Japanese Encephalitis

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1. JAPANESE ENCEPHALITIS Presentation By: Dhanya George, MBNC,Bardoli .

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. I ncidence 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.

4. Epidemiological Triad Agent Host Environment

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: Prodromal stage Acute Encephalitic stage 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. Acute Encephalitic stage This stage begins by 3-5 th 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 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.

15. 2. Vaccination Japanese encephalitis vaccine

16. 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.

17. 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)

18. 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

19. 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.

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