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JAPANESE

ENCEPHALITIS

MD.KABIUL AKHTER ALI


Vector Borne Disease Consultant
NVBDCP, NRHM
District Heath & Family Welfare Samiti
Uttar Dinajpur

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

the Latin flavus


Flavus means yellow
Refers to yellow fever virus

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

1935: Virus first isolated


From a fatal human encephalitis case
1938: Isolated from Culex tritaeniorhynchus
1952: First evidence of J E
1955:First case in India
1958:First viral isolation in India
1973:First outbreak inBankura/Burdwan
1978:widespread occurance/monitoring NMEP
Initiation of immunisation killed mouse brain vaccine

Economic Impact
Animals
Porcine

High mortality in piglets

Equine

Up to 5% mortality rate

Humans

Cost for immunization and medical treatment

Geographic Distribution
Endemic in temperate

and tropical regions of


Asia
Reduced prevalence in
Japan
Has not occurred in
U.S.

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

Horses, humans,(dead end)

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

Clinical Signs: Swine


Incubation period not known
Exposure early in pregnancy more

harmful
Birth of stillborn or mummified fetuses
Piglets: Neurological signs, death
Boars: Infertility, swollen testicles

Post Mortem Lesions


Horses
Non-specific
Nonsuppurative
meningoencephalitis
Swine
Fetuses
Mummified and dark in appearance
Hydrocephalus
Cerebellar hypoplasia
Spinal hypomyelinogenesis

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

proper authorities should be contacted


Samples should only be sent under secure

conditions and to authorized laboratories to


prevent the spread of the disease

Diagnosis
Clinical
Horses: Fever and CNS disease
Swine: High number of stillborn piglets
Laboratory Tests
Definitive: Viral isolation

Blood, spinal cord, brain, CSF

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

Clinical Signs: Severe


Acute encephalitis
Headache, high fever, stiff neck, stupor
Severe encephalitis
Paralysis, seizures, convulsions, coma, and
death
Neuropsychiatric sequelae
45-70% of survivors
In utero infection possible
Abortion of fetus

Post Mortem Lesions


Pan-encephalitis
Infected neurons

scattered throughout
CNS
Occasional microscopic
necrotic foci
Thalamus generally
severely affected

Diagnosis and Treatment


Clinical
Laboratory Tests
Tentative diagnosis
Antibody titer: HI, IFA, CF, ELISA
JE-specific IgM in serum or CSF

Definitive diagnosis
Virus isolation: CSF sample, brain

No specific treatment
Supportive care

Public Health Significance


Strengthening of surveillance
Capacity building for diagnosis/case

management to reduce fatality


Clinical laboratory support/adequacy of
medicines in hospitals
Vector surveillance strengthening
Focused IEC for early reporting
Increasing indigenous capacity of vaccine
production

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

Personal protective measures


Avoid prime mosquito hours/IVM
Space spray-Fogging with pyrethrum/malathion
Use of repellants /ITN/curtains

Prevention(Program
mode)
Strengthening JE surveillance- identifying

/setting of 50 sentinel sites


12 Apex Referral laboratories(Diagnosis)
Guidelines for AES/JE surveillance
VBD Control Surveillance Unit at BRD Medical
College Gorakhpur
Sub office ROHFW Lucknow at Gorakhpur
NIV Pune unit at BRD Medical College
Gorakhpur(funded by GOI/ICMR)

Vaccination
Live attenuated vaccine
Used in equine and swine
Successful for reducing incidence
Inactivated vaccine (JE-VAX)/SA 14-14-2

Chinese-Single dose IM(Children 1-15 years)


Used for human beings
2006-11 districts in 4 states(Assam,Karnataka,WB
&UP)
2007 Expanded to 27 districts in 9 states
2008- 23 districts in 9 states covered
Left out and new cohorts covered in routine
immunisation

THANK YOU

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