A rare and viral disease caused by Flavi virus that infects animals and human which is transmitted by Culex mosquitoes in humans called japenese encephalitis

1. PRESENTED BY
P.Asma Afreen,
Pharm.D Intern.

2. INTRODUCTION
 Japanese encephalitis(JE) is a viral disease caused by Flavi virus that infects
animals and humans. It is transmitted by Culex mosquitoes in humans . It
directly affects central nervous system and may cause severe
complication.
 Japanese encephalitis virus are mild (fever and headache) or without
apparent symptoms, but sometimes 1 in 200 infections can result in severe
disease characterized by rapid onset of high grade fever, headache, neck
stiffness, disorientation, coma, seizures, spastic paralysis and death.

3. Epidemiology:
•Muar Strain, identified from a patient in Malaya in 1951 is the prototype strain of genotype V.
•In India,the fist human case was reported from north Arcot district of tamil nadu in 1955
•Until 1973, the disease was confined to southern parts of India, with low prevalence; subsequently
the disease spread to various other parts of India.
•The first outbreak of JE was recorded in 1973 from Burdwan and Bankura districts of west bengal.
• The fist epidemic of je was reported in 1978 in Uttar Pradesh.
• In India, while 24 states are endemic for je. Uttar pradesh contributed more than 75% of cases
during the recent past.
• India _fist reported -1955 from vellore(TN)
•1973- bengal
•1978-recorded in 21 states of India
•1978-2009 -gorakhpur(up)
• Genotype lll- india subcontinent
• Genotype l - gorakhpur (up) in 2009
• West Bengal in 2010

4. ETIOLOGY
 Japanese encephalitis is caused by a flavi virus. This type of
virus can affect both animals and humans. The virus is passed
on to humans from animals through an infected mosquito
called Culex mosquito.

5. Mode of transmission:

6. Pathophysiology:

7. SIGNS AND SYMPTOMS
 person with Japanese encephalitis will probably have no symptoms at all, but if there are
symptoms, they will appear 5 to 15 days after being infected.
 A person with mild Japanese encephalitis might only develop a fever and a headache, but in
more severe cases, more serious symptoms can develop quickly.
 Possible symptoms include:
 a headache
 high fever
 tremors
 nausea
 vomiting
 stiff neck

8. Complications
 It can lead to mild complications like:
 Uncontrollable shaking of the hands
 Changes to personality
 Muscle weakness and twitching in the arms and hands.Moderate disability
can take the form of:
 Mild learning difficulties
 Paralysis of a single limb
 Weakness on one side of the body

9. Risk factors:
 Residents or military in Southeast Asia and Western Pacific regions.
 Summer season.
 Outdoor recreational activities.
 Accommodations in endemic areas that lack air conditioning, bed nets, or
window screens.
 Age extremes.
 Contact with: Mosquitoes, Birds, Pigs.

10. DIAGNOSIS
 Doctor examine any symptoms, verify where the individual lives, and ask about the
destinations of any recent visits from which the infection could have emerged.
 Immunofluorescence tests can detect human antibodies.
 Blood tests: To know the antibodies present in the blood.
 Lumbar puncture: It is also done to check for antibodies in CSF and spinal fluid.
 Scans: In case of brain encephalitis:
 A computerized tomography (CT) scan, which takes a series of X-rays of body at slightly
different angles to produce a clear image of the inside of body
 A magnetic resonance imaging (MRI) scan, which uses a strong magnetic field and radio
waves to produce detailed images of the inside of body.

11. Treatment:
 There is no cure for JE and treatment is mainly supportive
 Patients are not infectious, but should avoid further mosquito bites.
 Antiviral agents L INF alfa- 2a and diethyldithiocarbamate
 Mannitol might be used to reduce intracranial pressure.
 Minocycline,: Reduces neuronal apoptosis, microglial activation, active caspase
activity, Proinflammatory mediators, and viral titer markedly on the ninth day after
infection.
 N- methyl isatin- b thiosemi carbazone derivative, Inhibition of JEV replication
completely in vitro.
 Treatment is symptomatic. Rest, fluids, and use of pain relievers and medication to
reduce fever may relieve some symptoms.

12. Prevention
 Prevention and control measures for Japanese Encephalitis (JE):
 (A) At Individual Level
 • Adopt measures to reduce vector density.
 • Take personal protection measures against mosquito bites.
 • Wear proper clothing to reduce mosquito bites specially during peak biting hours.
 • Use of mosquito repellent creams, liquids, coils, mats etc.
 • Use insecticide treated mosquito bed nets.
 • Sleeping in rooms with close-fitting windows and doors.
 • Spraying the room with insecticide specially in the early evening.
 (B) In the Community
 • Sensitizing and involving the community for detection of vector.
 • Adopt Eco-management system to reduce mosquito breeding.
 • From human dwellings piggeries should be kept away,at least 4-5 kms.
 • The place around the Hand Pump should be properly cemented and along with drainage system.

13.  C) Prevention During Travel
 • If travelling, try to find out the Japanese encephalitis (JE) risk in that particular
area and take the advice from doctor before visiting that area.
 (D) Prevention of Japanese Encephalitis (JE) during Pregnancy
 • Use of treated nets/LLINs(Long Lasting Insecticidal Nets).
 • All the personal preventions as mentioned above.
 Some Do’s and Don’t
 • Don’t spray/cream insect repellent directly onto your face, spray it onto your hands
and then apply it to your face.
 • Do not use it on cuts and wounds.
 • Avoid area around eyes, lips, mouth and ears canal.
 • Help children and youngsters to apply repellent. Don’t allow young children to
apply it themselves.

14. REFERENCE
1. https://www.cdc.gov/japaneseencephalitis/symptoms/index.html
2. https://www.aimu.us/2018/01/20/japanese-encephalitisje-symptoms-
causes-diagnosis
3. https://www.google.com/search?q=RISK+FACTORS+FOR+JAPENES
E+ENCEHALITIS
4. https://www.slideshare.net/vetvinodh/epidemiology-of-japanese-
encephalitis-in-india