21).
The Ministry of Agriculture, through the Decree of the Minister of Agriculture No:
237/Kpts/PK400/M/3/2019 regulates 15 priority zoonoses in Indonesia that require
effective control measures. Japanese encephalitis is recognized as the sixth priority
zoonosis among these 15 diseases. However, the Ministry of Agriculture has not
allocated a specific budget for the control of Japanese encephalitis.
Managing JE involves vector control, the implementation of an early alert system for
JE outbreak detection, outbreak management, environmental prevention,
vaccination as a preventive measure, health promotion, and community
empowerment. A national strategy is required to provide direction and sustainable
program development through cross-sector cooperation with a one health approach
in order to meet JE prevention targets in Indonesia.
b. JE Countermeasure Program Management and Challenges
The development and management of the national JE program is one of the

programs coordinated by the Arboviruses Working Team of the Directorate of P2PM
of the Indonesian Ministry of Health. The Japanese Encephalitis Prevention and
Control Guidelines were published in 2017 to provide guidelines for health workers
90
and the community in efforts to control JE disease in Indonesia. The immunization
campaign has been carried out in Bali, with the primary health center (Puskesmas)
playing a crucial role as the implementer. At the Puskesmas level, suspected AES
cases are promptly referred to the hospital for further evaluation and treatment.
The JE surveillance program is currently limited to sentinel hospitals in endemic
areas. As a result, the reporting of JE cases is still under-reported.
The Japanese encephalitis (JE) control program is currently not receiving sufficient
prioritization in all provinces of Indonesia, resulting in challenges in implementing
effective JE case surveillance and limited funding allocation. The availability of
functional entemologists for vector control and field surveys at provincial and
district offices is limited. In addition, vector surveillance and reservoir control
programs are not yet a priority. Although Japanese encephalitis is included in the 15
priority zoonoses that need control in Indonesia, there is no allocated budget
specifically dedicated to JE control. Successful implementation of JE control policies
requires cross-sectoral support, coordination, involvement, and commitment.
JE surveillance currently encompasses 11 provinces, with a total of 60 sentinel

hospitals, including: 6 provinces with 1 sentinel hospital, 2 provinces with 2 sentinel
hospitals, 2 provinces with 13 sentinel hospitals, and 1 province with 24 sentinel
hospitals (see appendix 6). Given Indonesia’s diverse geographical conditions, there
are challenges in sending samples from sentinel hospitals located in the islands with
limited access and accommodation. Moreover, the limited number of sentinels in
some provinces hinders optimal case finding, particularly due to the tiered referral
system from health insurance since 2018. In addition, obstacles to case finding are
also influenced by access to healthcare services in remote areas of certain provinces,
as well as socio-cultural factors that may deter seizure patients from seeking
hospital care.
91
The Covid-19 pandemic has further hindered the implementation of JE surveillance.
JE surveillance program was suspended during the pandemic due to the relocation
of resources and funds to focus on tackling Covid-19. Furthermore, the supply of JE
vaccine in Bali Province faced disruptions during the pandemic, as it is an area that
routinely conducts JE vaccination under the Ministry of Health's program.
5. Innovation Research and Information Systems
JE is an endemic disease that occurs in many Asian countries, and the availability of
diagnostic facilities for its detection is limited. In a study conducted in Vietnam, a JE
diagnosis method was developed using the IgM Dot Enzyme Immunoassay (MAC
DOT) technique which is easy and fast to perform. The technique has the following
sensitivity and specificity: serum samples have a sensitivity of 83% and specificity of
99%; cerebrospinal fluid samples have a sensitivity of 91% and specificity of 95%;
combined serum and cerebrospinal fluid samples have a sensitivity of 98.3% and
specificity of 99.2% (Solomon et al., 1998). Early in onset, cerebrospinal fluid
samples have a higher positive rate than serum samples until day 13 of onset.
Examination of cerebrospinal fluid samples is effective on days 1-8, whereas serum
IgM may not be detected until day 9 or later (Chanama et al., 2005). To date, JE
serologic testing in Indonesia has been conducted using the MAC DOT method for
cerebrospinal fluid and serum. A study in Laos from 2014-2017 conducted JE
detection through throat swabs. Although 11 patients showed positive MAC DOT
results, RT-qPCR examination with cerebrospinal fluid and serum samples yielded
negative results. However, JE RNA was detected in two out of 11 patients through
the examination of throat swab samples, providing a non-invasive alternative that
does not require specialized facilities and can be helpful to the facilities for
performing lumbar puncture are limited (Bharucha et al., 2018). A case report of JE
in China demonstrated the use of metagenomic next-generation sequencing
(mNGS) to examine cerebrospinal fluid samples with results suggestive of JE virus
92
infection. The result was confirmed by a positive JE IgM result two days later. The
mNGS examination can be an effective and rapid method for JE identification (Li et
al., 2022).
A systematic review of JE mortality and morbidity was conducted in 2021 and

published in 2022 (Cheng et al., 2022). The results of the case fatality rate (CFR) of
JE in general are as follows: 26% in 1961-1979, 20% in 1980-1999, 14% in 2000-
2018, and 14% in 2019-2030. JE CFR in Indonesia after 2018 is expected to be below
10%. Several factors contribute to this decline in CFR, including strengthened
surveillance systems, expanded immunization coverage, older age of infection,
more advanced confirmation methods, and improved healthcare system quality.
There was an increase in countries that implement routine JE surveillance and
testing from 21% (5/24) in 2012 to 92% (22/24) in 2016. In this systematic review,
morbidity was assessed by indicators of recovery at hospital discharge and routine
examination conducted six months later. At hospital discharge, approximately 59%
of patients had neurologic sequelae. Among pediatric patients, 44% made a full
recovery, compared to 23% of adults who made a full recovery at the time of
discharge. Moreover, during the six-month follow-up, it was estimated that 3-75%
of patients could not live independently (Cheng et al., 2022).
93
Appendix 6. History of JE Surveillance in Indonesia
Table 13. History of JE Surveillance and Sentinel Hospital in Indonesia
Year Province Hospital
2001-2003 Bali (community-based)
2014 -2017 4 provinces (Bali, North Sulawesi, West 4 hospitals (Sanglah General Hospital Bali, Kandow General Hospital North Sulawesi, Soedarso
Kalimantan, and East Nusa Tenggara) General Hospital Pontianak, Johanes General Hospital East Nusa Tenggara)
2018 11 provinces (Bali, North Sulawesi, West 11 hospitals (Sanglah General Hospital Bali, Kandow General Hospital North Sulawesi, Soedarso
Kalimantan, East Nusa Tenggara, Riau, General Hospital Pontianak, Johanes General Hospital East Nusa Tenggara, Embung Fatimah General
North Sumatra, West Nusa Tenggara, DKI Hospital Riau, Pirngadi General Hospital Medan, Mataram General Hospital West Nusa Tenggara,
Jakarta, DI Yogyakarta, West Java, Central Cipto Mangunkusumo General Hospital Jakarta, Sardjito General Hospital Yogyakarta, Hasan Sadikin
Java) General Hospital Bandung, Kariadi General Hospital Semarang)
2019 11 provinces 58 hospitals
2020- 2022 11 provinces 60 hospitals
• Bali: Prof. dr. I.G.N.G Ngoerah general hospital, Negara hospital, Bunda Negara hospital,
hospital Buleleng, Kertha Usada hospital Buleleng, Karya Dharma Husada Hospital Buleleng,
Balimed Hospital Buleleng, Tabanan Hospital, Wisma Prasanti Hospital Tabanan, Surya
94
Husada Hospital Nusa Dua, Kasih Ibu Hospital, Kedonganan Hospital Badung, Siloam Hospital
Badung, Sanjiwani Hospital Gianyar, Ari Canti Hospital Gianyar, Ganesha Hospital Gianyar,
Bangli Hospital, BMC Hospital Bangli, Klungkung Hospital, Permata Hati Hospital Klungkung,
Karangasem Hospital, BaliMed Hospital Karangasem, Wangaya Hospital, Puri Bunda
Maternity Hospital Denpasar, Bali Royal Hospital Denpasar
• North Sulawesi: Kandow General Hospital
• West Kalimantan: Soedarso Hospital, Sultan Syaarif Mohamad Alkadri Hospital, St. Antonius
Hospital, dr. Abdul Azis Hospital, St. Vincentius Hospital, dr. Rubini Hospital, Bengkayang
Hospital, Landak Hospital, Sambas Hospital, Mth Djaman Hospital, Ade Mohammad Djoen
Hospital, dr. Agoesdjam Hospital, dr. Achmad Diponegoro Hospital
• East Nusa tenggara: Prof. Dr. W.Z Johannes Hospital, Ende Hospital
• Riau islands: Embung Fatimah Hospital Batam
• North Sumatera: Pirngadi Hospital Medan
• West Nusa Tenggara: Mataram Hospital
• DKI Jakarta: Cipto Mangunkusumo Hospital
• DI Yogyakarta: DR. Sardjito General Hospital, Prambanan Hospital, Nyi Ageng Serang
Hospital, Panembahan Senopati Hospital, Yogyakarta Hospital, Wonosari Hospital, Wates
Hospital, Sleman Hospital, Panti Rapih Hospital, Bethesda Hospital, PKU Muhamadyah
Hospital, UGM academic hospital, JIH Hospital
• West Java:Hasan Sadikin General Hospital
• Central Java: Kariadi General Hospital, and Wongsonegoro Hospital
95
Appendix 7. WHO-based Surveillance Performance Indicators for JE
Table 14. Performance indicators based on WHO
Supervision Indicator Target Calculation Method (numerator/denominator) Comment

attributes
Completeness of Percentage of surveillance units ≥ 80% # surveillance units in the reporting country / # None
reporting reported to the national level, even in surveillance units in the country x 100
the absence of cases
Timeliness of Percentage of surveillance units ≥ 80% # surveillance units in the country reported by At each level, reports
reporting reported to the national level on time, deadline / # surveillance units in country x 100 must be submitted on or
even in the absence of a case (e.g. before the requested
monthly) at least quarterly reporting. date.
Specimen collection Percentage of all suspected cases for ≥ 90% # AES cases with specimens collected/ # of AES None
which at least one specimen was cases x 100
collected
Percentage of suspected AES cases for ≥ 90% # suspected AES cases with lumbar puncture/ # None
which a lumbar puncture is performed of suspected AES cases x 100
Percentage of serum samples taken at ≥ 80% # serum samples obtained at least 10 days after This applies to where
least 10 days after onset onset of illness / samples received at the the testing methodology
laboratory x 100 is the IGM Capture ELISA
Specimen adequacy Percentage of CSF and serum samples ≥ 80% # CSF and serum samples that reached the Adequately defined
that reach the laboratory in adequate laboratory in the adequate condition / all CSF
condition
96
and serum samples received at the laboratory x
100
Timeliness of Percentage of laboratory results ≥ 80% # laboratory test results reported <1 month The indicator only
reporting reported to national public health from specimen receipt/# specimens received by applies to public
laboratory results authorities 7 days after receiving the lab x 100 laboratories.
specimens
Sensitivity Minimum AES rate per 100,000 > # AES cases detected by surveillance / # of It applies to national
population 2/100,000 target population in the country x 100,000 and sentinel level
surveillance
97
MINISTRY OF HEALTH,
REPUBLIC OF INDONESIA
98

National Strategy JE 2023-2027

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National Strategy JE 2023-2027

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Jakarta, 19 June 2023

Dr. dr. Maxi Rein Rondonuwu, DHSM, MARS

This National Strategies document consists of six chapters, namely Introduction;

The process of developing the National Strategies to Countermeasure JE involves

Jakarta, 19 June 2023

dr. Imran Pambudi, MPHM

Illustrator & Designer

occurrence meaningful morbidity and/or mortality in an area within a

certain period of time, and is a situation that can lead to

Regional : Governor, regent or mayor, and regional apparatus as

Government elements of regional government

Central : The President of the Republic of Indonesia who holds the

Government governmental power as referred to in the 1945

Constitution of the Republic of Indonesia.

Countermeasures : Actions that prioritize promotive and preventive aspects

aimed at reducing and eliminating morbidity and

mortality, as well as limiting a disease transmission and

spread to prevent cross-regions and cross-countries

escalation which potentially lead to extraordinary

Epidemiologic : A series of activities held to identify the cause and

Investigation characteristics, source, mode of transmission, and factors

that affect the onset of a disease or other health problem,

occurrence or its aftermath/outbreak.

PSN : Efforts to control JE vector made by the community

through draining, covering, and recycling.

Table 1. Key Indicator Target ........................................................................ 20

Photo source 1. Center for Tropical medicine, Universitas Gadjah Mada

Indicators and Targets:

Indicator Main Means of Baseline Target

1.1 Global Commitment to Countermeasure Japanese

Japanese Encephalitis (JE) virus is the most common cause of viral

Japanese Encephalitis can develop into extraordinary occurrence

Figure 1. Countries or Endemic Regions of JE in Asia Pacific

WHO makes a number of commitments to accelerate JE control as stated in the

2. To eliminate and control diseases that can be prevented by vaccination.

3. To increase access to vaccination for all at-risk populations with

new and existing vaccines.

Japanese Encephalitis is one of the major vector-borne diseases in humans

Controlling JE requires collaborative efforts from multiple sectors, primarily human,

3. Control and eradicate endemic zoonotic diseases, neglected tropical

4. Strengthen food safety risk assessment and management.

5. Overcoming antimicrobial resistance.

6. Integrating the environment into One Health.

1.2 National Commitment to Countermeasure Japanese Encephalitis

Japanese Encephalitis is a zoonotic disease which the virus is transmitted through

The 2020-2024 National Medium-Term Development Plan (hereinafter referred to

Japanese Encephalitis is one of many diseases that is preventable through

1.3 The Process of Developing National Strategies

The National JE Countermeasure Strategies 2023—2027 were developed by a team

Preparatory meetings, consensus, and discussions involved various programs and

Figure 2. The Process of Developing the JE National Strategies of 2023—2027

The situation analysis aims to describe the current situation of JE

2.1.1 JE Cases in Indonesia

Japanese Encephalitis is a health issue in Indonesia as it is one of the

Based on the sentinel surveillance system in 11 provinces in Indonesia in 2014-2021,

2.2.2 Case Management

The key to successful JE management is the prevention of JE disease. Although the

Evaluation of the factors contributing to the causes of death from JE needs to be

2.2.3 The society

2.2.4 JE Surveillance System

Figure 3. The procedure of the JE surveillance system in Indonesia

2.2.5 Policy and Program Management

2.2.6 Innovation Research and Information Systems