JAPANESE ENCEPHALITIS

Synonym
Japanese B encephalitis, arbovirus B, and mosquito-borne encephalitis virus.
Etiology
• JE is caused by the Japanese encephalitis virus (JEV), an arbovirus (arbovirus is short
for arthropod-borne virus).
• JEV is an enveloped virus (Genus Flavivirus, Family Flaviviridae). It is a positive
sense single stranded RNA genome is packaged in the capsid, formed by the capsid
protein.
• JEV is antigenically associated with West Nile virus and St. Louis encephalitis virus.
• The outer envelope is formed by envelope (E) protein and is the protective antigen. It
aids in entry of the virus to the inside of the cell.
• JEV is maintained principally by biological transmission between mosquitoes and
vertebrates.
Reservoir and incidence
• Domestic pigs and wild birds (herons and egrets) are reservoirs of the virus.
• Human, cattle and horses are dead-end hosts.
• Swine acts as amplifying host and has very important role in epidemiology of the
disease.
• Japanese encephalitis is an endemic disease in tropical areas. Epidemics occur during
rainy season and a seasonal disease in temperate regions.
• JE is most common in Asian countries, with 30,000 - 50,000 cases reported annually.
• Case-fatality rates range from 0.3% to 60% and depends on the population and on
age.
• People living in rural areas where the disease is common.
Transmission
• JEV is transmitted by a biological vector, Culex tritaeniorhynchus that lives in rural
paddy fields and stray pigs roaming regions.
• Other mosquitoes like Culex vishnui and Culex pseudovishnui Culex pipiens also acts
as vectors
• Breeding of this mosquito is very high in rice fields and stagnated water bodies.
• Inoculation of this virus in to the susceptible person leads to invasion in to the central
nervous system, including the brain and spinal cord.
• Spread of JE is enhanced by several socio-economic status of rural people: low cost
houses with open windows, open drainage, semi-urban and dwellers.
• No human to human transmission.
• Transplacental spread has been reported in human beings
• Mosquitoes become infected by feeding on pigs and wild birds infected with JEV.
Transmission cycle

Clinical Signs
Equine:
• Incubation period: 8 to 10 days
• Usually subclinical
• Fever, impaired locomotion, stupor, teeth grinding, photophobia
• Blindness, coma, death (rare)
pigs
• Incubation period unclear
• Exposure early in pregnancy more harmful
• Birth of stillborn or mummified fetuses
• Piglets: Neurological signs, death
• Boars: Infertility, swollen testicles
Birds
• The black crowned night heron and the little egret and
• plumed egrets are important in transmission cycle showing
• high level of viraemia as well as antibody.
Man :
• Incubation period ranges from 4 to 14 days.
• The majority of human infections are asymptomatic, only 1 in 500 - 1000 develops
JE.
 • The onset is rapid and usually starts as a flu-like illness, with fever (between 38 and
41°C), chills, tiredness, headache, nausea and vomiting, sometimes swelling of the
testicles in male. Cerebral and meningeal manifestations are stiff neck, convulsions in
children, confusion, disorientation, delirium and finally progressing to coma in
humans.
• The illness can progress to a serious infection of the brain (encephalitis) and case
fatality is about 30%, mostly in children. Among the survivors, 30% may have serious
brain damage, including paralysis.
• JE affects the ear, particularly the cochlea due to neurological involvement.
• Life-long neurological defects such as deafness, psychic and motor deformity as
sequealae.
Diagnosis
• Clinical signs
• Laboratory Tests
– Definitive: Viral isolation from blood, spinal cord, brain, CSF
(1) inoculation of suckling mice and
(2) inoculation of vertebrate cell culture (PS cell line) or
insect cell culture (Ae. albopicatus cell line).
• Serological tests
• Neutralization, HI, IF, CF, ELISA(IgM is captured instead of IgG )
• Cross reactivity of flaviviruses
• MAC ELISA – for acute serum samples
• Paired sera test- 4 fold rise in Ab titre – done after 3-4 wks post onset
of illness.
• Demonstration of viral antigen in the autopsy specimens of brain by fluorescent
antibody (FA) technique.
Treatment
• Supportive treatment with clinical management is highly required to the infected
person.
• Raised intracranial pressure due to JE may be managed with mannitol.
• Affected person do not need to be isolated, because, there is no person to person
transmission.
Prevention and control
• Prompt reporting of JE incidence to the local authority. Recovered patients from JEV
confer life-long immunity.
• Control in Pig like Segregation Slaughtering Vaccination.
• Composite culture of fish in the rice fields, Water fern Azolla microphylla in rice
fields.
• Biocides like Bacillus sphaericus; Bacillus thuringiensis var israelensis -as
biological larvicides
• Environment and personal hygiene.
• Food and water sanitation.
• Prompt treatment.
• Use of mosquito net and mosquito repellents.
Vaccination
• Vaccination of the susceptible population comprised of children.
• A formalin-inactivated mouse-brain derived vaccine was first produced in
Japan in the 1930.
• The mouse-brain derived vaccine is replaced by a cell-culture derived vaccine
(Nakayama or Bejing 1 strain)that is both safer and cheaper to produce.
• Inactivated primary hamster kidney cell derived vaccine (China)
• Inactivated Vero cell-derived vaccines
• Live attenuated cell culture vaccine (SA 14-14-2)
• 2 doses of the vaccine 4 weeks apart with booster after one year