Japanese encephalitis, a mosquito-borne illness endemic to the Philippines and

which is fatal in nearly 3 out of 10 severe cases, may be on the rise, a World
Health Organization (WHO) report said, after the discovery last year by Chinese
researchers that the current vaccine may not be effective against a re-emerging
strain of the virus.

Three billion people are at risk from Japanese encephalitis, the WHO report said,
with an average fatality rate of 3 out of every 10 patients who exhibit severe
symptoms, which affect about one out of every 250 people who contract the
illness. There are about 68,000 severe cases of Japanese encephalitis worldwide
annually, most in Asia.

The WHO also said that nearly all survivors of the illness may experience
permanent effects, with 30 to 50 percent of those who survive left with severe
permanent disabilities. About 20 percent of victims experience convulsions,
cognitive, and language problems, while 30 percent may suffer from motor
deficiencies. Other survivors may suffer less severe learning disabilities or
behavioral problems.

Japanese encephalitis is a mosquito-transmitted disease carried by the Culex

tritaeniorhynchus, a mosquito endemic to tropical and sub-tropical countries like
the Philippines.

The disease is present in all regions of the Philippines, as well as throughout most
of Asia.

The WHO said that children below the age of 15 are most susceptible to the
disease, with children younger than four years being nine times more likely to be
infected with Japanese encephalitis than older children. About 15 percent of
Japanese encephalitis cases are adult victims.

The most recent case of Japanese encephalitis in the Philippines was a 52-year-old
man in Davao City in July 2016. Davao City Health Officer Dr. Josephine Villafuerte
said the patient survived, but now suffers from neurological diseases, including
memory lapses.

Japanese encephalitis is considered incurable, but can be prevented through

vaccination and mosquito abatement procedures. A WHO-recommended vaccine
was licensed for use in the Philippines in 2013, and is part of the Department of
Health’s vaccine program for school-aged children, similar to programs in other
countries.

New strain emerging

However, researchers in China discovered last year that the current vaccine might
not provide protection against an emerging strain of the Japanese encephalitis
virus.

A team led by Dr. Liang Guodong, from the Chinese Center for Disease Control
and Prevention in Beijing discovered that the rarest of the five known Japanese
encephalitis genomes, called G5, has been found with increasing frequency since
it reemerged in South Korea in 2009. The genome was first identified in 1951, but
had not been detected again for more than 50 years.

The present vaccines are based on the more common G3 genome, and provide
adequate protection against the G1 to G4 varieties of the virus. However, the
researchers discovered that only 35 to 65 percent of patients
developed antibodies to the G5 strain after being vaccinated.

The researchers’ findings were published in PLOS Neglected Tropical Diseases.

While they pointed out that the number of G5-strain Japanese encephalitis
infections is not known yet, they recommended that health officials increase their
vigilance and testing of possible Japanese encephalitis cases, even those that are
considered mild, to determine the extent of the new strain to help development
of a new vaccine.

9 deaths reported in PHL due to Japanese encephalitis

Tuesday, September 05, 2017

NINE people, including seven in Central Luzon, have already died this year due to
the mosquito-borne Japanese encephalitis (JE), the Department of Health (DOH)
said Tuesday.
Of the nine deaths reported from January 1 to August 26, the health authorities
said seven were reported in Central Luzon, including four in Pampanga, two in
Zambales, and one in Nueva Ecija.

The other two deaths were recorded in Pangasinan and Laguna.

Of the 133 JE cases recorded this year, 53 are in Central Luzon.

Health Secretary Paulyn Ubial said there is nothing unusual with the number of JE
cases.

There is no surge. The cases reported this year is lower than last year," said Ubial
in an interview.

Ubial however stressed the lower number of cases this year will not stop them
from including the JE in the DOH's Expanded Program on Immunization by 2018.

Japanese encephalitis is a disease spread through mosquito bites.

Symptoms of the JE, which usually take five to 15 days to develop, include fever,
headache, vomiting, confusion, and difficulty in moving.

JE is also known to cause swelling around the brain and, subsequently, result to
the patient going on coma, thereby making it a serious disease that may cause
death. (HDT/SunStar Philippines)

SAN PEDRO CITY — Single mother Pamela Flores, 25, has heard about Japanese
encephalitis (JE). But when told about the cost of the vaccine, Flores, an average-
wage earner from this city, said she could not afford it for her 3-year-old son.
“That’s expensive. We just get Pio’s (her son) vaccines from the (government
health) center. I’ll probably just pray for him,” Flores said.
In a similar situation, Cristina Hubid said she would have wanted to get the
vaccine for her 4-year-old son. But the price of the vaccine, ranging from P2,800
to P4,000 per shot depending on the hospital where it was availed of, costs more
than her month’s salary as a house helper.

JE is a vector-borne disease transmitted by the culex mosquito. It commonly

causes abdominal pains, fever and seizures.
According to the World Health Organization, the “case-fatality” rate among those
with JE “can be as high” as 30 percent, meaning three out of 10 stricken by JE
could die.
The vaccines were not only expensive, but in Laguna, they were hard to find.
The Inquirer on Monday asked a number of private hospitals in the province and
was told that they had run out of stock of the vaccine.
Most of JE cases involved children. There is also no cure for the disease.

SAN PEDRO CITY — Single mother Pamela Flores, 25, has heard about Japanese
encephalitis (JE). But when told about the cost of the vaccine, Flores, an average-
wage earner from this city, said she could not afford it for her 3-year-old son.
“That’s expensive. We just get Pio’s (her son) vaccines from the (government
health) center. I’ll probably just pray for him,” Flores said.
In a similar situation, Cristina Hubid said she would have wanted to get the
vaccine for her 4-year-old son. But the price of the vaccine, ranging from P2,800
to P4,000 per shot depending on the hospital where it was availed of, costs more
than her month’s salary as a house helper.
ADVERTISEMENT
JE is a vector-borne disease transmitted by the culex mosquito. It commonly
causes abdominal pains, fever and seizures.
According to the World Health Organization, the “case-fatality” rate among those
with JE “can be as high” as 30 percent, meaning three out of 10 stricken by JE
could die.
The vaccines were not only expensive, but in Laguna, they were hard to find.
The Inquirer on Monday asked a number of private hospitals in the province and
was told that they had run out of stock of the vaccine.
Most of JE cases involved children. There is also no cure for the disease.
“There is a demand probably because of the scare. I’m receiving a lot of calls
asking me to reserve them a vaccine,” said Laguna provincial health officer Dr.
Rene Bagamasbad on the shortage of the vaccines.
In Laguna, the health office recorded two confirmed cases—a 9-year-old child
who died in Calauan town, and a 6-year-old from San Pablo City. The child from
San Pablo survived.
There are several suspected cases of JE but Bagamasbad said tests done at the
Research Institute for Tropical Medicine in Muntinlupa City usually takes two
weeks.
In the Philippines, the only available brand of the vaccine at present is the Imojev,
which is being supplied by pharmaceutical company, Sanofi Pasteur, said
Bagamasbad.
On Monday, he said he had talked with representatives of Sanofi but was told
there had been no new supply.
Bagamasbad said he talked with several distributors and drugstores and was told
that a fresh batch of the vaccine should be available “middle to end of this week.”

The Department of Health, in a statement, said it planned to include the JE

vaccine in the government’s national immunization program by next year.

DOH confirms 57 Japanese encephalitis cases in PHL

Published September 2, 2017 10:13pm
The Department of Health (DOH) has recorded a total of 57 confirmed cases of
Japanese encephalitis in the country since January.

A 24 Oras report by Lei Alviz on Saturday said the Regional Institute for Tropical
Medicine (RITM) is conducting tests if the viral infection was the cause of death of
20-year-old engineering student Danica Rose Salangad in San Fernando,
Pampanga.

The RITM said last week that it had recorded 32 confirmed cases in
Pampanga alone.

Nearly 260 suspected cases have been recorded in the province since July.

Fever is one among the symptoms of the viral infection, but there are cases that
there are no signs at all.

"Kasi isang uri kasi ng virus 'yon na inaatake 'yung utak, namamaga. So ang
sintomas non lagnat, kombulsyon, pananakit ng ulo tapos may kapuna-punang
movement ng extremities. Parang winawagayway 'to na hinahampas sa dingding,"
said DOH Spokesperson Eric Tayag.

"Pagka minsan tiningnan mo ang mukha ng pasyente para siyang maskara, ibig
sabihin walang emosyon, nakadilat lang sayo parang walang pananaw. 'Yung iba
naman kala mo may pilay, may polio," he added.

Japanese encephalitis is a mosquito-borne viral infection which is common in

agricultural areas.

"'Yung lamok na 'to sa gabi nangangagat di katulad nung lamok sa denge.

Pangkaraniwang nakukuha ng lamok 'to sa mga hayop katulad ng baboy.
Aksidente lang nalilipat sa atin kung saan maraming palayan, sa rice fields," Tayag
explained.

The DOH said vaccines for Japanese encephalitis will be available in the country
by next year. —

The scourge of encephalitis has once again struck parts of Uttar Pradesh
and killed or crippled a large number of children. This dance of death has
become an annual feature. The public health community views it as a
crisis that can be controlled, if the political will to engage in reforms
exists. For one thing, the pattern of the epidemic, with Gorakhpur as its
nucleus, has been studied well, after a major outbreak more than three
decades ago. It is clearly linked to the monsoon rain, which inundates the
large number of rice fields in this area, leading to a rapid rise in the
density of Culex mosquitoes. The period between July and November
then becomes transmission season for encephalitis through mosquito
bites. The epidemic is amplified by the presence of large numbers of pigs,
which act as hosts. What all this underscores is the need for a State-wide
massive prevention campaign that should consist of three parts:
distributing insecticide-treated bed nets, free or subsidised, to protect
against mosquito bites; creating awareness on the need to keep pigs away
from habitations; and persuading people to avoid outdoor movement
when the mosquito is most active. Gorakhpur, where more than one child
is assigned to the same hospital bed during an epidemic, also needs rapid
expansion of its infrastructure.
Prevention is likely to be the more effective approach to curb the spread
of encephalitis in India. The Indian Council of Medical Research is yet to
confirm the different virus strains causing the annual epidemics. Last year,
the ICMR said Japanese Encephalitis represents only about 15 per cent of
the fatal cases, and it would take more research to isolate the other
viruses. Union Health Minister Ghulam Nabi Azad has reiterated this view.
If this is correct, vaccination against Japanese Encephalitis can only be of
limited value, even if it is scaled up to cover the entire population. Public
health policy should therefore focus on removing the factors that aid
transmission. This can only be achieved through massive investments in
hygienic housing, sanitation, supply of bed nets, vector control, and
behaviour modification. Relocating pigs is a sensitive issue in the
encephalitis-hit districts, and calls for measures that inspire confidence in
the community. Andhra Pradesh has carried out such a programme
successfully and may offer important lessons. Moreover, incentives for
hygienic practices are bound to persuade those rearing the animals to do
the right thing. What is worrying is that the infection is spreading — to
more places in Uttar Pradesh and Bihar. The epidemic needs action on a
war footing.