scholarly journals Epidemiological Situation of Japanese Encephalitis in Nepal

2005 ◽  
Vol 44 (158) ◽  
Author(s):  
Mahendra Bahadur Bista ◽  
J M Shrestha
Keyword(s):  
Japanese Encephalitis ◽  
Specific Treatment ◽  
Case Fatality ◽  
Eastern Region ◽  
Mosquito Vector ◽  
Supportive Treatment ◽  
Indwelling Catheter ◽  
Average Case ◽  
Transmission Cycle ◽  
Conscious Patient

A human Japanese encephalitis (JE) case is considered to have elevated temperature (over 380C) along withaltered consciousness or unconsciousness and is generally confirmed serologically by finding of specific anti-JEIgM in the cerebro spinal fluid. No specific treatment for JE is available. Only supportive treatment likemeticulous nursing care, introduction of Ryle’s tube if the patient is unconscious, dextrose solution if dehydrationis present, manitol injection in case of raised cranial temperature and diazepam in case of convulsion. Intravenous fluids, indwelling catheter in conscious patient and corticosteroids unless indicated should be avoided.Pigs, wading birds and ducks have been incriminated as important vertebrate amplifying hosts for JE virusdue to viremia in them. Man along with bovines, ovines and caprines is involved in transmission cycle asaccidental hosts and plays no role in perpetuating the virus due to the lack of viremia in them. The species Cxtritaeniorhyncus is suspected to be the principal vector of JE in Nepal as the species is abundantly found in therice-field ecosystemof the endemic areas during the transmission season and JE virus isolates have been obtainedfrom a pool of Cx tritaeniorhyncus females. Mosquito vector become infective 14 days after acquiring the JRvirus from the viremic host. The disease was first recorded in Nepal in 1978 as an epidemic in Rupandehidistrict of the Western Development Region (WDR) and Morang of the Eastern Region (EDR). At present thedisease is endemic in 24 districts.Although JE as found endemic mainly in tropical climate areas, existense andproliferation of encephalitis causing viruses in temperate and cold climates of hills and valleys are possible.Total of 26,667 cases and 5,381 deaths have been reported with average case fatality rate of 20.2% in anaggregate since 1978. More than 50% of morbidity and 60% mortality occur in the age group below 15 years.Upsurge of cases take place after the rainy season (monsoon). Cases start to appear in the month ofApril - Mayand reach its peak during late August to early September and start to decline from October. There are fourdesignated referral laboratories, namely National Public Health Laboratory (Teku), Vector Borne DiseasesResearch and Training Center (Hetauda), B.P. Koirala Institute of Medical Sciences (Dharan) and JE Laboratory(Nepalgunj), for confirmatory diagnosis of JE. For prevention of JE infection;chemical and biological controlof vectors including environmental management at breeding sites are necessary. Segregate pigs from humanshabitation. Wear long sleeved clothes and trousersand use repellent and bed net to avoid exposure to mosquitos.For the prevention of the disease in humans, safe and efficacious vaccines are available. Therefore immunizepopulation at risk against JE. Immunize pigs at the surroundings against JE. 225,000 doses of live attenuatedSA-14-14.2 JE vaccine were received in donation from Boran Pharmaceuticals, South Korea for the first timein Nepal. Altogether 224,000 children aged between 1 to 15 years were vaccinated in Banke, Bardiya andKailali districts during 1999. From China also, 2,000,000 doses of inactivated vaccine were received in 2000and a total of 481,421 children aged between 6m to 10 yrswere protected from JE during 2001/2002. Ministryof Agriculture, Department of Livestock Services has vaccinated around 200,000 pigs against JE in terai zoneduring February 2001.Key Words: Supportive treatment, viremia, amplifying host, vectors, vaccination/immunization.

scholarly journals High vaccination coverage and inadequate knowledge: Findings from a community-based cross-sectional study on Japanese Encephalitis in Yangon, Myanmar

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 6
Author(s):  
Pyae Phyo Kyaw ◽  
Hemant Deepak Shewade ◽  
Nang Thu Thu Kyaw ◽  
Khaing Hnin Phyo ◽  
Htar Htar Lin ◽  
...  
Keyword(s):  
Japanese Encephalitis ◽  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
Specific Treatment ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
Multi Stage

Background: Japanese encephalitis (JE) is a mosquito-borne disease with high case fatality and no specific treatment. Little is known about the community’s (especially parents/guardians of children) awareness regarding JE and its vaccine in Yangon region, which bears the highest JE burden in Myanmar. Methods: We conducted a community-based cross-sectional study in Yangon region (2019) to explore the knowledge and perception of parents/guardians of 1-15 year-old children about JE disease, its vaccination and to describe JE vaccine coverage among 1-15 year-old children. We followed multi-stage random sampling (three stages) to select the 600 households with 1-15 year-old children from 30 clusters in nine townships. Analyses were weighted (inverse probability sampling) for the multi-stage sampling design. Results: Of 600 parents/guardians, 38% exhibited good knowledge of JE, 55% perceived JE as serious in  children younger than 15 years and 59% perceived the vaccine to be effective. Among all the children in the 600 households, the vaccination coverage was 97% (831/855). Conclusion: In order to reduce JE incidence in the community, focus on an intensified education program is necessary to sustain the high vaccine coverage in the community.

scholarly journals High vaccination coverage, inadequate knowledge and high vector density: Findings from a community-based cross-sectional study on Japanese Encephalitis in Yangon, Myanmar

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 6
Author(s):  
Pyae Phyo Kyaw ◽  
Hemant Deepak Shewade ◽  
Nang Thu Thu Kyaw ◽  
Khaing Hnin Phyo ◽  
Htar Htar Lin ◽  
...  
Keyword(s):  
Japanese Encephalitis ◽  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
Specific Treatment ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
Multi Stage

Background: Japanese encephalitis (JE) is a mosquito-borne disease with high case fatality and no specific treatment. Little is known about the community’s (especially parents/guardians of children) awareness regarding JE and its vaccine in Yangon region, which bears the highest JE burden in Myanmar. Methods: We conducted a community-based cross-sectional study in Yangon region (2019) to explore the knowledge and perception of parents/guardians of 1-15 year-old children about JE disease, its vaccination and to describe JE vaccine coverage among 1-15 year-old children. We followed multi-stage random sampling (three stages) to select the 600 households with 1-15 year-old children from 30 clusters in nine townships. Analyses were weighted (inverse probability sampling) for the multi-stage sampling design. Results: Of 600 parents/guardians, 38% exhibited good knowledge of JE, 55% perceived JE as serious in  children younger than 15 years and 59% perceived the vaccine to be effective. Among all the children in the 600 households, the vaccination coverage was 97% (831/855). Conclusion: In order to reduce JE incidence in the community, focus on an intensified education program is necessary to sustain the high vaccine coverage in the community.

scholarly journals High vaccination coverage, inadequate knowledge and high vector density: Findings from a community-based cross-sectional study on Japanese Encephalitis in Yangon, Myanmar

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 6
Author(s):  
Pyae Phyo Kyaw ◽  
Hemant Deepak Shewade ◽  
Nang Thu Thu Kyaw ◽  
Khaing Hnin Phyo ◽  
Htar Htar Lin ◽  
...  
Keyword(s):  
Japanese Encephalitis ◽  
Vaccination Coverage ◽  
Vaccine Coverage ◽  
Specific Treatment ◽  
Case Fatality ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
Multi Stage

Background: Japanese encephalitis (JE) is a mosquito-borne disease with high case fatality and no specific treatment. Little is known about the community’s (especially parents/guardians of children) awareness regarding JE and its vaccine in Yangon region, which bears the highest JE burden in Myanmar. Methods: We conducted a community-based cross-sectional study in Yangon region (2019) to explore the knowledge and perception of parents/guardians of 1-15 year-old children about JE disease, its vaccination and to describe JE vaccine coverage among 1-15 year-old children. We followed multi-stage random sampling (three stages) to select the 600 households with 1-15 year-old children from 30 clusters in nine townships. Analyses were weighted (inverse probability sampling) for the multi-stage sampling design. Results: Of 600 parents/guardians, 38% exhibited good knowledge of JE, 55% perceived JE as serious in  children younger than 15 years and 59% perceived the vaccine to be effective. Among all the children in the 600 households, the vaccination coverage was 97% (831/855). Conclusion: In order to reduce JE incidence in the community, focus on an intensified education program is necessary to sustain the high vaccine coverage in the community.

Japanese Encephalitis

2021 ◽  
Author(s):  
Wolfgang Bender
Keyword(s):  
Japanese Encephalitis ◽  
Neutralizing Antibodies ◽  
Viral Encephalitis ◽  
Resource Competition ◽  
Severe Disease ◽  
Specific Treatment ◽  
Case Fatality ◽  
Vector Borne ◽  
Endemic Areas ◽  
Animal Reservoirs

Japanese Encephalitis (JE) is an endemic vector-borne (mosquitoes) zoonotic flavivirus disease in Asia with severe neurological manifestations (case fatality rate CFR 20–30%; 30–50% of survivors with serious sequelae). Japanese Encephalitis Virus (JEV) is the leading cause of viral encephalitis in Asia and exposes an estimated 3 billion people to the risk of infection. Other regions of the world have conditions suiting JEV without circulation of the virus (yet). Most JEV infections are asymptomatic or only cause mild symptoms. 1 in 250 infections progresses to severe disease for which no specific treatment is yet available. Neutralizing antibodies develop after infection. In endemic areas this occurs usually during childhood followed by subclinical re-exposure with life-long immunity protecting against disease. Disease in adult populations in endemic areas is rare. General prevention includes avoidance of mosquito bites, e.g., repellents, long-sleeved clothes, coils and vaporizers. Vaccine prevention: Neutralizing antibodies (PRNT50 titer ≥ 1:10) is the correlate of protection. Vaccines currently used are live attenuated JE vaccines and recombinant chimeric JE vaccines (mostly in endemic countries) and cell culture-derived inactivated JE vaccines (travelers, endemic countries). As animal reservoirs of the JEV cannot be eradicated, universal vaccination of humans can control the disease in humans. Optimal JE control in endemic countries is limited by issues around vaccine supply, surveillance (burden of disease underestimation), and resource competition / prioritization.

#53: High Burden of Serious Bacterial Infections in African Children Treated for Cancer

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S6-S6
Author(s):  
G Naidu ◽  
A Izu ◽  
R Wainwright ◽  
S Poyiadjis ◽  
D MacKinnon ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Case Fatality ◽  
Morbidity And Mortality ◽  
Coagulase Negative Staphylococci ◽  
Children With Cancer ◽  
Indwelling Catheter ◽  
High Burden ◽  
African Children ◽  
Serious Bacterial Infections ◽  
Living With Hiv

Abstract Background Infectious complications in children treated for cancer contribute to their morbidity and mortality. There is a paucity of studies on the incidence, microbiological etiology, risk factors, and outcome of serious bacterial infections in African children treated for cancer. Aim The aim of the study was to delineate the epidemiology of infectious morbidity and mortality in South African children with cancer. Methods This prospective, single-center, longitudinal-cohort study enrolled children one-19 years old hospitalized for cancer treatment at the Paediatric Oncology Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. Children were investigated for infection as part of the standard of care. Results In total, 169 children were enrolled, 82 with hematological malignancy (HM), 87 with a solid tumor (ST), median age was 68.5 months and 10.7% were living with HIV. The incidence (per 100 child-years) of septic episodes (SE) and microbiologically confirmed SE (MSCE) was 101 (138 vs. 70, P < 0.001) and 70.9 (99.1 vs. 47.3; P < 0.001), respectively; higher in children with HM than ST. The incidence of MCSE in children with high-risk HM (137.7) was 4.32-fold greater compared with those with medium-risk HM (30.3; P < 0.001). Children with metastatic ST had a higher incidence (84.4) of MSCE than those with localized ST (33.6; aOR: 2.52; P < 0.001). The presence of an indwelling catheter was 3-fold (P < 0.001) more likely to be associated with MCSE compared with those without. There was no association for age group, nutritional status or HIV-status, and incidence of MCSE. The incidence of gram-positive (GPB) and gram-negative (GNB) SEs was 48.5 and 37.6, respectively, and higher in children with an HM. The most commonly identified GPB were Coagulase-negative Staphylococci, Streptococcus viridans and Enterococcus faecium; while the most common GNB were Escherichia coli, Acinetobacter baumannii, and Pseudomonas species. The median CRP was higher in children with MSCE compared with those with culture-negative SE (CNSE) (116.5 vs. 92; P < 0.001) in both HM (132.5 vs. 117; P < 0.001) and ST (87.5 vs. 46; P < 0.001). The procalcitonin was higher in those with MSCE compared with those with CNSE (2.30 vs. 1.40; P < 0.001) in both HM (2.95 vs. 1.60; P = 0.002) and ST (2.10 vs. 1.20; P < 0.001). The case fatality risk was 40.4%; 80% was attributed to sepsis. Of these, 35 (72.92%) had HM and 34 of the 35 (97.14%) had HR-HM. Children with HM had an overall sepsis CFR of 42.68%. Four (30.77%) of the 13 sepsis-related deaths in STs had metastatic disease and 8 (16.67%) of the total number of sepsis-related deaths were in children living with HIV. There was no association between malnutrition or HIV-positivity and death. The odds of dying from sepsis were higher in children with profound (aOR 3.96; P = 0.004) and prolonged (aOR 3.71; P = 0.011) neutropenia. Pneumonia (58.85% vs. 29.23%; aOR 2.38; P = 0.025) and tuberculosis (70.83% vs. 34.91%; aOR 4.3; P = 0.005) were independently associated with a higher CFR. Conclusion The current study emphasizes the high burden of sepsis in African children treated for cancer, and especially HM, and highlights the association of tuberculosis and pneumonia as independent predictors of death in children with cancer.

scholarly journals Active Circulation of Madariaga Virus, a Member of the Eastern Equine Encephalitis Virus Complex, in Northeast Brazil

Pathogens ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 983
Author(s):  
Laura H. V. G. Gil ◽  
Tereza Magalhaes ◽  
Beatriz S. A. S. Santos ◽  
Livia V. Oliveira ◽  
Edmilson F. Oliveira-Filho ◽  
...  
Keyword(s):  
Phylogenetic Analyses ◽  
Case Fatality ◽  
Febrile Illness ◽  
Encephalitis Virus ◽  
Northeast Brazil ◽  
Eastern Equine Encephalitis Virus ◽  
Eastern Equine Encephalitis ◽  
Vaccination Programs ◽  
Transmission Cycle ◽  
Equine Encephalitis Virus

Madariaga virus (MADV) is a member of the eastern equine encephalitis virus (EEEV) complex that circulates in Central and South America. It is a zoonotic, mosquito-borne pathogen, belonging to the family Togaviridae. Disturbances in the natural transmission cycle of this virus result in outbreaks in equines and humans, leading to high case fatality in the former and acute febrile illness or neurological disease in the latter. Although a considerable amount of knowledge exists on the eco-epidemiology of North American EEEV strains, little is known about MADV. In Brazil, the most recent isolations of MADV occurred in 2009 in the States of Paraíba and Ceará, northeast Brazil. Because of that, health authorities have recommended vaccination of animals in these regions. However, in 2019 an equine encephalitis outbreak was reported in a municipality in Ceará. Here, we present the isolation of MADV from two horses that died in this outbreak. The full-length genome of these viruses was sequenced, and phylogenetic analyses performed. Pathological findings from postmortem examination are also discussed. We conclude that MADV is actively circulating in northeast Brazil despite vaccination programs, and call attention to this arbovirus that likely represents an emerging pathogen in Latin America.

Yellow Fever

2021 ◽  
Author(s):  
Melvin Sanicas ◽  
Merlin Sanicas
Keyword(s):  
South America ◽  
Yellow Fever ◽  
Survival Rates ◽  
Antiviral Drug ◽  
Specific Treatment ◽  
Preventive Measure ◽  
Hemorrhagic Disease ◽  
Supportive Treatment ◽  
Tropical Areas ◽  
At Risk Populations

Yellow fever is an acute viral hemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice from direct liver damage. The virus is endemic in tropical areas of Africa and Central and South America. There is no specific treatment or antiviral drug for yellow fever but appropriate supportive treatment in hospitals improves survival rates. Vaccination is the single most important preventive measure. Several yellow fever vaccines are manufactured by different developers. All of them are safe, affordable, and appear to provide protection for >30–35 years. Some are WHO-prequalified. The Eliminate Yellow Fever Epidemics (EYE) Strategy launched in 2017 aims at protecting at-risk populations, preventing international spread, and containing outbreaks rapidly. By 2026, it is expected that more than 1 billion people will be protected against the disease.

scholarly journals COVID-19: Spatial Analysis of Hospital Case-Fatality Rate in France

2020 ◽  
Author(s):  
Marc SOURIS ◽  
Jean-Paul Gonzalez
Keyword(s):  
International Organizations ◽  
Rate Ratio ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Healthcare Systems ◽  
Fatality Rate ◽  
Average Case ◽  
Hospital Case ◽  
Reporting Systems ◽  
Overall Efficiency

When the population risk factors and reporting systems are similar, the assessment of the case-fatality (or lethality) rate (ratio of cases to deaths) represents a perfect tool for analyzing, understanding and improving the overall efficiency of the health system. The objective of this article is to estimate the influence of the hospital care system on lethality in metropolitan France during the inception of the COVID-19 epidemic, by analyzing the spatial variability of the hospital case-fatality rate between French districts (i.e. French departements). The results show that the higher case-fatality rates observed by districts are mostly related to the level of morbidity, therefore to the overwhelming of the healthcare systems during the acute phases of the epidemic. However, the magnitude of this increase of case-fatality rate represents less than 10 per cent of the average case-fatality rate and cannot explain the magnitude of the variations in case-fatality rate reported per country by international organizations or information sites. These differences can only be explained by the systems for reporting cases and deaths, which, indeed, vary greatly from country to country, and not attributed to the care or treatment of patients, even during hospital stress due to epidemic peaks.

scholarly journals Experimental Evaluation of the Role of Ecologically-Relevant Hosts and Vectors in Japanese Encephalitis Virus Genotype Displacement

Viruses ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 32 ◽  
Author(s):  
Ajit K. Karna ◽  
Richard A. Bowen
Keyword(s):  
Japanese Encephalitis Virus ◽  
Japanese Encephalitis ◽  
Experimental Evaluation ◽  
Encephalitis Virus ◽  
Viral Fitness ◽  
Avian Host ◽  
Mosquito Vector ◽  
Virus Genotype ◽  
Southern Asia

Japanese encephalitis virus (JEV) is a flavivirus that is maintained via transmission between Culex spp. mosquitoes and water birds across a large swath of southern Asia and northern Australia. Currently JEV is the leading cause of vaccine-preventable encephalitis in humans in Asia. Five genotypes of JEV (G-I–G-V) have been responsible for historical and current outbreaks in endemic regions, and G-I and G-III co-circulate throughout Southern Asia. While G-III has historically been the dominant genotype worldwide, G-I has gradually but steadily displaced G-III. The objective of this study was to better understand the phenomenon of genotype displacement for JEV by evaluating both avian host and mosquito vector susceptibilities to infection with representatives from both G-I and G-III. Since ducks and Culex quinquefasciatus mosquitoes are prevalent avian hosts and vectors perpetuating JEV transmission in JE endemic areas, experimental evaluation of virus replication in these species was considered to approximate the natural conditions necessary for studying the role of host, vectors and viral fitness in the JEV genotype displacement context. We evaluated viremia in ducklings infected with G-I and G-III, and did not detect differences in magnitude or duration of viremia. Testing the same viruses in mosquitoes revealed that the rates of infection, dissemination and transmission were higher in virus strains belonging to G-I than G-III, and that the extrinsic incubation period was shorter for the G-I strains. These data suggest that the characteristics of JEV infection of mosquitoes but not of ducklings, may have play a role in genotype displacement.

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