JE ppt


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Presentation made by Md. Kabiul Akhter Ali, VBD Consultant, Uttar Dinajpur, West Bengal

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  • JE ppt

    1. 1. MD.KABIUL AKHTER ALI Vector Borne Disease Consultant NVBDCP, NRHMDistrict Heath & Family Welfare Samiti Uttar Dinajpur
    2. 2. OverviewEconomic impactHistoryEpidemiologyTransmissionClinical SignsDiagnosis and TreatmentDisease in HumansPrevention and ControlActions to Take/Program mode
    3. 3. 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
    4. 4. 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
    5. 5. Economic ImpactAnimals Porcine  High mortality in piglets Equine  Up to 5% mortality rate Humans  Cost for immunization and medical treatment
    6. 6. Geographic DistributionEndemic in temperate and tropical regions of AsiaReduced prevalence in Korea Japan Japan ChinaHas not occurred in U.S. India Philippine s Indonesia
    7. 7. 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%
    8. 8. 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)
    9. 9. 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
    10. 10. 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
    11. 11. Post Mortem LesionsHorses Non-specific Nonsuppurative meningoencephalitisSwine Fetuses  Mummified and dark in appearance  Hydrocephalus  Cerebellar hypoplasia  Spinal hypomyelinogenesis
    12. 12. Differential DiagnosisEquine  Other viral encephalitides, Hendra, rabies, neurotoxins, toxic encephalitisSwine Myxovirus-parainfluenza 1, coronavirus, Menangle virus, porcine parvovirus
    13. 13. 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
    14. 14. 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
    15. 15. TreatmentNo effective treatmentSupportive care
    16. 16. 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
    17. 17. 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
    18. 18. Post Mortem LesionsPan-encephalitisInfected neurons scattered throughout CNSOccasional microscopic necrotic fociThalamus generally severely affected
    19. 19. 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
    20. 20. 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
    21. 21. 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
    22. 22. 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
    23. 23. 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)
    24. 24. 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
    25. 25. THANK YOU