2. JAPANESE ENCEPHALITIS
Japanese encephalitis is a
mosquito-borne viral infection.
Japanese Encephalitis is the
inflammation of brain,due to Group B
Arbo virus transmitted by Culex
mosquitoes.
It is directly affect to the central
nervous system and may cause severe
complications.
3. Incidence
Japanese encephalitis is most common in Japan,
widespread throughout Southeast Asia.
China, Korea, Japan, Taiwan, and Thailand have
had outbreaks in the past, but they have mainly
controlled the disease by vaccination.
In India,It was diagnosed first time in 1995 at
Vellore, and in Assam, UP,Bihar,TN has been
reported later.
The majority of cases about 85% among children
below 15 years of age.
5. Agent
Group B Arbo virus in the genius group of
Flaviviridae
Domestic pigs and wild birds
(especially herons) are reservoirs of the
virus.
6. Host
All age groups & Both gender
More in children under 15 years of
age
Environment
Rainy season.
7. Incubation Period
5-15 days.
Clinical Manifestations
Clinical features are divided into 3
stages:
1. Prodromal stage
2. Acute Encephalitic stage
3. Late stage
8. 1. Prodromal stage
The onset of illness is usually acute & the
duration of this stage is usually 1-6 days.
Fever(38-41’c)
Headache
Rigors (Intensive shivering)
GI disturbances
Nausea & Vomiting
Lethargy
9. 2. Acute Encephalitic stage
This stage begins by 3-5th day
High grade fever
Nuchal rigidity
Convulsions signs of increased ICP
Unconsciousness
Dystonia
Dysphasia
Hemiplegia
Quadriplegia
10. 3. Late stage
This stage begins when active
inflammation reduced
ie,the temperature & ESR touch
normal.
CNS involvement is more in this stage.
Mental impairment
Epilepsy
Behavioural abnormalities.
The average period between the onset of
illness and death is about 9 days only.
11. Laboratory Diagnosis
• Detection of Antigen from serum or
cerebrospinal fluid (CSF) to detect virus-
specific IgM antibodies within 7 days of
onset of disease.
• 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
12. Laboratory Diagnosis
Confirmatory testing is only available
at CDC (Centers for Disease Control and
Prevention) and a few specialized
reference laboratories.
Healthcare providers should contact
their state or local health department
or the CDC Arboviral Diseases Branch
for assistance with diagnostic testing
13. Prevention & Control of Japanese Encephalitis
1. Early Detection,First Aid & Referral
JE can be recognised by following
symptoms and first Aid can be given by
parents till the child is shifted to the
hospital;
Fever
Loss of consciousness or altered
behavioural changes over 1 hour to 4 days
Observe for new development of
symptoms like abnormal movements &
posture,Squint,mouth deviating to one
side.
14. Guidelines for parents
While shifting the child to hospital,:
Keep the nose & mouth clean and
saliva should be cleared from
mouth.
Keep the child on one side with
head in a little lower position
If cold,wrap in a cloth & if fever,do
sponging.
17. 3. Vector control
• Chemical Control
Insecticides.eg: malathion, fenitrothion
• Biological Control
Larvivorous fish are those that feed on
immature stages of mosquitoes where the
stagnation of water for their growth.
• Personal Prophylactic Measures
Bed mosquito nets, wear long sleeves to
cover the exposure body parts,mosquito
repellents.
18. Medical Management of Japanese
Encephalitis
Control Hyperthermia by
hydrotherapy & antipyretics.
eg:Paracetamol
Manage convulsion with anti-convulsive
drugs such as:
Phenytoin 15-20mg/kg
Diazepam 0.1-0.3 mg/kg (sedative)
19. Maintain ICP with initial dose of
Mannitol 2.5 ml/kg of 20% solution to
be given.
After 30 minutes of mannitol
infusion,re-assess the ICP and still
increased,then administer Frusemide
1mg/kg in Q12H
Symptomatic treatment
20. Nursing Management
• Assess the condition of the
patient
• Monitor vital signs
• Maintain Intake-output chart.
• Monitor BP & potassium level frequently.
• Maintain fluid & electrolyte balance to
prevent Hypovolemia.
• Provide thorough mouth care.
