A study on- JAPANESE ENCEPHALITIS

Prepared and Presentated by-KULDIP DEKAB. PHARM 4TH YEARRegd. No- 1227 of 2012-13DEPARTMENT OF PHARMACEUTICAL SCIENCESDIBRUGARH UNIVERSITY

Introduction of JE It is a viral infection of the central nervous system First case was documented in 1871 in Japan.Transmitted by the of infected Culex species mosquitoesSymptoms with phages:i)Prodromal stage: fever, headache, vomiting and diarrhea.lasts for 2-5 days.ii)Acute encephalitic stage: headache, convulsions and

deterioration of mental status. May lasting from several days to several weeks.

iii)Convalescent stage: This varies from a week to months and in patients recovery left with paralysis, ataxia, mental retardation and seizures.

Prevalence; Demographic Data from locality:In India annual incidence ranged between 1,765 to 3,428 cases and deaths ranged between 466 to 707, according to the National Vector Borne Disease Control ProgrammeYear Cases( AES and JE) Deaths(AES and JE)Up to 2000 58 28

2002-2005 300 86

2012 300 79

2013 348 107

2014 259 60

2015 199 55

2016 20 6

Data from- NAMP ,NICD and Joint Director of Health and Services, Dibrugarh

Causative Agent and their Life CycleCaused by Flavivirus which is zoonotic,neurotorpic and arbovirus which was initially isolated in Japan 1935Belonging to family “Flaviviridae” includes 67 viruses of which 29 cause human illness.Diameter : 40 – 60 mm Genetic material-RNA Covered with a protein envelop of Glycoprotein E and Membrane protein M

Life cycle of the viruses

Sources of the Viruses• Mosquito:Transmission host: Through the bite of

infected Culex species mosquitoes, particularly Culex tritaeniorhynchus.Transfer the viruses from the infected pigs and wading birds to humans(dead-end hosts)

• Amplifying Host: Water birds: herons, egrets, night herons, and bitterns Once infected swine: The virus grow most in the tonsils. Allow virus multiplication without suffering from disease. Infected pigs discharge the virus in their saliva through the mouth or nose.

• Also Introduction of JE virus strains from endemic areas may happen in some cases.

Pathogenesis of the disease JEV causes neuronal damage in the brain through- JEV may cross the BBB by passive transport across the endothelium.Monocytes and macrophages -carriers of the virus in the CNS- deterioration of BBB stability.JEV infection activates microglia which causes raise in the level of pro-inflammatory mediators, such as IL-6, TNF-α, MCP-1 etc. involved in inducing neuronal death

Enzyme-linked Immune Sorbent Assay (ELISA): IgM assayPlaque Reduction Neutralization Test(PRNT): Differentiate the JE virus from other viruses.RT-PCR(Reverse transcription polymerase chain reaction): To detect the RNA expression

Diagnosis

Specimen collection and handling; Choice of specimen: For detection of IgM antibodies to JEV Details Information include in storeCerebrospinal fluid (CSF) collection: Minimum 0.5ml of CSF is requiredShould be stored in 20°C Blood specimen collection: 5 ml for older children and adults and 1 ml for infants and younger children.

From vein-allow to clot at RT-Centrifuged-serum-IgM test.

Laboratory Procedures

Preventive Majors

Life Style to prevent the disease:•Proper clothing to reduce mosquito bite.•Use insecticide treated mosquito bed nets. •Use repellents ;available in sprays, roll-ons, sticks and creams. E.g.-DEET (diethyltoluamide) •Vaccination is an important tool for preventionPossible Therapeutic Treatment available:IXIARO-Suspension ;Intramuscular Injection ;U.S. Approval: 2009

From 2 months infants up to elder 2 doses are given; 1st – as soon as possible after infection and 2nd is after 28 days of 1st dose

IMOJEV-Can be administered to 9 months of age and over JEEV -for active immunization against JE(WHO approved- 18 to 49 years)Diethyldithiocarbamate(DDTC)-antiviral agents Diethyldithiocarbamate – Immunomodulator

Vector control: Provide bed netsThermal fogging with insecticide like MalathionImmunizations:

PHC TOTAL TARGET COVERED % COVERAGE

KHOWANG 51083 46836 92

BORBORUAH 53292 36972 69

LAHOWAL 49097 43495 89

PANITOLA 43632 35491 81

TENGAKHAT 66152 67066 101

NAHARANI 93346 101796 109

DIBRUGARH 53009 26505 50

TOTAL = 409611 358161 72.57(Average)

JE-immunization of children report 2nd -21st July, 2006,Dibrugarh, Assam

National And International Program For Prevention And Cure

JE vaccination campaign was launched during 2006 wherein 11 most sensitive districts in AssamDuring 2009-2010 an amount of Rs.2.90 crores was allocated to the JE endemic statesGuidelines were developed on AES/JE case management and on prevention and control of which have been circulated to the statesAs on 22nd February, 2014, adult vaccination was launched in nine districts of Assam -Kamrup, Sivasagar, Golaghat, Jorhat, Dibrugarh, Tinsukia, Dhemaji and Lakhimpur. By this footstep, Assam is become the first state in the country to administer vaccination for Japanese Encephalitis for adults.

The Steps Taken By Govt. Of India for Prevention :

IMPORTANT FACTS FROM OUR LOCALITY

The presence of unvaccinated people who refused to take the vaccine or the people who were not present in their locality during vaccination period, may be at risk for JE infection in near future due to lack of immunity against JE virus in their bodyRecent increase in the swine population is a major reason for the rapid spread of JE in the regionFlooding of paddy fields helps for proliferation of the mosquito population.Prevalence of animal, human and bird vectors is also greater in numbers in JE endemic areas in Assam than in the other parts of the statePig firming gaining importance for business purpose.Migration of people carrying greater risk of JE virus transmission

CONCLUSIONFrom the observation of JE scenario in Assam especially in Dibrugarh, it has been depicted that, maximum numbers of JE positive cases were detected during the year 2013. In the same year, nearby state West Bengal shares the second largest burden of JE.Environmental and ecological factors are responsible for the spread of JEV in assam.The first outbreak was reported in 1978 from Lakhimpur District of AssamThe peak season foir transmission was noticed during the month of June to July every year/There is no specific treatment for JE; only prevention can control the disease. By developing a high-quality immunization program.To control the burden, first and foremost thing is to provide awareness among the people regarding the cause and route of JE transmission.

BIBLIOGRAPHY:1. National Vector Borne Disease Control Programme, Government of India, New Delhi: Directorate General of Health Services; Annual report 2014-15Official website-http://www.nvbdcp. gov.in/malaria.

2. World Health Organization.Vector-borne diseases, Factsheet # 387, March 2014.Accessed on 26May 2016.

3.Author-Borah J,Dutta P, Khan SA, Mahanta J.A comparison of clinical features of Japanese encephalitis virus infection in the adult and pediatric age group with acute encephalitis syndrome. J Clin Virol 2011; 52:45-9.

4. Authors- Dev V, Sharma VP, Barman K; Title-Mosquito-borne diseases in Assam, north-east India: current status and key challenges; a review article; Published on- WHO South-East Asia J Public Health 2015; 4(1): 20–29

5. Authors-Sharma J, Baruah MK, Pathak A, Khan SA, Dutta P.title- Epidemiology of Japanese encephalitis cases in Dhemaji district of Assam, India. 2014; 5:50-4.