Japanese Encephalitis JE

Organism The Japanese encephalitis virus (JEV) is a member of the flavivirus family, the same group of viruses as West Nile and St Louis encephalitis.

Clinical features Japanese encephalitis presents as a sudden onset of fever, headache, body aches and pains. Mild cases recover completely, but a high proportion develop encephalitis and progressive coma. Children under 10 years of age may present with gastro-intestinal symptoms and convulsions, rapidly leading to death. Those who survive the severe disease may have residual neurological or psychiatric disabilities.

Diagnosis is by finding the specific IgM in CSF or serum. The virus can be cultured in specialist laboratories.

Transmission The main vectors are Culex tri-taeniorhynchus, C. gelidus and C. fuscoce-phala, mosquitoes that predominantly breed in rice fields. The reservoir of infection is probably wading birds, but domestic pigs also harbour the virus, from which it is transferred to humans. The mosquito breeds when the rice fields are flooded and the first green shoots appear, dying off when the rice grows and shades the water, thereby displaying a marked seasonality, with a peak period of July and August in Thailand, August in China, and September and November in India and Nepal. In irrigated areas, mosquito breeding can occur throughout the year, while outbreaks have occurred in urban areas, where suitable stagnant water permits the breeding of vector mosquitoes.

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