JAPANESE ENCEPHALITIS

Q. What is Japanese Encephalitis? A. Japanese Encephalitis is a viral disease It is transmitted by infective bites of female mosquitoes mainly belonging to Culex tritaeniorhynchus, Culex vishnui and Culex pseudovishnui group. However, some other mosquito species also play a role in transmission under specific conditions JE virus is primarily zoonotic in its natural cycle and man is an accidental host. JE virus is neurotorpic and arbovirus and primarily affects central nervous system Q. How is Japanese encephalitis transmitted? A. By rice field breeding mosquitoes (primarily the Culex tritaeniorhynchus group) that become infected with Japanese encephalitis virus (a flavivirus antigenically related to St. Louis encephalitis virus). Q. How do people get Japanese encephalitis? A. By the bite of mosquitoes infected with the Japanese encephalitis virus. Q. What is the basic transmission cycle? A. Mosquitoes become infected by feeding on domestic pigs and wild birds infected with the Japanese encephalitis virus. Infected mosquitoes then transmit the Japanese encephalitis virus to humans and animals during the feeding process. The Japanese encephalitis virus is amplified in the blood systems of domestic pigs and wild birds. Q. Could you get the Japanese encephalitis from another person? A. No, Japanese encephalitis virus is NOT transmitted from person-to-person. For example, you cannot get the virus from touching or kissing a person who has the disease, or from a health care worker who has treated someone with the disease. Q. Could you get Japanese encephalitis from animals other than domestic pigs, or from insects other than mosquitoes? A. No. Only domestic pigs and wild birds are carriers of the Japanese encephalitis virus. Q. What are sign and symptoms of JE? A. JE virus infection presents classical symptoms similar to any other virus causing encephalitis JE virus infection may result in febrile illness of variable severity associated with neurological symptoms ranging from headache to meningitis or encephalitis. Symptoms can include headache, fever, meningeal signs, stupor, disorientation, coma, tremors, paralysis (generalized), hypertonia, loss of coordination, etc. Prodromal stage may be abrupt (1-6 hours), acute (6-24 hours) or more commonly subacute (2-5 days) In acute encephalitic stage, symptoms noted in prodromal phase convulsions, alteration of sensorium, behavioural changes, motor paralysis and involuntary movement supervene

and focal neurological deficit is common. Usually lasts for a week but may prolong due to complications. Amongst patients who survive, some lead to full recovery through steady improvement and some suffer with stabilization of neurological deficit. Convalescent phase is prolonged and vary from a few weeks to several months. Clinically it is difficult to differentiate between JE and other viral encephalitis JE virus infection presents classical symptoms similar to any other virus causing encephalitis.

Q. What is the incubation period for Japanese encephalitis? A. Usually 5 to 15 days. Q. What is the mortality rate of Japanese encephalitis? A. Case-fatality rates range from 0.3% to 60%. Q. How many cases of Japanese encephalitis occur in the world and the U.S.? A. Japanese encephalitis is the leading cause of viral encephalitis in Asia with 30-50,000 cases reported annually. Fewer than 1 case/year is reported in U.S. civilians and military personnel traveling to and living in Asia. Rare outbreaks in U.S. territories in Western Pacific have occurred. Q. How is Japanese encephalitis treated? A. There is no specific therapy. Intensive supportive therapy is indicated. Q. Is the disease seasonal in its occurrence? A. Seasonality of the illness varies by country Q. Who is at risk for getting Japanese encephalitis? A. Residents of rural areas in endemic locations, active duty military deployed to endemic areas, and expatriates who visit rural areas. Japanese encephalitis does not usually occur in urban areas. Q. Where do Japanese encephalitis outbreaks occur? A. Japanese encephalitis outbreaks are usually circumscribed and do not cover large areas. They usually do not last more than a couple of months, dying out after the majority of the pig amplifying hosts have become infected. Birds are the natural hosts for Japanese encephalitis. Epidemics occur when the virus is brought into the peridomestic environment by mosquito bridge vectors where there are pigs, which serve as amplification hosts, infecting more mosquitoes which then may infect humans. Countries which have had major epidemics in the past, but which have controlled the disease primarily by vaccination, include China, Korea, Japan, Taiwan and Thailand. Other countries that still have periodic epidemics include Viet Nam, Cambodia, Myanmar, India, Nepal, and Malaysia. Q. Is there any vaccine available against JE virus in India? A. Inactivated Mouse Brain-Derived JE Vaccine is available against JE in India. The Vaccine is prepared by subjecting the mouse brain infected with Nakayama strain of JE virus to a sequence of protamine sulphate treatment, formalin inactivation and ultrafilteration and ammonium sulfate precipitation. The purified product is without myclin basic protean and supplied in a freeze dried form. The Vaccine in manufactured at Central Research Institute, Kasauli, Himachal Pradesh.

Q. Who should be vaccinated against Japanese Encephalitis? A. Seroprevalance studies disclose nearly universal infection by early adulthood and in areas where viral transmission is particularly intense Seroprevalance rates may increase during childhood. The age group for immunization should be decided based on available Seroepidemiological data from the area.

Q. What are the Prevention and control measures of JE? The preventive measures are directed at reducing the vector density and in taking personal protection against mosquito bites using insecticide treated mosquito nets. The reduction in mosquito breeding requires eco-management, as the role of insecticides is limited. JE vaccine is produced in limited quantities at the Central Research Institute, Kasauli. Three doses of the vaccine provide immunity lasting a few years. The vaccine is procured directly by the state health authorities. Vaccination is not recommended as an outbreak control measure as it takes at least one month after second dose to develop antibodies at protective levels and the outbreaks are usually short lived. There is no specific treatment of JE. Clinical management is supportive and in the acute phase is directed at maintaining fluid and electrolyte balance and control of convulsions, if present. Maintenance of airway is crucial. The state governments have been advised that in the endemic districts, anticipatory preparations should be made for timely availability of medicines, equipment and accessories as well as sufficient number of trained medical, nursing and paramedical personnel. The Government of India supports training programmes. Technical support is provided, on request by the state health authorities, for outbreak investigations and control. Factors that make the prevention and control of JE challenging are: o Outdoor habit of the vector o Scattered distribution of cases spread over relatively large areas o Role of different reservoir hosts o Specific vectors for different geographical and ecological areas o Immune status of various population groups is not known making it difficult to delineate vulnerable population groups. Piggeries may be kept away (4-5 kms) from human dwellings.

Q. Treatment of Japanese Encephalitis A. There is no specific anti-viral medicine available against JE virus. The cases are managed symptomatologically. Clinical management of JE is supportive and in the acute phase is directed at maintaining fluid and electrolyte balance and control of convulsions, if present. Maintenance of airway is crucial.