---
title: "Knowledge, Attitudes, and Behaviour toward Japanese Encephalitis Vaccination: A Systematic Review"
id: "pubmed-42556299"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42556299"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42556299/"
doi: "10.1016/j.vaccine.2026.128999"
published_at: "2026-08-30T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Knowledge, Attitudes, and Behaviour toward Japanese Encephalitis Vaccination: A Systematic Review
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42556299
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42556299/)
- **DOI:** [10.1016/j.vaccine.2026.128999](https://doi.org/10.1016%2Fj.vaccine.2026.128999)
- **Published At:** 2026-08-30T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This systematic review examined primary studies on knowledge, attitudes, and behaviours (KABs) regarding **Japanese encephalitis (JE) vaccination** to inform program delivery, policy and practice. - Searches covered seven bibliometric databases, grey literature, and reference lists; outputs were independently screened and data were synthesised descriptively. - Twenty-six studies met inclusion; most were conducted in JE-endemic countries and included travellers, caregivers, non-traveller adults, and vaccine providers/advocates. - Adult recipients generally had low **knowledge** and awareness of the **JE vaccine**, while caregivers showed higher awareness. - Attitudes to JE vaccination were mostly positive across study populations. - Reported influences on vaccination behaviour included health workers and community leaders, perceived risk, cost, time constraints, migration, and vaccine availability and accessibility. - The review found limited KABs research using rigorous, consistent methods, highlighting methodological gaps and uneven coverage across populations. - Authors conclude that barriers to uptake exist and that empowering **health professionals** and vaccine advocates is central to increasing JE vaccine coverage in diverse populations. - The review underscores the need for more consistent, rigorous KABs studies to guide JE vaccine program design and implementation.
## Clinical Analysis & Structured Key Points
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Epub 2026 Aug 5. # A systematic review of knowledge, attitudes, and behaviour towards Japanese encephalitis vaccination [Rebika Nepali](https://pubmed.ncbi.nlm.nih.gov/?term=Nepali+R&cauthor_id=42556299)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#full-view-affiliation-1 "Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia. Electronic address: rnep6306@uni.sydney.edu.au."), [Catherine King](https://pubmed.ncbi.nlm.nih.gov/?term=King+C&cauthor_id=42556299)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#full-view-affiliation-2 "Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia."), [Julie Leask](https://pubmed.ncbi.nlm.nih.gov/?term=Leask+J&cauthor_id=42556299)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#full-view-affiliation-2 "Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia."), [Emma Campbell](https://pubmed.ncbi.nlm.nih.gov/?term=Campbell+E&cauthor_id=42556299)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#full-view-affiliation-3 "Sydney School of Public Health, The University of Sydney, Australia."), [Cameron E Webb](https://pubmed.ncbi.nlm.nih.gov/?term=Webb+CE&cauthor_id=42556299)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#full-view-affiliation-4 "School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Medical Entomology, NSW Health Pathology, Australia."), [Majdi M Sabahelzain](https://pubmed.ncbi.nlm.nih.gov/?term=Sabahelzain+MM&cauthor_id=42556299)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#full-view-affiliation-3 "Sydney School of Public Health, The University of Sydney, Australia."), [Adeline Tinessia](https://pubmed.ncbi.nlm.nih.gov/?term=Tinessia+A&cauthor_id=42556299)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#full-view-affiliation-3 "Sydney School of Public Health, The University of Sydney, Australia."), [Victoria J Brookes](https://pubmed.ncbi.nlm.nih.gov/?term=Brookes+VJ&cauthor_id=42556299)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#full-view-affiliation-5 "Sydney Infectious Disease Institute, The University of Sydney, Australia; Sydney School of Veterinary Science, The University of Sydney, Australia."), [Kerrie Wiley](https://pubmed.ncbi.nlm.nih.gov/?term=Wiley+K&cauthor_id=42556299)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#full-view-affiliation-2 "Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia.") Affiliations Expand ### Affiliations * 1 Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia. Electronic address: rnep6306@uni.sydney.edu.au. * 2 Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia. * 3 Sydney School of Public Health, The University of Sydney, Australia. * 4 School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Medical Entomology, NSW Health Pathology, Australia. * 5 Sydney Infectious Disease Institute, The University of Sydney, Australia; Sydney School of Veterinary Science, The University of Sydney, Australia. * PMID: **42556299** * DOI: [ 10.1016/j.vaccine.2026.128999 ](https://doi.org/10.1016/j.vaccine.2026.128999) Free article Item in Clipboard # A systematic review of knowledge, attitudes, and behaviour towards Japanese encephalitis vaccination Rebika Nepali et al. Vaccine. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Vaccine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Vaccine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Vaccine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42556299/) . 2026 Aug 30:89:128999. doi: 10.1016/j.vaccine.2026.128999. Epub 2026 Aug 5. ### Authors [Rebika Nepali](https://pubmed.ncbi.nlm.nih.gov/?term=Nepali+R&cauthor_id=42556299)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#short-view-affiliation-1 "Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia. Electronic address: rnep6306@uni.sydney.edu.au."), [Catherine King](https://pubmed.ncbi.nlm.nih.gov/?term=King+C&cauthor_id=42556299)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#short-view-affiliation-2 "Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia."), [Julie Leask](https://pubmed.ncbi.nlm.nih.gov/?term=Leask+J&cauthor_id=42556299)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#short-view-affiliation-2 "Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia."), [Emma Campbell](https://pubmed.ncbi.nlm.nih.gov/?term=Campbell+E&cauthor_id=42556299)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#short-view-affiliation-3 "Sydney School of Public Health, The University of Sydney, Australia."), [Cameron E Webb](https://pubmed.ncbi.nlm.nih.gov/?term=Webb+CE&cauthor_id=42556299)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#short-view-affiliation-4 "School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Medical Entomology, NSW Health Pathology, Australia."), [Majdi M Sabahelzain](https://pubmed.ncbi.nlm.nih.gov/?term=Sabahelzain+MM&cauthor_id=42556299)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#short-view-affiliation-3 "Sydney School of Public Health, The University of Sydney, Australia."), [Adeline Tinessia](https://pubmed.ncbi.nlm.nih.gov/?term=Tinessia+A&cauthor_id=42556299)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#short-view-affiliation-3 "Sydney School of Public Health, The University of Sydney, Australia."), [Victoria J Brookes](https://pubmed.ncbi.nlm.nih.gov/?term=Brookes+VJ&cauthor_id=42556299)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#short-view-affiliation-5 "Sydney Infectious Disease Institute, The University of Sydney, Australia; Sydney School of Veterinary Science, The University of Sydney, Australia."), [Kerrie Wiley](https://pubmed.ncbi.nlm.nih.gov/?term=Wiley+K&cauthor_id=42556299)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42556299/#short-view-affiliation-2 "Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia.") ### Affiliations * 1 Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia. Electronic address: rnep6306@uni.sydney.edu.au. * 2 Sydney School of Public Health, The University of Sydney, Australia; Sydney Infectious Disease Institute, The University of Sydney, Australia. * 3 Sydney School of Public Health, The University of Sydney, Australia. * 4 School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Medical Entomology, NSW Health Pathology, Australia. * 5 Sydney Infectious Disease Institute, The University of Sydney, Australia; Sydney School of Veterinary Science, The University of Sydney, Australia. * PMID: **42556299** * DOI: [ 10.1016/j.vaccine.2026.128999 ](https://doi.org/10.1016/j.vaccine.2026.128999) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Introduction:** Three billion people globally are at risk of Japanese Encephalitis (JE), a mosquito-borne disease primarily spread by Culex mosquitoes. Despite the availability of JE vaccine, uptake is limited and a deeper understanding of people's knowledge, attitudes, and behaviours (KABs) towards JE vaccine is needed to improve this. This study systematically reviewed the existing research on KABs towards JE vaccination, with a view to informing JE vaccine program delivery, policy and practice. **Methods:** Seven bibliometric databases, grey literature and references of included studies were searched for primary studies on KABs towards JE vaccination. Search outputs were independently screened; data were extracted and synthesised descriptively. **Results:** Of the 26 studies included, most were conducted in JE endemic countries and examined four participant groups: travellers from non-endemic settings, caregivers of vaccine recipients and non-traveller adults from endemic settings, and vaccine providers/advocates from both settings. Of the few studies, adult vaccine recipients had low knowledge and awareness of the vaccine, whereas caregivers' knowledge and awareness were higher. Attitudes towards JE vaccination were generally positive and KABs were often influenced by health workers, community leaders, risk perception, cost, time constraints, migration, and vaccine availability and accessibility. **Conclusion:** There were limited KABs studies regarding JE vaccination using rigorous and consistent methodological approaches. This review highlights the barriers to JE vaccination and the role of health professionals and vaccine advocates in JE vaccination programs. Focusing on empowering these groups is key to increasing JE vaccine uptake across different populations. **Keywords:** Attitudes; Behaviours; Japanese encephalitis; Knowledge; Systematic review; Vaccination. Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Similar articles * [ Regional variation in pig farmer awareness and actions regarding Japanese encephalitis in Nepal: implications for public health education. ](https://pubmed.ncbi.nlm.nih.gov/24416402/) Dhakal S, Joshi DD, Ale A, Sharma M, Dahal M, Shah Y, Pant DK, Stephen C.Dhakal S, et al.PLoS One. 2014 Jan 9;9(1):e85399. doi: 10.1371/journal.pone.0085399. eCollection 2014.PLoS One. 2014.PMID: 24416402Free PMC article. * [ Japanese Encephalitis: Understanding Its Impact, Prevention, and the Role of Vaccination. ](https://pubmed.ncbi.nlm.nih.gov/41755551/) Shaikh MS, Khan ZZ, Majeed SSA, Iftekhar SS, Imran SJ, Faiyazuddin M, Sharma S, Mohanty A, Sah S, Mehta R, Srivastava S, Alshammari TM, Zambrano L, López-Marín JF, Rodriguez-Morales AJ.Shaikh MS, et al.Rev Med Virol. 2026 Mar;36(2):e70123. doi: 10.1002/rmv.70123.Rev Med Virol. 2026.PMID: 41755551Review. * [ Japanese Encephalitis Vaccine Decision Aid for Travelers: A Randomized Clinical Trial. ](https://pubmed.ncbi.nlm.nih.gov/42223942/) McGuinness SL, Eades O, Morris J, Seale H, Cheng AC, Leder K.McGuinness SL, et al.JAMA Netw Open. 2026 Jun 1;9(6):e2615190. doi: 10.1001/jamanetworkopen.2026.15190.JAMA Netw Open. 2026.PMID: 42223942Free PMC article.Clinical Trial. * [ Allergic reactions to Japanese encephalitis vaccine. ](https://pubmed.ncbi.nlm.nih.gov/14753386/) Plesner AM.Plesner AM.Immunol Allergy Clin North Am. 2003 Nov;23(4):665-97. doi: 10.1016/s0889-8561(03)00102-4.Immunol Allergy Clin North Am. 2003.PMID: 14753386Review. * [ Community Perspectives on Japanese Encephalitis Risk and Prevention in an Endemic Region of Australia. ](https://pubmed.ncbi.nlm.nih.gov/42334065/) White J, Murray P, Vilder M, Saxby S, Durrheim DN.White J, et al.Aust J Rural Health. 2026 Jun;34(3):e70227. doi: 10.1111/ajr.70227.Aust J Rural Health. 2026.PMID: 42334065Free PMC article. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42556299) ## Publication types * Systematic Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Systematic+Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42556299/) ## MeSH terms * Encephalitis, Japanese* / prevention & control Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Encephalitis%2C+Japanese%2Fprevention+and+control%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Encephalitis%2C+Japanese) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42556299/) * Health Knowledge, Attitudes, Practice* Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Health+Knowledge%2C+Attitudes%2C+Practice%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Health+Knowledge%2C+Attitudes%2C+Practice) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42556299/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc)
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