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ENCEPHALITIS
Overview
Economic impact
History
Epidemiology
Transmission
Clinical Signs
Diagnosis and Treatment
Disease in Humans
Prevention and Control
Actions to Take/Program mode
Japanese Encephalitis
Flaviviridae
Flavivirus
The name is derived from
Enveloped
Single stranded RNA virus
Morphology not well defined
History
1870s: Japan
Summer encephalitis epidemics
1924: Great epidemic in Japan
6,125 human cases; 3,797 deaths
Economic Impact
Animals
Porcine
Equine
Up to 5% mortality rate
Humans
Geographic Distribution
Endemic in temperate
Kore
a
Japan
Chin
a
India
Philippin
es
Indonesi
a
Morbidity/Mortality
Swine
High mortality in piglets
Death rare in adult pigs
Equine
Morbidity: 2%, during an outbreak
Mortality: 5%
Humans
Mortality: 5-40%
Serious neurologic sequelae: 45-70%
Transmission
Vector-borne disease
Enzootic cycle
Mosquitoes: Culex species
Culex vishnuii/pseudovishnui/tritinorinchus
Paddy fields
Reservoir/Amplifying hosts
Pigs, bats
Ardeid (wading) birds
Possibly reptiles and amphibians
Incidental hosts
Global Problem
Leading cause of viral encephalitis
3 billion live in endemic areas
50000 cases reported annually
10-15 thousand deaths annually
INDIA-33o million live in endemic areas in 15
states/ut
135 districts are affected
harmful
Birth of stillborn or mummified fetuses
Piglets: Neurological signs, death
Boars: Infertility, swollen testicles
Differential Diagnosis
Equine
Other viral encephalitides, Hendra, rabies,
neurotoxins, toxic encephalitis
Swine
Myxovirus-parainfluenza 1, coronavirus,
Menangle virus, porcine parvovirus
Sampling
Before collecting or sending any samples, the
Diagnosis
Clinical
Horses: Fever and CNS disease
Swine: High number of stillborn piglets
Laboratory Tests
Definitive: Viral isolation
Rise in titer
Neutralization, HI, IF, CF, ELISA
Cross reactivity of Flaviviruses
Treatment
No effective treatment
Supportive care
Clinical Signs-Humans
Incubation period: 5 to 15 days
Most asymptomatic or mild signs
Children < 15 years and Elderly
At highest risk for severe disease
Elderly: High case fatality rate (30%)
For every case 200-1000 undetected/asymptomatic
cases
Disease clinical perspective divided into
mild/moderate/severe/asymptomatic cases
scattered throughout
CNS
Occasional microscopic
necrotic foci
Thalamus generally
severely affected
Definitive diagnosis
Virus isolation: CSF sample, brain
No specific treatment
Supportive care
Disinfection
Biosafety Level 3 precautions
Chemical
Ethanol, glutaraldehyde, formaldehyde
Sodium hypochlorite (bleach)
Iodine, phenols, iodophors
Physical
Deactivation at 133oF (for 30 minutes)
Sensitive to ultraviolet light and gamma
radiation
Prevention
Vector control
Eliminate mosquito breeding areas
Adult and larvae control( chemical larvicides,
Biolarvicides, larvivorous fish)
Environmental management
Vaccination
Equine and swine
Humans
Prevention(Program
mode)
Strengthening JE surveillance- identifying
Vaccination
Live attenuated vaccine
Used in equine and swine
Successful for reducing incidence
Inactivated vaccine (JE-VAX)/SA 14-14-2
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