2. INTRODUCTION
• Japanese Encephalitis is a viral disease
• caused by an arbovirus, group B (Flavivirus)
transmitted by culex mosquitoes.
• It is transmitted by infective bites of female
mosquitoes mainly belonging to Culex
tritaeniorhynchus, Culex vishnui and Culex
pseudovishnui group.
• JE virus is primarily zoonotic in its natural cycle
and man is an accidental host.
• JE virus is neurotropic primarily affects CNS.
3. DISTRIBUTION
• Occurs almost all Asian countries.
• Japan, Korea and some parts of china,
The disease is increasingly reported from.
Bangladesh,India,Pakistan,Nepal,Bhutan,
Burma, Sri Lanka and Thailand In the form of-
outbreaks, sporadic cases and endemic.
4. cont
• An estimated 50000cases of JE occurs globally
each year with 10,000deaths and nearly
15,000disabled.
• The wast majority of the cases ie 85% occure
in the childrens less then 15 yrs of age n
nearly 10% of the cases ocuure over 60yrs
6. Problem in india
1952 - First evidence of JE viral activity during sero-surveys for arbo-
viruses.
1955 - First human case
1958 - First viral isolation.
1973 - First outbreak- Bankura and Burdwan in West Bengal.
1976 - Repeat outbreak in Burdwan.
1978
Widespread occurrence of suspected JE cases.
National level monitoring initiated by NMEP in 1978.
Initiation of immunization using inactivated mouse brain vaccine
7. • Andhra Pradesh
• Assam
• Bihar
• Haryana
• Kerala
• Karnataka
• Maharashtra
• Manipur
• Nagaland
• Tamil Nadu
• Uttar Pradesh
• West Bengal
8. Distribution of cases & deaths of JE in India since
1996.
Years Cases Deaths
1996 2244 593
1997 2516 632
1998 2120 507
1999 3428 680
2000 2593 556
2001 2061 479
2002 1765 466
2003 2568 707
2004 1695 367
2005* 4647 1045
9. Aetiology
• Cased by arbovirus of family Flavivirus.
Transmitted by the bite of five genera of
Culex,
Anopheles,
Aides,
Mansonia
Amergeres.
10. Epidemiology
• Infects - nearly 50,000 people
• Deaths -10,000
• zoonotic disease -pigs, birds and horses.
• Man -accidental host plays no role in
propagating the virus.
11. cont
• Start -in the month of April-May,
• Peak -August & September.
• Decline -by the end of September and the
beginning of October, to level
of in the month of November.
• 90% -ranging from mid July to October,
coinciding with the rainy season and after the
rainy season.
15. JE in man
• Incubation -5-15 days.
• Not all individuals bitten by the infected
mosquitoes develop the disease.
• The ratio of overt disease of in apparent
infection varies from 1:300 to 1:1000.
17. Signs & Symptoms
• Symptoms can include headache, fever,
meningeal signs, weakness, disorientation,
coma, tremors, paralysis (generalized), loss of
coordination, etc.
• Prodromal stage may be abrupt (1-6 hours),
acute (6-24 hours) or more commonly
subacute (2-5 days)
18. cont
a) Prodromal stage- fever,
- headache,
- malaise,
- lasts 1-6 days.
a) Acute encephalitic stage:
high fever,
neck rigidity, ,
convulsions,
death may occur.
c) Late stage & sequelae:
symptoms of CNS involvement starts disappearing
and convulsion are prolonged.The period between
the onset of illness and death is about 9 days.
19. Dignosis
Clinical:
febrile illness of variable severity associated with
neurological symptoms ranging from headache to
meningitis or encephalitis.
Symptoms can include headache, fever,
meningeal signs, stupor, disorientation, coma,
tremors, paralysis (generalized), hypertonia , loss
of coordination.
20. cont
• Laboratory:
• Antibody detection: Heamagglutination Inhibition Test
(HI), Compliment Fixation Test (CF), Enzyme Linked
Immuno-Sorbant Assay (ELISA) for IgG (paired) and IgM
(MAC) antibodies, etc.
• Antigen Detection: RPHA, IFA, Immunoperoxidase etc.
• Genome Detection - RTPCR
• Isolation - Tissue culture, Infant mice, etc
• In view of the limitations associated with various tests,
IgM ELISA is the method of choice provided samples
are collected 3-5 days after the infection.
21. Treatment of Japanese Encephalitis
There is no specific anti-viral medicine available
against JE virus.
• Clinical management of JE is supportive and in
the acute phase is directed at maintaining fluid
and electrolyte balance and control of
convulsions, if present. Maintenance of airway is
crucial.
22. Control & prevention of J E
1. Early case detection and prompt treatment
2. Vector control.INTEGRATED VECTOR MANAGEMENT (IVM)
3. Vaccination
23. EARLY CASE DETECTION AND PROMPT TREATMENT
Early case detection
Prompt treatment
Building surveillance
networking
Improved access to
Rapid Diagnostic
Tests (RDTs)
Improved access to
treatment
24. V
E
C
T
O
R
C
O
N
T
R
O
L
BREEDING PLACES OF VECTOR MOSQUITOES
• Constructi
on projects
• Discarded,
Old tyres
• Coolers
• Plastic
containers
/cups
• Water
storage
tanks
• Barrels/Du
stbins
• Junk yards
• Cocoanut
shells
25. Indoor Residual Spray- DDT,
Malathion, Synthetic Pyrethroids
in selected high risk pockets
INTEGRATED VECTOR MANAGEMENT (IVM)
26.
27. IVM (LARVIVOROUS FISH)
• Cost-effective,
• Environment-friendly
• Emphasis on perennial natural water bodies
as hatcheries due to climatic conditions.
28. • Bed nets for high risk rural
tribal areas.
• Priority beneficiaries - Below
Poverty Line population
especially pregnant women
and children.
• Synthetic Pyrethroid tablet
formulation for treatment of
bed nets at individual level.
IVM (INSECTICIDE TREATED BED NETS)
29. vaccination
1. Mouse brain inactivated vaccine:
Dose 2 doses / subcutaneously at an
interval 4 weeks apart.
Booster -after 1 year and then after 3
years.
Dose 0.5 ml for 1-3 year child.
1 ml for all above 3 years.
30. 2. Cell culture inactivated vaccine: it is Beijing P3
vaccine and propagated in primery hestor
kidney cells.
Dose - 0.5 ml for all ages.
Doses -2
Interval -1week
Route -sc
Booster dose -after 6 months to 1 year and
then at third year.
.
31. 3. Cell culture live attenuated vaccine : it SA 14-
14-2 strain and is propagated in primary
Hamster kidney cells.
single dose -0.5 ml
Route -subcutaneously
Booster -after 2 years.
32. Prevention & control
• Govt of India: task force at a national level
in operation →reviews JE
situations time
to time.
• Under NVBDCP →technical support provided to
states for outbreak investigation & control
33. Strategy
• Strengthening surveillance activities through
sentinel sites in tertiary care institutions.
• Early diagnosis & proper case management at
PHCs, CHCs, & hospitals.
• Behavior change communication of community
to promote early case reporting, personal
protection, isolation of amplifier host.
34. • Integrated vector control measures like fogging
during outbreaks, spraying in animal dwellings,
antilarval operations & personal protection.
• Capacity building through training of medical &
nursing staff
• Development of a safe & standard indigenous
vaccine. Vacination for high risk population, children
of 1-15 yrs age.
35. • Epidemiological monitoring of disease for
effective implementation of prevention &
control strategies.
• Responding to out break situations
• Investigation of epidemic & its containment
• Community awareness through IEC activities
• Sentinel surveillance through serological &
clinical surveilance.
36. THE STEPS TAKEN BY GOVT. OF INDIA TOWARDS PREVENTION
AND CONTROL OF AES/JE ARE AS FOLLOWS
• JE vaccination campaign was launched during 2006 wherein 11
most sensitive districts in Assam, Karnataka and Uttar Pradesh
were covered. Altogether 86 JE endemic districts in the states
of Assam, Andhra Pradesh, Bihar, Haryana, Goa, Karnataka,
Kerala, Maharashtra, Tamil Nadu, Uttar Pradesh and West
Bengal have been covered.
• During 2009-2010 an amount of Rs.2.90 crores was allocated to
the JE endemic states.
• Re-orientation training course on JE case management is a
continuing process. Such orientating training courses were
carried out in Andhra Pradesh, Assam, Haryana, Karnataka,
Tamil Nadu, Uttar Pradesh and West Bengal during 2008 and
2009 respectively.
37. • The diagnostic facilities have been strengthened at 50
sentinel and 13 Apex Referral Laboratories including 15
sentinel sites established in Uttar Pradesh. These have
been supplied with diagnostic kits free of cost from
National Institute of Virology (NIV), Pune.
• Guidelines were developed on JE case management
and on prevention and control of Entero-viruses which
have been circulated to the states.
• For establishing a Physical, Medicine & Rehabilitation
(PMR) department at BRD Medical College for treating
physical disabilities due to AES/JE, MOU has been
submitted to the state of Uttar Pradesh.
38. • One Vector Borne Disease Surveillance Unit
(VBDSU) and one JE sub-office was established
at BRD Medical College, Gorakhpur, Uttar
Pradesh.
• Further, for establishing 50 bedded AES/JE
treatment facilities at BRD Medical College,
Gorakhpur, an amount of Rs.5.88 crores has
been released under NRHM during 2009-10.
*****
39.
40. Chikungunya
• Chikungunya (chik.-en-GUN-yah), also called
chikungunya virus disease or chikungunya fever, is
a viral illness that is spread by the bite of infected
mosquitoes. The disease resembles dengue fever,
and is characterized by severe, sometimes
persistent, joint pain(arthiritis), as well as fever
and rash. It is rarely life-threatening.
• Chikungunya occurs in Africa, India and
Southeast Asia. It is primarily found in urban
/peri-urban areas.
• Incubation 4-7 dys
42. Statement of the problem
• 1st found in Tanzania 1952-53
• First out break in india at Kolkota 1963-64
• Chennai 1965 viz gave rise to 300000 cases in
chennai city alone
• The disease has reappered after 41 years
during 2006 ther was largeoutbreak in india
with 1.3 million officially reported cases
spread over 16 states
43. • The states affected by chikungunya are Andhra
Pradesh, Karnataka, Maharasthra, TamilNadu,
Madhya Pradesh, Gujarat, Kerala, A&N Island,
GNCT of Delhi, Rajasthan,Pondicherry, Goa.
47. Transmission
• Chikungunya is spread by the bite of an
Aedes mosquito, primarily Aedes aegypti.
• Humans are thought to be the major source,
or reservoir, of chikungunya virus for
mosquitoes. Therefore, the mosquito usually
transmits the disease by biting an infected
person and then biting someone else. An
infected person cannot spread the infection
directly to other persons.
50. Signs & symptoms
• Abrupt onset of fever
• Severe joint pain.
• Other S/S
Muscle pain,
Headache,
Nausea,
Fatigue and rash.
• Joint pain is often very
debilitating,
51. Diagnosis
• Chikungunya is diagnosed by blood tests
(ELISA). Since the clinical appearance of both
chikungunya and dengue are similar,
laboratory confirmation is important
especially in areas where dengue is present.
• Diagnosis by Real Time – Polymerase chain reaction
(RT–PCR) Test
52. Treatment
• There is no specific treatment for
chikungunya. Supportive therapy that helps
ease symptoms, such as administration of
non-steroidal anti-inflammatory drugs, and
getting plenty of rest, may be beneficial.
• Infected persons should be isolated from
mosquitoes as much as possible in order to
avoid transmission of infection to other
people.
53. Vector control measures
1.Indoor space spraying:
Pyrethrum extract after dilution is
sprayed
Advantages of Indoor pyrethrum
space spray:
Non-toxic to humans and
other non-target organisms
Not developed resistance
Equipment is cheap, and
easily available
54. 2 Outdoor space spraying
Ultra Low Volume (ULV) Spray:
Minimum volume of liquid insecticide formulation
Organo-phosphorous insecticides (malathion)
More cost-effective than thermal fogging
55. Control and prevention
• Avoiding mosquito bites.
Eliminating mosquito
breeding site
• Use mosquito repellents on
skin and clothing
When indoors, stay in well-
screened areas. Use bed
nets if sleeping in areas that
are not screened or air-
conditioned.
56. • By elimination of all potential vector breeding
places near the domestic or peridomestic areas.
• Not allowing the storage of water for more than a
week.
• Straining of the stored water by using a clean cloth
once a week to remove the mosquito larvae from
the water and the water can be reused. The sieved
cloth should be dried in the sun to kill immature
stages of mosquitoes.
57. Use of larvicides
• Where the water cannot be removed but used for
cattle or other purposes,
Temephos can be used once a week at a dose of 1 ppm
(parts per million).
• Pyrethrum extract (0.1% ready-to-use emulsion) can be
sprayed in rooms (not
outside) to kill the adult mosquitoes hiding in the
house.
Biological control
• Like introduction of larvivorous fish, namely Gambusia
and Guppy in water tanks
and other water sources.
********
58.
59. Kala azar Leishmania
Donovani
1-4
Months
13 million
cases
worldwide
•Control reservoir
•Treatment
•Sand fly control
•Personal prohylaxis
•K.A controle prog
•National health
polocy 2002
•Elim 2010
Dengue Aedes aegypti 3- 10 dys 50million
each year
•V cntrol
•Envi managnt
•H edu
•2003-04 conciderd as
Vb diseases
•Namp utilization
Je Culex
tritaeniorhynchus
5-15 dys 5lack/10000
globaly
•Early case detection
• Tretmnt
•Vector control
•Vaccine
•2003-04 conciderd as
Vb diseases
Chickunguny Aedes 4-7 dys 1390322 in
india 2006*
•Vector control
•Persnl prophlaxis
•NAMP guidelines
Utilized
Disease Cstive orga Icubation Burden Control mes Gvt Plans
•NVBDCP
60. references
• K Park: text book of preventive and social
medicine; edt -18 & 21
• Text of Public Health and Community
Medicine: Armed Force Pune
• Davidson`s Principles and practice of medicine
• Sundarlal Adarsh Pankaj: text book of
community medicine; edt-1st
• www.whoindia.int/chi
• www.nvbdcp.com
61. • Topley & Wilsons Text book of parasitology 9th
(Edn), 428-524
• O P Ghai Text book of preventive and social
medicine, 161-162
• Harrisons Text book of Medicine, 15th (Edn),1428-
1430
• Ananth Narayans Text book of Microbiology, 2nd
(Edn),209-211
