FAQs about JAPANESE ENCEPHALITIS

 Culex Mosquito

What is Japanese Encephalitis?

- Japanese encephalitis (JE) is a mosquito-borne viral infection transmitted by the bite of an infected female
Culex mosquito. It is a dangerous disease which can cause death in about 30% of cases and many survivors
may have long-term abnormal brain functions. However, it is also a highly preventable disease.
- It is the leading cause of viral encephalitis in Asia. Encephalitis is an inflammation of the brain that can
cause fever, headache, confusion, seizures, and, in some cases, death.
- Fewer than 1 percent of people infected with the virus develop symptoms.
- However, according to the World Health Organization (WHO), it is fatal for 30 percent of those who do
develop symptoms.
- Researchers estimate the number of fatalities from Japanese encephalitis is to be between 13,600 and
20,400 a year.
- A host is the source of a virus, and the vector passes it on. Wild birds are likely to be the natural hosts of
JEV, and mosquitoes are the vectors. A vector does not cause disease but passes it on.
- When mosquitoes infect an animal, the animal might become a carrier of the virus. When other mosquitos
feed on these animals that have newly acquired the virus, they take it on board and infect other animals.
- People are at the highest risk in rural areas where the virus is common. Japanese encephalitis is common
around towns and cities.
- It is more likely to affect children because adults in areas where the virus is endemic generally become
immune as they get older.

History of Japanese Encephalitis

- The history of the clinical recognition and recording of JE dates to the 19th century.
- JE appeared as recurring encephalitis outbreaks in the summer season. The first clinical case of JE was
recorded in 1871 in Japan.
- Half a century later, also in Japan, a large JE outbreak involving >6,000 cases was documented.
- Subsequent outbreaks occurred in 1927, 1934, and 1935. In 1924 an agent from human brain tissue was
isolated; 10 years later, it was proven to be JEV by transfection into monkey brains.
- The role of Cx. tritaeniorhynchus as a vector and the involvement of wading ardeids and pigs as reservoir
hosts were demonstrated in 1938
- On the Korean Peninsula, the first JE cases were recorded in 1933.
- On the Chinese Mainland, the first JE cases were documented in 1940. In the Philippines, first reports of JE
cases occurred in the early 1950s.
- Eventually, the JE epidemic reached Pakistan (1983) as the furthest extension in the West, and Papua New
Guinea (1995) and northern Australia (Torres Straight) as the furthest south.
- In parts of southeastern Russia (Primorje Promorsij), a few JE cases have been reported occasionally (e.g.,
2 cases from 1986 to 1990) (18).
- JE is potentially endemic to Afghanistan, Bhutan, Brunei Darussalam, and the Maldives, but to our
knowledge, no cases have been reported in these countries in the past 30 years.
- According to the World Health Organization (WHO), JE is endemic to the Western Pacific Islands, but
cases are rare.
- The enzootic cycle on those Pacific islands might not sustain viral transmission; hence epidemics occur
only after introduction of virus from JE-endemic areas.
- Subtle changes in the spatiotemporal distribution of JEV are difficult to track; thus, the year when a first
case of JE in a country is reported does not necessarily correspond with the actual first occurrence of JE in
that country
Where was JE introduced?
- JE was likely introduced into northern Australia by wind-blown mosquitoes from Papua New Guinea.

What are the characteristics of the Culex Mosquito?

- It is a brown-colored mosquito
- Breeds locally in the rice fields, ground pools, water hyacinth ponds, slow streams, irrigation ditches, and
canals.
- Adult females strongly feed on pigs at night, but will also feed on birds and humans
- A generally night-biting mosquito but its peak of biting is at twilight hours (at dusk and dawn or just after
sunset and just before sunrise).
- Average flight range is 2 km.

What are the signs and symptoms?

 It may range from mild to acute infection. It is characterized by:
o Headache
o Fever
o Muscle pains
o Abdominal pains and vomiting

 The illness may progress to an infection of the brain with:

o Stiffness of the neck
 o Pain in the eyes when looking at light
o Disturbances in behavior
o Seizures / convulsions

What is the diagnosis?

- JE suspects can be confirmed in the laboratory testing the cerebrospinal fluid or blood. Collected samples
are being tested at the Research Institute for Tropical Medicine (RITM).

What are the ways for prevention?

 Avoiding mosquito bites:
o Sleep in screened rooms, or in an insecticide-treated nets, or in sprayed houses
o Use long-sleeve, pants and socks
o Wear loose-fitting light-colored clothes, as mosquitoes can bite through skin-tight clothing
o Apply a good-quality insect repellent to any exposed areas of skin
 Vaccination is the best way to prevent Japanese Encephalitis
 Strengthen disease surveillance.

 To diagnose Japanese encephalitis, the doctor will examine any symptoms, verify where the individual lives,
and ask about the destinations of any recent visits from which the infection could have emerged.

- If a doctor suspects encephalitis, the patient will undergo tests, such as a CT or MRI scan of the brain.
- The physician might use a lumbar puncture or spinal tap to draw fluid from the spine. The results can show
which virus is causing the encephalitis.
- Immunofluorescence tests can detect human antibodies. The antibodies show up after the doctor tags them
with a fluorescent chemical.

 Treatment
- There is no treatment or cure for Japanese encephalitis.
- Once a person has the disease, treatment can only relieve the symptoms. Antibiotics are not effective
against viruses, and effective anti-viral drugs are available.

 Prevention is the best form of treatment for Japanese encephalitis.

There is a likely increase in Japanese Encephalitis (JE) Transmission with the following:
 Presence of pigs and water birds.
 Domestic ducks and chickens may also carry the virus
 Living near Culex breeding sites such as rice fields, water ponds, and canals.
 JE has also been detected in urban areas
IMPORTANT!

- Safe and effective vaccines are available to prevent JE.

- The World Health Organization (WHO) recommends that JE vaccination be integrated into national
immunization schedules in all areas where JE disease is recognized as a public health issue.

 Japanese Encephalitis Vaccine (JEV)

- Je-Vax (Japanese Encephalitis Virus Vaccine Inactivated) is a vaccine used to help prevent Japanese
encephalitis virus disease in adults and children who are at least 12 months old.
 - Common side effects of Je-Vax include:

 injection site reactions (redness, pain, swelling, or arm soreness)

 low fever
 chills
 flu symptom
 headache
 tired feeling
 muscle pain
 nausea
 vomiting
 stomach pain
 mild itching, hives, or skin rash

 For persons 3 years of age and older, a single dose is 1.0 mL of vaccine. For children 1 year to 3 years of
age, a single dose is 0.5 mL of vaccine. Je-Vax may interact with steroids, medicines to treat or prevent
organ transplant rejection, or medications to treat psoriasis, rheumatoid arthritis, or other autoimmune
disorders.
 Tell your doctor all medications and supplements you use and other vaccines you have recently received.
Vaccines may be harmful to a fetus. However, not vaccinating the mother could be more harmful to the
baby if the mother becomes infected with a disease that this vaccine could prevent.
 Your doctor will decide if you should receive this vaccine, especially if you have a high risk of infection
with the Japanese encephalitis virus. Consult your doctor before breastfeeding.

Who should be considered for vaccination against JE?

- JE-CV is recommended for individuals aged 9 months and older, to be given subcutaneously as a single
dose.
- The vaccine is recommended in the following schedule and dose:
 Children 9 months up to 17 years old, as a single primary dose then followed by a booster dose at
12-24 months after the primary dose
 For immunocompetent adults, as single primary dose with no booster dose needed
 For those who wish to be protected, vaccine can be given at any time if without contraindications