Japanese Encephalitis: Overview and Management
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Vandana Gupta
Medical microbiology, Sem VI
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An infection of the brain caused by the Japanese encephalitis virus (JEV).
•
Mostly little or no symptoms, occasional inflammation of the brain occurs
•
Spread by Culex mosquitoes with Pigs and wild birds as reservoir
•
Diagnosis is based on blood or CSF testing.
•
Prevention is generally with the Japanese encephalitis vaccine, which is
both safe and effective. Other measures include avoiding mosquito
bites. Once infected, there is no specific treatment, with care being
supportive. This is generally carried out in hospital. Permanent problems
occur in up to half of people who recover from JE.
•
The disease occurs in Southeast Asia and the Western Pacific. About 3
billion people live in areas where the disease occurs. About 68,000
symptomatic cases occur a year, with about 17,000 deaths. Often, cases
occur in outbreaks. The disease was first described in 1871.
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IP of 2 to 26 days.
•
Majority of infections are
Asymptomatic
: only 1 in 250 (0.4%) infections develop
into encephalitis
•
Fever, headache and
malaise
are other
non-specific symptoms
last for a period of
between 1 and 6 days.
•
Acute encephalitic stage include neck rigidity,
hemiparesis
, convulsions and fever:
38–41 °C (100.4–105.8 °F). m
ental retardation
is usually developed.
•
Mortality generally higher in children.
•
Transplacental spread has been noted.
•
Lifelong neurological defects such as deafness, emotional lability
and
hemiparesis
may occur in those who have had
central nervous
system
involvement.
Etiology
•
Flaviviridae
•
+ve sense RNA, nonsegmented genome
•
Enveloped, icosahedral virus closely related to the
West Nile virus
and
the
St. Louis encephalitis
virus.
D
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a
g
n
o
s
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•
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Test kits detecting IgM Ab in serum and /or
cerebrospinal fluid
, for
example by IgM capture
ELISA
.
•
JE virus IgM antibodies are usually detectable 3 to 8 days after onset
of illness and persist for 30 to 90 days,
•
In fatal cases, nucleic acid amplification, and virus culture of autopsy
tissues can be useful. Viral antigen can be shown in tissues by IFM.
Prevention
Infection with Japanese encephalitis confers
lifelong immunity.
There are currently three
vaccines
available:
SA14-14-2,
IXIARO/ JESPECT (JEEV)
ChimeriVax-JE (marketed as IMOJEV). All current
vaccines are based on the genotype III virus.
boosters recommended every three years for people who
remain at risk
Mosquito population control
Treatment
•
no specific treatment
•
supportive therapy for
feeding
,
breathing
or
seizure
control as
required. Raised
intracranial pressure
may be managed with
mannitol
•
There is no
transmission
from person to person and therefore
patients do not need to be isolated.
•
Epidemiology
•
leading cause of viral encephalitis in ASIA, with up to 70,000 cases reported
annually, Case-fatality rates range from 0.3% to 60% and depend on the
population and age. Rare outbreaks in U.S. territories in the Western Pacific
have also occurred.
•
does not usually occur in urban areas.
•
There had been 116 deaths reported in Odisha's backward Malkangiri
district of India in 2016
•
Endemic in Gorakhpur in UP
Evolution
•
The virus appears to have originated from its ancestral virus in the mid-
1500s in the Indonesia-Malaysia region and evolved there into five
different genotypes and spread across Asia.
Japanese encephalitis (JE) is a viral infection of the brain spread by mosquitoes, with symptoms ranging from mild fever to severe complications like encephalitis. Prevention is key through vaccination and avoiding mosquito bites. Diagnosis involves blood or CSF testing. Lifelong neurological issues can result from JE, making supportive care essential. The etiology involves Flaviviridae viruses, and diagnosis is done through IgM detection. Lifelong immunity is conferred with vaccination against Japanese encephalitis.
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Presentation Transcript
Japanese encephalitis Japanese encephalitis (JE JE) Vandana Gupta Medical microbiology, Sem VI
Japanese encephalitis Japanese encephalitis (JE JE) An infection of the brain caused by the Japanese encephalitis virus (JEV). Mostly little or no symptoms, occasional inflammation of the brain occurs Spread by Culex mosquitoes with Pigs and wild birds as reservoir Diagnosis is based on blood or CSF testing. Prevention is generally with the Japanese encephalitis vaccine, which is both safe and effective. Other measures include avoiding mosquito bites. Once infected, there is no specific treatment, with care being supportive. This is generally carried out in hospital. Permanent problems occur in up to half of people who recover from JE. The disease occurs in Southeast Asia and the Western Pacific. About 3 billion people live in areas where the disease occurs. About 68,000 symptomatic cases occur a year, with about 17,000 deaths. Often, cases occur in outbreaks. The disease was first described in 1871.
Signs and symptoms Signs and symptoms IP of 2 to 26 days. Majority of infections are Asymptomatic: only 1 in 250 (0.4%) infections develop into encephalitis Fever, headache and malaise are other non-specific symptoms last for a period of between 1 and 6 days. Acute encephalitic stage include neck rigidity, hemiparesis, convulsions and fever: 38 41 C (100.4 105.8 F). mental retardation is usually developed. Mortality generally higher in children. Transplacental spread has been noted. Lifelong neurological defects such as deafness, emotional lability and hemiparesis may occur in those who have had central nervous system involvement.
Etiology Flaviviridae +ve sense RNA, nonsegmented genome Enveloped, icosahedral virus closely related to the West Nile virus and the St. Louis encephalitis virus.
Diagnosis Diagnosis Test kits detecting IgM Ab in serum and /or cerebrospinal fluid, for example by IgM capture ELISA. JE virus IgM antibodies are usually detectable 3 to 8 days after onset of illness and persist for 30 to 90 days, In fatal cases, nucleic acid amplification, and virus culture of autopsy tissues can be useful. Viral antigen can be shown in tissues by IFM.
https://upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Japanese_encephalitis_vaccine_%22ENCEVAC%222016.jpg/220px-Japanese_encephalitis_vaccine_%22ENCEVAC%222016.jpghttps://upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Japanese_encephalitis_vaccine_%22ENCEVAC%222016.jpg/220px-Japanese_encephalitis_vaccine_%22ENCEVAC%222016.jpg Prevention Infection with Japanese encephalitis confers lifelong immunity. There are currently three vaccines available: SA14-14-2, IXIARO/ JESPECT (JEEV) ChimeriVax-JE (marketed as IMOJEV). All current vaccines are based on the genotype III virus. boosters recommended every three years for people who remain at risk Mosquito population control
Treatment no specific treatment supportive therapy for feeding, breathing or seizure control as required. Raised intracranial pressure may be managed with mannitol There is no transmission from person to person and therefore patients do not need to be isolated.
Epidemiology leading cause of viral encephalitis in ASIA, with up to 70,000 cases reported annually, Case-fatality rates range from 0.3% to 60% and depend on the population and age. Rare outbreaks in U.S. territories in the Western Pacific have also occurred. does not usually occur in urban areas. There had been 116 deaths reported in Odisha's backward Malkangiri district of India in 2016 Endemic in Gorakhpur in UP Evolution The virus appears to have originated from its ancestral virus in the mid- 1500s in the Indonesia-Malaysia region and evolved there into five different genotypes and spread across Asia.
