JAPANESE ENCEPHALITIS

INTRODUCTION
Japanese encephalitis virus originated from an ancestral virus in the
area of malay of Archipelago . 1st clinical case in 1871, at Japan.
Subsequent epidemics in Japan during 1924, 1927, 1934 and 1935 .
Japanese encephalitis was isolated from an infected brain tissue in
1924. Culex was found out as the vector in 1938 .The disease then
spread to Korea, China, Pakistan, India, Northern Australia and
several other countries.

What is Japanese encephalitis?

Japanese Encephalitis is a vector borne viral disease that occurs in

South Asia, South East Asia, East Asia and the Pacific .This disease
affects both man and animals .It is Caused by a Flavivirus.It is
transmitted by the vector, mosquitoes belonging to the Culex species .
Globally, 30,000 to 50,000 new cases of Japanese Encephalitis are
reported every year .More than 3 billion people are at risk of
developing the disease.
All ages can be affected in a
population without previous exposure. Japanese encephalitis tends to
be a childhood disease in endemic areas, where most people develop
immunity by the time they reach adulthood. Japanese encephalitis
virus is the most important cause of viral encephalitis in Asia.
What causes Japanese encephalitis?
Japanese encephalitis is caused by a flavivirus, which can affect both
humans and animals. The virus is passed from animals to humans
through the bite of an infected mosquito. Pigs and wading birds are
the main carriers of the Japanese encephalitis virus. A mosquito
becomes infected after sucking the blood from an infected animal or
bird. The mosquitoes that carry Japanese encephalitis usually breed in
rural areas where there are flooded rice fields or marshes. But
mosquitoes have also been found in urban areas. They usually feed
between sunset and sunrise. Japanese encephalitis cannot be passed
from person to person.

How is Japanese encephalitis diagnosed?

A laboratory test is required in order to confirm Japanese encephalitis
virus infection and to rule out other causes of encephalitis. According
to WHO ,testing for Japanese encephalitis virus -specific IgM
antibody in a single sample of cerebrospinal fluid or serum, using an
IgM-capture ELISA is highly recommending.Testing of CSF sample
is preferred to reduce false-positivity rates from previous infection or
vaccination.
Compliment Fixation Test: To detect the antibodies for infection.
Neutralization Test: To detect the presence of virus infections.
Immunofluorescence Assay: To detect the antigen & antibodies.
Laboratory Diagnosis-Confirmatory testing is only available at
Centers for Disease Control and Prevention and a few specialized
reference laboratories.

What is the treatment for Japanese encephalitis ?

There is no specific treatment for Japanese encephalitis. Support and
care is needed.

Who has an increased risk of being exposed to Japanese

encephalitis?
The people most at risk are those who live and work in rural areas
such as on pig farms and in rice fields and children under the age of
15.
How common is Japanese encephalitis and where is it found?
According to WHO, 24 countries in the WHO South-East Asia and
Western Pacific regions have endemic JEV transmission, exposing
more than 3 billion people to risks of infection. It is mostly common
in temperate and tropical regions of Asia, in subtropical and tropical
areas, the season depends on the rainfall and patterns of bird
migrations.
In some tropical areas, transmission might occur at any time of the
year, depending partly on agricultural practices. It’s incidence has
been declining in Japan and some regions of China. It has not
occurred in U.S
The Japanese encephalitis affected areas in India are
o Andhra Pradesh
o Assam
o Bihar
o Haryana
o Kerala
o Karnataka
o Maharashtra
o Manipur
o Nagaland
o Tamil Nadu
o Uttar Pradesh
o West Bengal
How is Japanese encephalitis transmitted?
Japanese encephalitis is transmitted to humans through the bite of an
infected mosquito, primarily Culex species. In Asia, the rice-field
breeding mosquitoes, mainly C. tritaeniorhynchus, usually transmit
JEV. In the Torres Strait islands outbreak, virus was isolated from C.
annulirostris mosquitoes, which were considered to be the main
vector involved.

Agent
Group B Arbo virus in the genius group of Flaviviridae

HOST
o Horses are the primary affected domestic animals of Japanese
encephalitis though essentially a dead-end host and other equids
are also susceptible
o Pigs act as amplifiers of the virus producing high viraemias
which infect mosquito vectors .
o The natural maintenance reservoir for Japanese encephalitis
virus are birds of the family Ardeidae mainly herons and egrets.
o All age groups of human beings and more in children under 15
years of age
Environment
The environment is rainy season.

There are three different stages

1. Prodromal stage
 o The onset of illness is usually acute and the duration of
this stage is usually 1-6 days.
o Fever(38-41’c)
o Headache
o Rigors
o GI disturbances
o Nausea & Vomiting
o Lethargy
2. Acute Encephalitic stage
o This stage begins by 3-5 th day
o High grade fever
o Nuchal rigidity
o Convulsions signs of increased ICP
o Unconsciousness
o Dystonia
o Dysphasia
o Hemiplegia
o Quadriplegia
3. Late stage
o This stage begins when active inflammation reduced
o CNS involvement is more in this stage.
o Mental impairment
o Epilepsy
o Behavioural abnormalities.
o The average period between the onset of illness and death
is about 9 days only

The virus is maintained in a cycle between mosquitoes and vertebrate

hosts, primarily pigs and wading birds. Humans are vulnerable to this
disease and humans are dead-end host. Humans are dead-end hosts
because they usually do not develop high enough concentrations of
Japanese encephalitis virus in their bloodstreams to infect feeding
mosquitoes.

LIFE CYCLE OF JAPANESE ENCEPHALITIS

What can be done to reduce the risk of acquiring Japanese

encephalitis ?
o Early Detection- Japanese encephalitis can be recognised by
following symptoms and first Aid can be given by parents till
the child is shifted to the hospital .Observe for new development
of symptoms
 o Vaccination- vaccines are available to prevent disease. There are
4 main types of Japanese encephalitis vaccines currently in use:
inactivated mouse brain-derived vaccines, inactivated Vero cell-
derived vaccines, live attenuated vaccines, and live recombinant
vaccines.
o use of mosquito repellents, long-sleeved clothes, coils and
vaporizers

o All travellers to endemic areas should take precautions to avoid

mosquito bites.

Can epidemics of be Japanese encephalitis prevented?

Japanese encephalitis can be prevented by following methods

o Personal protective measures and mosquito elimination are the

most important
o Travellers going to endemic areas may consider vaccination
o Avoid going to areas with water accumulation during dusk and
dawn when the mosquitoes are most active
o Wear light-coloured, long-sleeved clothing and trousers
o Apply mosquito-repellents over exposed parts of the body and
clothes every 4 to 6 hour
o Place of accommodation should have mosquito nets
o Use insecticides or coil incenses to repel mosquitoes
o install mosquito nets to doors and windows so that mosquitoes
can’t get in
o Ensure that there is no blockage in the drains.
National Programmes on Japanese encephalitis
o National Vector Borne Disease Control Programme

It was Launched in 2003-04 by merging National anti-malaria

control programme, National Filaria Control Programme and
Kala Azar Control programmes, Japanese Encephalitis and
Dengue.

Among these the program for Japanese Encephalitis is Japanese

Encephalitis Control Programme. It’s objectives are as follows

 Strengthening early diagnosis and prompt case management at

PHCs, CHCs and hospitals through training of medical and
nursing staff.
 IEC for community awareness to promote early case reporting,
personal protection, isolation of amplifier host, etc.;
 Vector control measures mainly fogging during outbreaks, space
spraying in animal dwellings, and antilarval operation where
feasible; and
 Development of a safe and standard indigenous vaccine.
Vaccination for high risk population particularly children below
15 years of age.

CONCLUSION

Japanese Encephalitis is zoonotic disease and caused by an

arbovirus and transmitted by Culex mosquitoes. There is no
specific treatment for Japanese Encephalitis and only prevention
can control the disease. Through immunization program we can
control the disease and the important thing is to provide
awareness among the people regarding the cause and route of
Japanese Encephalitis transmission.

REFERENCES

https://www.who.int/
PARK’S TEXTBOOK
https://www.cdc.gov/