This document describes a case of a 30 year old male who was admitted to a private hospital on the 2nd day of fever in a non-responsive state with no eye opening, limb movement, or abnormal movements. On the 3rd day, the patient experienced abnormal movements including uprolling of eyes and generalized tonic-clonic seizures of all four limbs with two similar episodes on the 4th and 5th days. The fever was moderate to high grade and the patient remained in an altered sensorium following the seizures.

4. Private hospital admission on D2 of fever
Non-responsiveness
No eye opening / movement of limbs
No abnormal movements
Abnormal movements on D3 of fever
Normal breathing
Uprolling of eyes / Generalized tonic-clonic
movements of all 4 limbs
2 similar episodes on D4 and D5 of illness
Moderate to high grade on D5, remained in altered
Following seizures
Undocumented till admission
sensorium
Not a/w chills / rigors
Present through out the day
Not responsive to Anti-pyretics
FEVER
D-7 D-4 Day of Admission
D-0

7. 30 yr old 33 yr old
On D 15 OL Soon after On D 3 OL 3 month old
Birth – INDEX case

9. DEVELOPMENTALLY NORMAL INFANT

12. Weight-for-age GIRLS
Birth to 5 years (z-scores)
30 30
3
28 28
2.5
26 26
2
24 24
22 22
20 20
Weight (kg)
18 0 18
16 16
14 -2 14
-2.5
12 -3 12
10 10
8 8
6 6
4 4
2 2
Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10
Birth 1 year 2 years 3 years 4 years 5 years
Age (Completed months and years)

23. Children with bacterial meningitis appear to be more
critically ill than those with viral meningoencephalitis but
for obvious reasons..

25. Cyto Sugar Protein G/S
C/S
10/10/11 No cells 42 184 Sterile
14/10/11 No cells 51 68 Sterile

26. BACTERIAL VIRAL
CELLS 1000 / cmm Usually < 1000/ cmm
75-95% polys
Turbidity ( >200- 400)
20% cases (< 250)
GLUCOSE Usually < 40 mg% Usually Normal
< 50% of serum glucose < 40 in mumps
PROTEINS 100 – 500 mg% 50 – 200 mg%
GRAM STAIN 70 – 90 % positive Negative

27. 10/10 12/10 13/10 13/10 14/10 15/10 16/10 18/10 18/10 19/10
Na 142 149 143 141 143 144 137 144 142 138
K HI 5.5 5.8 4.0 4.6 3.6 hi 4.5 4.7 4.5
Cl 118 123 116 101 104 114 91 102 101
Urea 21 13 14 14 11 14 19 14
Creat 0.4 0.4 0.3 0.2 0.2 0.6 0.2 0.2 0.6 0.4
T Bil 0.7 0.7
Ca 10 NR
PO4 NR
AST 74 68 42
ALT 42 40 44
ALP 168 NR NR
TP
ALB 2.8 2.5 2.1

28. 10/10 12/10 15/10 17/10 19/10
Hb 9.9 10.9 10.5 10.1 8.5
TLC 17800 10800 17500 23100 12900
DLC 58/34/3/1 50/42/9/6 58/38/3/1 34/60/0/6
Platelets 401,000 333,000 290,000
Peripheral N/N N/N
smear
P/A

29. 13/10 14/10 14/10 15/10
pH 7.56 7.38 7.47 7.42
pO2 160 138 159 167
pCO2 11.9 40 36 33.5
HCO3 10.4 23 26 21.5
BE -7.7 -1.2 3.0 -2
SpO2 (%) 99 99 99 99
SUPPORT Np O2 Np O2 NpO2 None

41. History
• 1870'’s: Japan
• “Summer encephalitis” epidemics
• 1924: Great epidemic in Japan
• 6,125 human cases; 3,797 deaths
• 62% case-fatality rate
• 1935: First isolated in Japan
• From a fatal human encephalitis case
• 1938: Isolated from Culex tritaeniorhynchus
41

42. 42

43. Outbreak 2005 in India
• Index case : Nepal, mid-June
• First case India : July 20th
• First outbreak alert : August 12th
• Confirmation JE : August 21st
• Total deaths : 1302
• Total cases : > 5000
43

45. Transmission: Sources of Infection
• Arthropod-borne viruses (Arboviruses)
• Enzootic or zoonoses disease
• Amplifying hosts
• Pigs (the main reservoir)
• Wading birds (egrets, herons), Bats
• Incidental hosts
• Horses, humans (dead-end hosts)
• Others
45

47. Transmission
• Vectors: Mosquitoes
• Culex tritaeniorhyncus
• The mosquitoes that transmit the virus breed in rice fields and
standing water.
• In winter, virus persist in arthropod eggs or migrate with
birds.
• Death of infected no-human vertebrates occurs before human
outbreak.
47

48. Transmission: Susceptible Population
Age: 2-10 years
Living in rural areas
People who live near
stagnant water
(mosquito breeding)
48

49. 49

50. 50

51. 51

52. 52

53. 53

54. 54

56. 56

57. Prevention
• Vector (Mosquito) control
• Eliminate mosquito breeding areas:
• Chemical larvicides, Biolarvicides, Environmental management
• Adult and larval control:
• Anti-larval treatment
• Vaccination
• Personal protective measures
• Avoid prime mosquito hours: from dusk to dawn
• Indoor spray and fogging: Use of Insecticide 57

58. Cell culture derived SA- 14-14-2 Vaccine
Not to be used as a “Outbreak response
Vaccine”
To be used in routine vaccination
Two doses at least 4 weeks apart

61. QUERIES ?