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Japanese Encephalitis: Case in Odisha
- 2. JAPANESE ENCEPHALITIS SUBASH KUMAR PATRA NEWSHREE ROUT 3RD SEMESTER S.C.B. MEDICAL COLLEGE CUTTACK DR BIMOCH PROJNA PATY ASSOCIATE PROFESSOR, DEPT. OF MICROBIOLOGY S.C.B. MEDICAL COLLEGE CUTTACK
- 3. INTRODUCTION Japanese Encephalitis is an arboviral infection of horses, pigs, birds and humans caused by mosquito borne Japanese Encephalitis Virus(JEV) Why the name ARBO ???ARTHROPOD BORNE
- 4. HISTORY 1871: 1st case of JE 1924: Great epidemic in Japan -6125 human cases, 3797 deaths 1930’s: JE vaccines first became available 1935: Virus first isolated -From a fatal human encephalitis case 1938: Virus first isolated from mosquito
- 7. DISTRIBUTION IN INDIA Mainly in the rural agricultural areas where flooding irrigation is practised Transmission is usually during rainy season but can also occur all round the year in tropical areas Highest incidence in states of: Uttar Pradesh Assam Bihar
- 8. ETIOLOGY
- 9. ABOUT THE VIRUS Caused by Arbo Virus CLASS B Genus: Flavivirus Genome: ss RNA Mol. Weight: 3x106 Dalton Virion: spherical, lipoprotein enveloped particles 40-50nm in diameter 3 structural and 7 non structural proteins
- 10. RESISTANCE Temperature: Destroyed by heating above 56oC for 30 minutes pH: Inactivated in acidic environment pH 1-3 Survival: sensitive to UV light and gamma irradiation
- 11. TRANSMISSION
- 12. HOSTS AND VECTORS Amplifying host: Pig Reservoir host: Ardeid birds (heron, erget) Incidental host: Human, horse, donkey Vector: Mosquito (Culex tritaeniorhynchus)
- 13. AMPLIFYING HOST An amplifying host is a host in which the level of pathogen can become high enough that a vector that feeds on it will probably become infectious.
- 14. RESERVOIR HOST A reservoir host can harbour a pathogen indefinitely with no ill effects
- 15. INCIDENTAL HOST An incidental host is an intermediate host that generally does not allow transmission of the virus, thereby preventing the parasite from completing its development They are also known as
- 16. VECTOR • Culex tritaeniorhynchus is the chief mosquito vector for JE • Wide host range • Oviposit in flooded fields • Active during twilight • Other species (ades, anopheles, mansonia)
- 17. ENVIRONMENT Flooded fields Fish ponds Rice paddy Ditches
- 18. I amso sick
- 19. PATHOGENESIS
- 20. Manifestation of various neuronal symptoms Virus proliferates and damages the neuronal tissue Virus is transported to brain via blood After multiplication in R.E. system, viremia ensues Virus enters the body through the bite of mosquito
- 21. CLINICAL FEATURES Prodermal stage Acute encephalitic stage Late stage Sequale
- 22. PRODERMAL STAGE Lasts for 1-6 days Fever, Rigor Headache GI problems Lethargy Malaise
- 23. ACUTE ENCEPHALITIC STAGE Convulsions Altered sensorium, unconsciousness, coma Tremor Abnormal movement of limbs Mask like face Stiff neck Muscular rigidity
- 24. LATE STAGE Mental impairment Increased deep tendon reflex Epilepsy Speech impairment Behaviour abnormalities
- 25. PATHOLOGICAL FEATURES Perivascular chronic inflammation Microglial nodules Neuronophagia Neutrophilic inflammatory filtrate Bilateral Thalamic Hemorrhage
- 27. DIAGNOSIS History Brain tissue analysis CSF analysis: moderately increased CSF protein Serological tests: JE specific IgM
- 28. TREATMENT No antiviral drug for JE has been found yet Only supportive treatment: Suction-oxygen IV fluids and mannitol Anti convulsion Inj. Paracetamol
- 29. JENVAC JENVAC ® is a purified inactivated JE vaccine Prepared at National Institute of Virology, Pune 2 doses of 0.5 ml at 28 days interval Booster dose after 1 year
- 32. SANITARY PROPHYLAXIS Housing of animals indoors in screened stabling During JE outbreaks During peak vector activity Aerial or ground fogging with ULV insecticides
- 33. MEDICAL PROPHYLAXIS Vaccination of humans, horses and pigs Available under UIP in 112 endemic districts of India Travellers are needed to take proper vaccination before visiting the south east Asian countries
- 34. AGRICULTURAL PRACTICES Adopt water management practices of paddy cultivation by having a dry day in a week this will: Conserve water Reduce larval population Increase rice grain yield Reduce emission of methane Using neem products as fertilizers.
- 35. ANIMAL RESERVOIR Japanese encephalitis was controlled in Japan by vaccinating the pig population All pig rearing practices must be undertaken away from human habitations This kind of practice of pig husbandry must be promoted (bank loans)
- 36. VECTOR CONTROL Eliminate mosquito breeding areas Adult and larva control: ULV insecticides and PPM Cover all water containers, wells, water storage tanks Use mosquito nets, coil incenses mosquito repellents
- 38. CASE SENARIO IN ODISHA Most affected district : Malkangiri 1st JE death – 8th Sept 2016 Death toll reached more than 130 Now Odisha has been added to the list of JE high burden state [23rd Nov 2016]
- 39. CAUSE More faith in tantriks than doctors Low availability of doctor No. of doctors Entire district District HQ Present 23 11 Required 115 45 23 Entire District 11 District HQ
- 40. EXPERTS SPEAK… Dr John Jacob, CMC Vellore suspected Cassia Occidentalis beans (bana chakunda) to be culprit Case similar to Saharanpur, UP case of 2007 (81 deaths)
- 41. REFERENCES