Recent outbreaks of Japanese encephalitis in new districts in Bihar, India underscore the importance of widespread immunization coverage and strong surveillance systems. PATH’s Dr. Satyabrata Routray gives papers for new vaccine transport vans to Bihar government officials. These vans will strengthen the vaccine supply chain in Bihar in the wake of the COVID-19 vaccination drive. Photo: PATH/Dr. Siddhartha Dutta. Japanese encephalitis begins like the flu. But this mosquito-borne viral infection of the brain can quickly progress to life-threatening encephalitis, causing paralysis, seizures, inability to speak, and coma. The case fatality rate from Japanese encephalitis (JE) can be as high as 30 percent, and most deaths are among children. Nearly half of all survivors can have severe, lifelong neurological disability.