japenese encephalitis is an important vector borne disease which carries a high mortality as well as high disability. it is a preventable disease and an effective vaccine is available for it.the vaccine is an important part of universal immunization program in india. Environmental modification and control of vector will go long way in the control of this disease.

1. Dr. Harivansh Chopra
2/7/2019 1
Classification of Arboviral diseases
and epidemiology of Japanese
Encephalitis
DR. HARIVANSH CHOPRA
M.D.,D.C.H.
PROFESSOR, COMMUNITY MEDICINE
LLRM MEDICAL COLLEGE,MEERUT

2. Dr. Harivansh Chopra
2/7/2019 2
Objective
to study the classification of
arbo virus infections in india
To study the epidemiology of
JAPANESE encephalitis

3. Dr. Harivansh Chopra
Defined as viruses “which are maintained in nature
principally, or to an important extent through biological
transmission between susceptible vertebrate hosts by
haematophagous arthropods”.
Arbovirus (arthropod borne virus)
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4. Dr. Harivansh Chopra
• They multiply in tissues of
arthropods and passed on to
new vertebrates by the bite
of arthropod after a period of
EXTRINSIC
INCUBATION.
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5. Dr. Harivansh Chopra
• The no of arbovirus known in India had risen from two
in1951(dengue and sand fly fever) to over 40 in1975 of
which more than 10 are known to produce human disease.
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6. Dr. Harivansh Chopra
Family Genus Important species
Togaviridae Alphavirus Chikungunya, sindbis
Flaviviridae Flavivirus Japanese encephalitis,
Yellow fever, Dengue type
1,2,3,4,K F D
Bunyaviridae Phlebovirus Sandfly fever virus , Rift
vally fever virus
Reoviridae Orbivirus African horse sickness
Rhabdoviridae Vesiculovirus Vesular stomatitis
virus,Chandipura virus
Some Arbovirus known to be prevalent
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Group A (ALPHA VIRUSES) Sindbis
chikungunya
Group B (Flaviviruses) K F D,JE,WEST NILE FEVER
OTHERS Umbre,Sathuperi,Chandipura,
Chittor,Ganjam,Minnal,Kaisodi
,Dengue,sandfly fever,African
horse Sickness
,vellore,venkatpuram
Some Arbovirus known to be prevalent in india

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2/7/2019 8
Only small number of arbo
viruses can produce disease
and three clinical syndromes
have been identified
A FEBRILE GROUP
characterized by the presence of
fever With or without rashes and
joint pains
CLINICAL SYNDROMES

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HAEMORRHAGIC
Characterised by the presence of
haemorrhagic fevers and high
mortality like KFD, DENGUE
HAEMORRHAJIC FEVER
CLINICAL SYNDROMES

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CLINICAL SYNDROMES
ENCEPHALITIDIS
Characterised by the
presence of meningitis and
encephalitis eg JAPANESE
encephalitis

11. Dr. Harivansh Chopra
• It is a mosquito- borne encephalitis caused by flavivirus and
transmitted by culicine mosquito.
• Its a zoonotic disease i.e. infecting mainly animals and
incidently man.
Japanese encephalitis
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12. Dr. Harivansh Chopra
• JE is the leading cause of viral
encephalitis in Asia and
occurs in almost all Asian
countries.
• Increasing no of cases are
reported from Bangladesh,
India, Nepal, Pakistan
,Thailand and Vietnam.
MAGNITUDE
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13. Dr. Harivansh Chopra
• Estimated 50,000 case
occur globally each year,
with 10,000 deaths and
nearly 15,000 disabled.
• About 85% cases are
children of less than 15
years of age.
MAGNITUDE
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14. Dr. Harivansh Chopra
• JE was first Serologically recognised
in 1955 in Tamil Nadu.
• Disease is endemic in 14 state.
• In India about 300 million population
is at risk.
• During 2011, 7,838 cases and 1,137
deaths were reported.
Problem in India
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15. Dr. Harivansh Chopra
2/7/2019 15
C
3073
4490
3540
5167
3490
7838
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
UTTAR PRADESH INDIA
CASES OF JE
2009 2010 2011
Cases of JE in india

16. Dr. Harivansh Chopra
DEATHS DUE TO J E IN INDIA
0
200
400
600
800
1000
1200
UTTAR PRADESH INDIA
556
774
494
679
579
1137
DEATHS DUE TO JE
2009 2010 2011
16

17. Dr. Harivansh Chopra
• Basic cycle of transmission
are:
A) Pig → mosquito → pig
B) The Ardeid bird →
mosquito → Ardied bird
• Man is an incidental “dead
end”host.
Epidemiological features
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18. Dr. Harivansh Chopra
• Pigs are major vertebrate host
and are considered as
“amplifiers” of virus.
• Infected Pigs do not
manifest any overt symptoms
of illness but circulate the
virus so that mosquito get
infected and can transmit the
virus to man.
Animal hosts
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19. Dr. Harivansh Chopra
• Cattle and buffaloes may also be infected and act as
“mosquito attractants”.
• Birds e.g pond herons ; cattle egrets and perhaps poultry
and duck appears to be involved in natural history of
disease.
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20. Dr. Harivansh Chopra
CULEX TRITAENIORHYNCHUS
• CULEX VISHNUI
• CULEX GELIDUS
Mosquito vectors
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2/7/2019 21
• These mosquitos generally
breed in irrigated rice field,
shallow ditches and pools.
BREEDING PLACES

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• Female mosquitoes get
infected after feeding on a
viraemic host, and after 9-
12 days incubation period
,they can transmit the
virus to other host.
• EXTRINSIC INCUBATION PERIOD

23. Dr. Harivansh Chopra
• Incubation period
• exact duration is not known
• varies from 5-15 days.
JE in man
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2/7/2019 24
Not all individual
bitten by
mosquitoes develop
disease

25. Dr. Harivansh Chopra
• The ratio of overt disease to in
apparent infection varies from
1:300 to 1:1000.
• Encephalitis due to JE may
show a scattered distribution.
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2/7/2019 26
COURSE OF DISEASE
Disease occurs in three stages
1. Prodromal stage
2. Acute encephalitic stage
3. Late stage and sequelae

27. Dr. Harivansh Chopra
• Prodromal stage-
• fever, headache,
gestrointestinal
disturbances
• ,lethargy, malaise
• .Duration 1-6 days.
COURSE OF DISEASE
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2/7/2019 28
• Encephalitis stage-
• fever is usually high 38 to
40.7degc., nuchal rigidity,
focal CNS sign,
convulsion, difficulty in
speech

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• dystonia,
• Ocular palsies,
• hemiplegia,
quardriplegia,
• extra pyramidal sign,
and in many cases
• coma.

30. Dr. Harivansh Chopra
• Late stage and sequelae-the
active inflammation is at an
end i.e. the temperature and
ESR touch normal.
• Neurological sign become
stationary or tend to improve.
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31. Dr. Harivansh Chopra
• The case fatality rate varies
between 20-40 percent and
may reach upto 58 percent.
• but approximately 30-50
% of the surviving patients
have permanent
neuropsychiatric sequelae
and complete recovery
occurs in only one-third of
patients.
•2/7/2019 31

32. Dr. Harivansh Chopra
2/7/2019 32
• Average period between the
onset of illness and death is
about 9 days.

33. Dr. Harivansh Chopra
• IgM- capture ELISA which detects specific IgM in CSF or
in blood of almost all patients with in 7 days of onset of
disease.
• Others- conventional antibody assay on paired sera, dot
blot IgM assay
Diagnosis
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34. Dr. Harivansh Chopra
Following an outbreak of JE in Gorakhpur and Basti division
in eastern UP during 2005,Directorate of NVBDCP
developed surveillance guidelines for endemic state and
advised that all the JE cases be reported under Acute
Encephalitis Syndrome.
Guidelines for management of ASE
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35. Dr. Harivansh Chopra
Acute onset of fever,not more than 5-7 days duration.
Change in mental status with / without
A)New onset of seizures(excluding febrile seizures)
B)Other early clinical findings including irritability,
somnolence and abnormal behavior.
Case definition
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36. Dr. Harivansh Chopra
• Laboratory –confirmed case
• A suspected case with any one of the following markers
• IgM antibodies in serum /csf
• Four fold rise in IgG
• Virus isolation from brain tissue
• Antigen detection by immunofluroscences
• Nucleic acid detection by PCR
Case classification
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2/7/2019 37
• Probable cases
• Suspected case in close geographic area and
Temporal relationship to a lab. Confirmed case
of JE/AES in an outbreak

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2/7/2019 38
• Acute encephalitis Syndrome due to other
agent
A suspected case in which
diagnostic testing is
performed and An
aetiological agent other
than AES/JE is identified

39. Dr. Harivansh Chopra
2/7/2019 39
Acute encephalitis Syndrome due
to unknown agent
A suspected case in which no
diagnostic testing is
performed/ no aetiological agent
is indentified/
Test results are indeterminate

40. Dr. Harivansh Chopra
MANAGEMENT OF AES INCLUDING JE AT COMMUNITY
LEVEL
2/7/2019 40
FEVER → SPONGING / PARACETAMOL
CONVULSION → ANTICONVULSANT
SECRETION → SUCTION

41. Dr. Harivansh Chopra
2/7/2019 41
Management of AES including JE
At community level
Indentification of danger signs
A letahargy
B unconsciousness
C convulsions
D other findings such as rash,
paralysis and hepato spelenomegaly

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2/7/2019 42
Management of AES including JE at FRU
Treatment
I/V LINE
Correction of blood sugar
Suction and oxygen
i/v anticonvulsant
Use of ambu bag
Decompression therapy with mannitol
Monitoring of vitals

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Management of AES including JE
No improvement/futher deterioration
Presence of shock
Cyanosis and need for ventilator
Referral to tertiary Centre

44. Dr. Harivansh Chopra
A) Vaccination
B) Vector control
Control of JE
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45. Dr. Harivansh Chopra
• Three types of vaccines
• 1Inactivated Cell
cultured derived S A -
14-14-2 vaccine
• Minimum age 1 year
Vaccination
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46. Dr. Harivansh Chopra
• Primary immunization
• 2 doses of .25 ml i/m
• On day 0 and 28 between 1-
3years
• Above the age of 3 years dose
is .5ml
• Need of booster -undetermined
Vaccination
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47. Dr. Harivansh Chopra
2/7/2019 47
• 2 VeroCell culture
derived inactivated
vaccine based on kolar
strain 821564XY made
in india by Bharat
Biotech

48. Dr. Harivansh Chopra
2/7/2019 48
• Primary immunization
• Minimum age 1 year
• 2 doses of 0.5 ml i/m
At an interval of 4 weeks
• Need of booster -undetermined

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2/7/2019 50
• 3 Cell culture derived-live
attenuated vaccine based
on SA14-14-2 strain.

50. Dr. Harivansh Chopra
• SA-14-14-2 single dose followed by single booster at an
interval of 1 year.
• This is an integral part of universal immunization program
in 83 endemic district of UP ,Assam ,West Bengal and
Karnataka in age goup 1-15 yeas.
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51. Dr. Harivansh Chopra
2/7/2019 52
As per Govt. of India
guidelines, 2 doses of JE
vaccine have been approved
to be included in UIP to be
given one along with
measles at the age of 9
months and the
second with DPT booster at
the age of 16-24 months
w.e.f. April, 2013

52. Dr. Harivansh Chopra
• Vaccination of swine is extremely important for both
public health and economic reasons.
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53. Dr. Harivansh Chopra
• Not easily amenable to
control.
• Ground fogging with ultra
low volume insecticides.
Vector control
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54. Dr. Harivansh Chopra
2/7/2019 55
• villages with in the proximity
of infected village should be
kept under surveillance.

55. Dr. Harivansh Chopra
2/7/2019 56observerzparadise.com

56. Dr. Harivansh Chopra
2/7/2019 57
MCQ
WHICH of the following states have maximum no of cases of JE
1. TAMIL NADU
2. ANDRA PRADESH
3. BIHAR
4. UTTAR PRADESH
4

57. Dr. Harivansh Chopra
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Q 2The ratio of overt disease to in apparent infection varies from
1. 1:100
2. 1:200
3. 1:300
4. NONE OF THE ABOVE
3
MCQ

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2/7/2019 59
Mortality due to japanese encephalitis is in between
1. 5-10%
2. 10-15%
3. 20-25%
4. 60-70%
3
MCQ

59. Dr. Harivansh Chopra
2/7/2019 60
Q.4 Age of administration of SA 14-14-2 vaccine is
1. One year
2. Two year
3. Three year
4. None of the above
4

60. Dr. Harivansh Chopra
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Q.5 WHICH OF THE FOLLOWING IS THE VECTOR
OF JAPANESE ENCEPHALITIS IN INDIA
1. CULEX TRITAENIORHYNCHUS
2. CULEX VISHNUI
3. CULEX GELIDUS
4. ALL OF THE ABOVE
4

61. Dr. Harivansh Chopra
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conclusion
Japenese encephalitis is a disease with high mortality
and leaves behind a cripping disability.
It can be prevented by the effective use of vaccine
as well by vector control and environmental modification

62. Dr. Harivansh Chopra
2/7/2019 63observerzparadise.com