1. Introduction
Japanese encephalitis virus (JEV) is a mosquito borne encephalitis caused by group B arbovirus (flavivirus) and transmitted by Culex mosquitoes.
It is a zoonotic disease,i.e. infecting mainly animals and incidentally man.
JE is the leading cause of viral encephalitis in asia and occurs in almost all Asian countries. Largely as a result of immunization, its incidence has been declining in japan, the Korean peninsula and in some regions of china, but the disease is increasingly reported from Bangladesh, India, Nepal, Pakistan, northern Thailand and Viet Nam.
World Encephalitis Day is celebrated on 22nd February every year by raising awareness about encephalitis.
2. Magnitude of problem
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.
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.
More than 3 billion people are at risk of developing the disease.
3. Global Scenario
Major epidemics were reported from Japan (1871 and 1924), northern Vietnam (1965), Thailand (1969, 1970), India (1973), Nepal (1978) and from Sri Lanka (1985-87).
At present, the geographic range of JEV infection extends from eastern to Southeast Asia and northern Australia, and to southern Asia.
However, it is likely to increase in Bangladesh, Cambodia, Indonesia, Laos, Myanmar, North Korea, Pakistan, Philippines and other countries because of population growth, intensified rice farming, pig rearing, and the lack of vaccination programs and surveillance.
4. Risk Factors
Common risk factors in the development of Japanese encephalitis are:
Residents or military in Southeast Asia and Western Pacific regions
Summer season
Outdoor recreational activities
Accommodations in endemic areas that lack air conditioning, bed nets, or window screens
Contact with: Mosquitos, Birds , Pigs
5. Agent Factor
JEV is transmitted to humans through bites from infected mosquitoes of the Culex species (mainly Culex tritaeniorhynchus).
The virus exists in a transmission cycle between mosquitoes, pigs and/or water birds (enzootic cycle).
6. Host factor
Pigs and aquatic birds (mainly herons and egrets of the Ardeidae family) are the natural hosts for the virus.
Pigs are considered amplifying hosts since they allow manifold virus multiplication without suffering from disease and maintain prolonged viraemia .
In endemic areas, most people are infected below the age of 15 years.
In hyper – endemic areas, half of all Japanese encephalitis cases occur before the age of four years, and almost all before 10 years of age.
7. Mode of Transmission
JE virus is transmitted to humans through the bite of infected Culex species mosquitoes, particularly Culex tritaeniorhynchus.
The virus is maintained in a cycle between mosquitoes and vertebrate hosts.
Swine flu is a respiratory disease. It is caused by the influenza viruses that infect the respiratory tract of pigs. It can lead to symptoms such as a barking cough, decreased appetite, nasal secretions, and listless behaviour; the virus can be transmitted to humans. The Swine flu vaccination or H1N1 vaccination is crucial to provide immunity against swine flu.
Swine flu is a respiratory disease. It is caused by the influenza viruses that infect the respiratory tract of pigs. It can lead to symptoms such as a barking cough, decreased appetite, nasal secretions, and listless behaviour; the virus can be transmitted to humans. The Swine flu vaccination or H1N1 vaccination is crucial to provide immunity against swine flu.
For the nurse to be effective in the dynamic complex health care system and to help client to achieve the outcome , nurses need to be knowledgeable , resourceful and able to work well with other health care practioners.
Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Immunization helps protect the child from life threatening diseases. It also helps reduce the spread of disease to others. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or
disease. Babies are born with some natural immunity which they get from their mother through breast-feeding. This immunity gradually diminishes as the baby's own immune system starts to develop. Immunization is one of the most cost-effective health investments and vaccination does not require any
major lifestyle change. There are two main types of immunization, active immunization and passive immunization.
Both types of immunization prepare the body to fight against certain diseases.
For the nurse to be effective in the dynamic complex health care system and to help client to achieve the outcome , nurses need to be knowledgeable , resourceful and able to work well with other health care practioners.
Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Immunization helps protect the child from life threatening diseases. It also helps reduce the spread of disease to others. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or
disease. Babies are born with some natural immunity which they get from their mother through breast-feeding. This immunity gradually diminishes as the baby's own immune system starts to develop. Immunization is one of the most cost-effective health investments and vaccination does not require any
major lifestyle change. There are two main types of immunization, active immunization and passive immunization.
Both types of immunization prepare the body to fight against certain diseases.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. CONTENT
Introduction
History
Magnitude of problem
Current scenario
Risk factors
Epidemiological situation in nepal
Agent, Host, Environment
Mode of transmission
Signs and Symptoms
3. Clinical features
Diagnosis
Treatment
Preventions and Controls
Vaccination
Policy of Government of Nepal
4.
5. INTRODUCTION
Japanese encephalitis virus (JEV) is a mosquito borne
encephalitis caused by group B arbovirus (flavivirus) and
transmitted by Culex mosquitoes.
It is a zoonotic disease,i.e. infecting mainly animals and
incidentally man.
JE is the leading cause of viral encephalitis in asia and occurs in
almost all Asian countries. Largely as a result of immunization, its
incidence has been declining in japan, the Korean peninsula and in
some regions of china, but the disease is increasingly reported
from Bangladesh, India, Nepal, Pakistan, northern Thailand and
Viet Nam.
World Encephalitis Day is celebrated on 22nd February every
year by raising awareness about encephalitis.
6. HISTORY
Genetic studies, suggest that JEV originated from an ancestral
virus in the area of malay of Archipelago.
Clinical recognition dates back to 19th century - 1st clinical case in
1871, at Japan.
1924, a severe epidemic was reported from japan.
1934, Hyashi reproduced the disease in monkey by intra-cerebral
inoculation.
1935, JE virus was isolated from human brain in Tokyo, japan, and
its virological and serological Prototype, Nakayama strain, was
established.
7. Magnitude of problem
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.
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.
More than 3 billion people are at risk of developing the disease.
8. Global Scenario
Major epidemics were reported from Japan (1871 and 1924),
northern Vietnam (1965), Thailand (1969, 1970), India (1973),
Nepal (1978) and from Sri Lanka (1985-87).
At present, the geographic range of JEV infection extends from
eastern to Southeast Asia and northern Australia, and to southern
Asia.
However, it is likely to increase in Bangladesh, Cambodia,
Indonesia, Laos, Myanmar, North Korea, Pakistan, Philippines and
other countries because of population growth, intensified rice
farming, pig rearing, and the lack of vaccination programs and
surveillance.
9.
10. Nepal Scenario
• As a concentrated Japanese encephalitis (JE) control measure,
phase-wise mass vaccination campaigns were started in 2006 and
were completed in 31 high-risk districts by 2011.
• JE vaccine was introduced in phase-wise manner in the routine
immunization of these 31 districts by 2012. After these measures
were taken, JE burden reduced significantly in Nepal.
• However, over the years, as identified by surveillance, JE was
reported from other districts of Nepal as well. Following mass
vaccination campaign in the remaining districts in 2016, JE vaccine
was introduced in the routine immunization of all remaining 44
districts in July 2016.
• As shown in Figure, JE burden in Nepal has reduced significantly
in 2019 compared to the initial years when surveillance was
started.
11.
12. • It shows that 65 districts have reported AES cases in FY
2076/2077. Out of these 65 districts, five districts (Kaski, Siraha,
Saptari, Sunsari, Sankhuwasaba) have reported higher number of
AES cases (between 51-100), and three districts (Morang, Sunsari,
Kathmandu) have reported the highest (> 100).
• In total, 917 AES cases were reported. Among the total reported
AES cases, only 65 (7.08%) were laboratory confirmed for JE.
• This is a major reduction compared to the years before JE
vaccination was started when around 50% of the AES cases were
positive for JE. The majority of laboratory confirmed JE cases (21
out of 65; 32.30%) were reported from Province-1.
13.
14.
15. Risk Factors
Common risk factors in the development of Japanese encephalitis
are:
Residents or military in Southeast Asia and Western Pacific
regions
Summer season
Outdoor recreational activities
Accommodations in endemic areas that lack air conditioning, bed
nets, or window screens
Contact with: Mosquitos, Birds , Pigs
16. Epidemiological situation in Nepal
Appear in Nepal in the late 1970s. The first clinical diagnosis of
JEV infection was done in 1978 . Since then, JE has been endemic
in Terai region of Nepal.
Terai is a tropical, low land plains of Nepal bordering India which is
experiencing larger outbreaks in every 2-5 years.
A total 26,667 cases and 5,381 deaths occurred from JE in Nepal
within the 25 year period (from 1978 to 2003) with 20.2% average
case fatality rate.
Though it is mainly a disease of children, JE has been confirmed in
all age groups in Nepal and higher cases reported in males than in
females. JE has a typical seasonal pattern of outbreak in Nepal.
17. Agent Factor
JEV is transmitted to humans through bites from infected
mosquitoes of the Culex species (mainly Culex tritaeniorhynchus).
The virus exists in a transmission cycle between mosquitoes, pigs
and/or water birds (enzootic cycle).
18. Host factor
Pigs and aquatic birds (mainly herons and egrets of the Ardeidae
family) are the natural hosts for the virus.
Pigs are considered amplifying hosts since they allow manifold
virus multiplication without suffering from disease and maintain
prolonged viraemia .
In endemic areas, most people are infected below the age of 15
years.
In hyper – endemic areas, half of all Japanese encephalitis cases
occur before the age of four years, and almost all before 10 years
of age.
19. Environmental factors
Environmental factors related to transmission of JE are related
principally to temperature and humidity conditions conducive to
breeding and survival of the vector.
In tropical and subtropical areas, transmission intensifies in the
rainy season. In temperate locations, transmission usually starts in
April and may last until October.
Habitats supporting the transmission cycle of JE virus are
principally in rural, agricultural locations.
In many Asian countries, major outbreaks of JE occur at intervals
of 2 - 15 years.
20. Mode of Transmission
JE virus is transmitted to humans through the bite of
infected Culex species mosquitoes, particularly Culex
tritaeniorhynchus.
The virus is maintained in a cycle between mosquitoes
and vertebrate hosts, primarily pigs and wading birds.
Humans are incidental or dead-end hosts, because they usually
do not develop high enough concentrations of JE virus in their
bloodstreams to infect feeding mosquitoes.
JE virus transmission occurs primarily in rural agricultural areas. In
temperate areas of Asia, JE virus transmission is seasonal. Human
disease usually peaks in the summer and fall. In the subtropics
and tropics, transmission can occur year-round, often with a peak
during the rainy season.
21.
22. Signs and Symptoms
Most JEV infections are mild (fever and headache). In children,
gastrointestinal pain and vomiting may be the dominant initial
symptoms.
Severe disease is characterized by rapid onset of high fever,
headache, neck stiffness, disorientation, coma, seizures, spastic
paralysis and ultimately death.
The case-fatality rate can be as high as 30% among those with
disease symptoms. Of those who survive, 20%–30% suffer
permanent intellectual, behavioural or neurological sequelae such
as paralysis, recurrent seizures or the inability to speak.
23.
24. Clinical feature
Incubation period of Japanese encephalitis ranges from 5 to 15
days.
The illness has three stages:-
a) Prodromal stage: with fever, headache, vomiting, and other
nonspecific symptoms.
b) Acute encephalitic stage: with convulsions, coma, and signs of
raised intracranial tension.
c) Later Stage: Persistence of signs of CNS injury such as Mental
impairment, Increased deep Tendon reflexes, Paralysis either of
the upper or lower motor neuron type, Speech impairment,
Epilepsy, Abnormal movements, Behavior abnormalities.
25.
26. Diagnosis
A laboratory test is required in order to confirm JEV infection and to
rule out other causes of encephalitis.
Specimen: Virus could be isolated from brain tissue, blood, or
cerebrospinal fluid (CSF) of humans.
Microscopic observation: To confirm JE, microscopic observation
can be implemented through use of JEV specific monoclonal
antibodies for detection via immunofluorescence or
immunohistochemistry.
27. Reverse-transcription polymerase chain reaction (RT-
PCR) can detect JE viral RNA in clinical samples or
cell culture fluid using primers based on conserved
sequences specific to JEV.
The WHO manual for laboratory diagnosis of JEV
recommends testing for JEV-specific IgM antibody in a
single sample of cerebrospinal fluid (CSF) or serum,
using an IgM-capture ELISA is the gold standard for
detection.
28. Treatment
No specific treatments have been found to benefit patients with JE,
but hospitalization for supportive care and close observation is
generally required.
Mostly Less than 1% of people infected with Japanese encephalitis
(JE) virus develop clinical illness.
Treatment is symptomatic. Rest, fluids (hydrated), and use of pain
relievers and medication to reduce fever (Paracetamol) may
relieve some symptoms.
29. Prevention and Control
Japanese encephalitis virus is spread to people through the bite of
an infected mosquito. Mosquitoes bite during the day and night.
The best way to prevent Japanese encephalitis virus infection is to
protect from mosquito bites.
Use insect repellent, wear long-sleeved shirts and pants, treat
clothing and gear, using mosquito nets, and get vaccinated before
traveling.
Permethrin-treated mosquito nets provide more protection than
untreated nets.
Safe and effective JE vaccines are available to prevent disease.
30. Even if the number of JE-confirmed cases is low, vaccination
should be considered where there is a suitable environment for JE
virus transmission.
Thus, vaccination of humans should be prioritized over vaccination
of pigs and mosquito control measures.
WHO recommends having strong JE prevention and control
activities, including JE immunization in all regions where the
disease is a recognized public health priority, along with
strengthening surveillance and reporting mechanisms.
31. There are 4 main types of JE vaccines currently in use: inactivated
mouse brain-derived vaccines, inactivated Vero cell-derived
vaccines, live attenuated vaccines, and live recombinant (chimeric)
vaccines.
To reduce the risk for JE, all travellers to Japanese encephalitis-
endemic areas should take precautions to avoid mosquito bites.
Personal protective measures and mosquito elimination are the
most important.
32. Vaccination
Mass JE vaccination campaigns are first conducted in endemic
districts where, all children in the age group of 1 to 15 years will be
vaccinated
Later, JE vaccination is introduced into the routine immunization
schedule of that district
2 doses, 0.5 ml, subcutaneously…
1st dose along with measles vaccine at 9 months of age
2nd dose along with the booster dose of measles at 18-24 months
of age.
33. • Inactivated Vero cell culture-derived Japanese encephalitis (JE)
vaccine (manufactured as IXIARO) is the only JE vaccine licensed
and available in the United States. This vaccine was approved in
March 2009 for use in people aged 17 years and older and in May
2013 for use in children 2 months through 16 years of age.
• Other JE vaccines are
manufactured and used in
other countries but are not licensed
for use in the United States.
34.
35.
36.
37. Goal of Government
The goal of the Programme is to reduce morbidity, mortality and
disability in children due to JE/AES.
To achieve Japanese Enchephalitis Elimination.
38. Objective
(i) to strengthen and expand JE vaccination in affected districts
(ii) to strengthen surveillance, vector control, case management and
timely referral of serious and complicated cases
(iii) to increase access to safe drinking water and proper sanitation
facilities to the target population in affected rural and urban
areas
(iv) to estimate disability burden due to JE/AES, and to provide for
adequate facilities for physical, medical, neurological and social
rehabilitation
(v) to improve nutritional status of children at risk of JE/AES
39. Policy of Government of Nepal
Through surveillance and immunization, Nepal has made
remarkable progress against JE in the past few decades.
However, JE continues to spread to additional districts in Nepal—
including those in the hills and mountains, which may prove more
difficult to reach. The Nepal Ministry of health is continuing to
improve its JE prevention and control program in the following
ways:
1. Expanding JE vaccination to additional districts
In 2015, Nepal applied for funding from Gavi to expand its JE
vaccination program to 47 of the 75 districts in Nepal.
40. These campaigns began in May 2016 with the aim of vaccinating
an additional four million children in 44 districts in Nepal and
intensifying coverage in three Terai districts with existing routine JE
immunization.
Eventually, the country plans to expand JE into the routine
immunization program nationwide.
2. Balancing JE vaccines with other new vaccines
In addition to adding JE vaccine to its EPI schedule in 2006, Nepal
also added pentavalent vaccine in 2009, inactivated polio vaccine
in 2014, and pneumococcal conjugate vaccine in 2015.
41. Through careful planning and evidence-based decision making,
Nepal continues to coordinate JE vaccination alongside an
everexpanding list of other lifesaving vaccines and maximize
protection of its children.
3. Ensuring continued safety of JE vaccines
The WHO position paper on JE vaccines states that CD-JEV has
an acceptable safety profile and studies evaluating CD-JEV in
Nepal found the vaccine to be safe.
42. To ensure continued safety, Nepal’s EPI has plans to intensify and
strengthen safety surveillance in all districts with JE vaccination
through the central and district immunization safety committees.
4. Improving JE awareness through education
Education about JE and the availability of vaccines helps increase
community demand for JE vaccines, which can improve
vaccination coverage.
A 2012 survey of pig farmers in Nepal found that, although they
are at high risk for JE, only 42 percent of the farmers had heard of
JE, and none were vaccinated against it.
43. By continuing to improve JE awareness through education, the
Nepal MOH aims to increase the reach and sustainability of JE
vaccination to all those at risk.
5. Identification of epidemic prone areas
And preparedness by early recognition and identification of JE in
peripheral health services; early diagnosis and timely management
of the disease, anti-vector measures (fogging/ULV spraying) in
epidemic foci; developing the necessary nursing care in hospitals.
44. 6. Japanese Encephalitis Control
Programs such as behavioral change communications (BCC),
surveillance, supply of necessary drugs, diagnosis and treatment,
disease infection risks minimization, mapping of risk-prone areas
and the people, and strengthening of the drugs procurement
system will be launched.
45. PATH’s role in Nepal’s JE program
Funded by the Bill & Melinda Gates Foundation, PATH’s work to
combat JE provided technical assistance to Nepal, from strategy
development through program implementation and evaluation. In
addition, PATH helped negotiate the low, public-sector price for
CD-JEV, which allowed Nepal to purchase the vaccine for its JE
immunization program.