ENCEPHALITIS
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Viral Meningitis/ Encephalitis !!

Non-viral causes of  Encephalomyelitis !!

JE virus encephalitis!!

Transmission Cycle Of JE Virus !!

JE encephalitis spectrum !!

Typical S/S of Viral Encephalitis !!

Geographical Distribution !!

Encephalitis cases since 1978 !!

Cases  in 2005 upto 31.8.05 !!

Management of Encephalitis !!

Reported Outcome!!

JE cases, PED. WARD at Nehru Hospital, Gorakhpur (1978-2004) !!

Available facilities !!

Prevention of JE !!

J E Vaccines !!

Vaccination 2004-05 !!

IEC Activities  !!

JE Incidence  in  relation to vaccine distribution, !!

Economy of JE !!

 

 

VIRAL MENINGITIS/ENCEPHALITIS

Herpesviruses  

     Herpes simplex

    Varicella-zoster

    Epstein Barr

    Cytomegalovirus

Myxo/paramyxoviruses

    Influenza/parainfluenzae

    Mumps

    Measles

    Adenoviruses 

    LCM

    Rabies

   HIV

   Enteroviruses

Polioviruses 

Coxsackieviruses

Echoviruses

Toga viruses /flaviviruses

JEV /West Nile

Eastern equine

Western equine

Venezuelan equine

St. Louis.  Powasson

Miscellaneous California

 

                                         

NONVIRAL CAUSES OF ENCEPHALOMYELITIS  

Rocky Mountain spotted fever               

Typhoid ,Typhus                                         

Mycoplasma                                

Brucellosis                                   

Subacute bacterial endocarditis        

Syphilis (meningovascular)                          

Relapsing fever                           

Lyme disease

Leptospirosis

Tuberculosis

Cryptococcus

Histoplasma

Naegleria

Acanthamoeba 

Toxoplasma

Plasmodium falciparum

Trypanosomiasis

Whipple’s disease

Behcet’s disease

Vasculitis

 

JE virus encephalitis

  

 

Transmission Cycle of JE Virus

Transmission Cycle of Japanese Encephalitis Virus

 

 

JE encephalitis spectrum

•    Asymptomatic

•    Mild symptoms - no CNS features

•    CNS features –mild –no seizures and unconciousness

•    CNS /S,seizures,uncounciosness,extrapyr.,resp,cardio,brainstem not involved

•    Severe CNS disease,multiorgan dys

 

Typical S/S of Viral Encephalitis

•Fever <7 days duration

•Headache

•Vomiting

•Convulsions

•Change in sensorium

•Weakness

•Rigidity & involuntary movement (JE)

 

Encephalitis cases since 1978

Year

Number of Cases

Year

Number of Cases

Year

Number of Cases

1978

274

1989

13

2000

646

1979

109

1990

313

2001

787

1980

280

1991

441

2002

540

1981

56

1992

305

2003

952

1982

86

1993

127

2004

876

1983

126

1994

300

2005

895 (31..8.2005)

1984

68

1995

490

   

1985

234

1996

519

   

1986

176

1997

160

   

1987

74

1998

804

   

1988

875

1999

787

Total

+adults-2005 only

11303

214

 

Geographical Distribution 

 

Cases  in 2005 upto 31.8.05

•      Total cases                              -  1109 + (214 adults)

•      Recovered                               -    379

•      Presently hospitalized          -    334

•      Deaths                                       -      311

•      Left w/o advice                        -      85

•      Maximum cases                        Maharajgang(314), Kushinagar(278) and Gorakhpur(262)

JE Positive Cases - 2005

Total samples Positive cases %
190 112 60

 

Management of Encephalitis

•    Symptomatic

•    Maintaining  airway patency,

•    Maintaining breathing- intubation &ventilation

•    Maintaining circulation

•    Fluids and nutrition

•    Seizure control

•    Control of raised ICP

•    Rx complications

 

Reported Outcome

•    Recovery 40-46%

•    Deaths 21-40%

•    Neurological deficits 15-21%

Outcome

•    Usually complete recovery if improvement in 6days

•    Recovery with ND/BP ,partially dependant if recovered in 7-15 days

•    mostly dependant if not recovered in2-3 wks

•    Few vegetative

 

JE cases, PED. WARD at Nehru Horpital, Gorakhpur (1978-2004)

•    Total No. of JE Patient - 10418

•   62% between 3-10 Yrs

•    Complete Recovery - 4702 (45.13%)

•    Recovery with ND/BP - 2045(19.62%)

•    Deaths - 2878 (27.62%)

•    Drop outs 793(7.6%)

 

Available facilities

•    Sufficient medicines and budget available for giving free medical care

•    3 +2 encephalitis ward with 275 beds created

•    Nodal officer and control room

•    Lab facilities and radiology

•    Additional staff arranged for epidemics

•    Intensive care facilities.

•    Serological diagnosis- serum and csf samples being done

ICU facilities

•    Ventilators

•    Monitors

•    Gas analysers

•    Electrolyte analysers

•    Defibrilators

•    Portable X ray

•    Color doppler

 

Prevention of JE

•    Vector control

•    Prevention of man-mosquito contact

•    Prevention on animal reservoir-mosquito contact

•    Immunization

•    Health education and community participation

Preventive measures -GKP and Basti Div.

•    Immunization in of 2 lac children in 17 blocks of Gorakhpur and Kushinagar district

•     pesticide spray/fogging/pyretherum in identified blocks-693 Vill. -2 rounds

•    Identification of 4157 piggeries and pesticide spray

•    Health education

•    Arrangements for free treatment and hospitalization at CHCs and PHCs

•    5-7 village/day/machine

•    11 vehicle mounted and 68 hand operated machine

•    Insecticides in abundance

•    District Level Micro Plan For Action on insecticide spray to Cover all Affected Village

 

J E Vaccines

•     Mouse Brain derived inactivated vaccine

•     Cell culture derived inactivated vaccine

•     Cell culture derived live attenuated vaccine

•     Only mouse Brain derived vaccine is commercially available except in China

Cell culture derived live attenuated vaccine

•     Dose 0.5ml subcutaneously to children at 1 year of age and again at 2 years.

•     Efficacy -98%

•     Side effects-Very safe -Mild fever  

•     Protective Efficacy of SA 14-14-2 Attenuated

•     Japanese Encephalitis Vaccine in Children (1-10 years of age) People's Republic of China

Mouse Brain derived inactivated vaccine

•     Efficacy -90%

•     AICP recommends 1ml or 0.5ml subcutaneously on days 0, 7, 30.

•     Booster after1year and every 3 years there after.

•     No data exist about the safety and efficacy of JE vaccines in infants.

Vaccination

•     Pilot Project – PHC Charagawan (Gorakhpur) in 2002.

•     Target age group       5 – 15 years

•     Vaccine received       40000

•     Vaccinated                 1st Dose 12859,    2nd Dose 12800  ,  3rd Dose 11293

 

Note: No JE cases reported from vaccinated  children during 2003-04.

 

Vaccination 2004-05

Description

Gorakhpur

Kushinagar

Target age Group

1 & 3 Yrs

 

Vacine Received

150000 ml

 

No. of block PHCs covered

17/19

 

Vaccination Year 2004

1st Dose

2nd Dose

3rd Dose

 

145980

140519

122000

 

158544 & 42291

155249 & 38220

63752 & 63506

Booster dose continued in 2005 and 1 Lac ml dose made available to each. Gorakhpur and Kushinagar Districs.

 

v

IEC Activities

•     Hand Bills

•     Print Media

•     Miking

•     Radio

•     Drum Beating

   Distribution of hand bills and pamphlets being done through peripheral health workers for early reporting of fever cases to nearest PHC/ CHC/District Hospitals

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One Management Protocol for JE cases  in all treating centers of both divisions. Capacity building of MOs (last4yrs). Adequate budget  by the state Government.

 

JE Incidence  in  relation to vaccine distribution,

CDC and NIH, 1988, Text book of pediatrics infectious diseases WB Saunders, 1987

 

 

 

Economy of JE

Every yr

 

3000 cases                    --  cost of Rx@5000/case =Rs1.5 m

840 deaths                    --  loss@ 2000/mx30yr    =Rs60.5m

810 disability               --  cost of care@2000/mx20yr=Rs38.8m

                                      --  loss@2000/mx30yr =Rs58.3m

Total value /yr              -- Rs159m

Cost of vaccine 1st yr  --12m(10 districts) x2000  =Rs24000m

Cost of vaccine from next yr -1/3rd