- by Dr. Truong Hoang Quy -
Japanese Encephalitis is a potentially severe neurological infection. It is caused by the Japanese encephalitis virus, and occurs in rural areas of Asia and the western Pacific. The disease is spread through these regions by mosquito bites.
In Vietnam, the first case of Japanese encephalitis was reported in 1952. The disease can occur throughout the country, but mostly in rural and agricultural areas in the North of Vietnam where people cultivate rice, fruit, vegetables, and farm pigs. In the past, it has been estimated that there were 2000-3000 cases of encephalitis annually, among them Japanese encephalitis accounting for 61.3%. Thanks to the Vietnam National Immunization program, the Japanese encephalitis vaccine is now provided to Vietnamese children.
Nowadays, only 10–15% of encephalitis diseases are caused by the Japanese encephalitis virus. From January 2017 until now, there have been 325 encephalitis cases in 31 provinces across Vietnam and five deaths reported. The incidence of encephalitis is at 65.8%, 12.3%, 17.5% and 4.4% in the Northern, Central, Southern, and Highlands regions respectively. Japanese encephalitis accounts for 15% of all encephalitis cases.
The symptoms of Japanese encephalitis vary. Infected individuals are likely to have been exposed to mosquitoes in an endemic area. The symptoms may include fever, headache, vomiting, and/or myalgia. After this, symptoms become worse with the onset of neurological signs such as altered mental states, seizure, flaccid paralysis, hyperpneic breathing and cranial nerve findings.
No antiviral agent is effective to treat the Japanese encephalitis disease. The treatment focuses on supportive care, including management of intracranial pressure, airway protection and seizure control.
A Japanese encephalitis vaccine is available. Other modes of prevention such as avoiding mosquito bites, decreasing the mosquito population and viral spread should be implemented.
Avoidance of mosquito exposure, particularly at night, is another good mode of prevention. People living in or traveling to endemic areas should strongly consider the use of bednets while sleeping and mosquito repellents with diethyltoluamide (DEET) during times of risk of mosquito contact. Wearing long-sleeved shirts and pants in endemic areas is also important.
Decreasing the mosquito population and controlling viral spread can include the use of insecticides and larvae-killing agents, breeding larvivorous fish in rice paddies, and draining the rice paddies.
There are about four classes of Japanese encephalitis vaccines worldwide, including inactivated mouse brain vaccines, inactivated Vero cell-derived vaccines, live attenuated vaccines and live recombinant (chimeric) vaccines, which are derived from the yellow fever virus strain. The dosage schedule for vaccines vary by country and also depend on the kind of vaccine that is used. For example, the schedule for the Vietnamese vaccine is three doses administered intramuscularly: the first dose when the child is above one year of age and the second 1–2 weeks after the first shot. The third dose is given one year after the second shot. Then child will need a booster shot after every 3–4 years until 15 years of age.
Dr. Truong Hoang Quy
With a decade of pediatric experience under his belt,Dr. Quy is the only Vietnamese national in Family Medical’s pediatric practice, and he brings a strong focus on internal medicine and infectious diseases as well as nutrition and vaccination to our team.
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