Kolhe, Surpam, Munde, Gawande, and Bobade: Serological study of Japanese encephalitis virus (JEV) among acute encephalitis syndrome cases at Chandrapur, Maharashtra


Introduction

Japanese encephalitis Virus (JEV) a flaviviridae family member (genus Flavivirus) is the main cause of meta-zoonotic viral encephalitis in many Asian countries.1, 2

The disease was primarily reported in 1952 from Nagpur territory of Maharashtra recording nearly 16 deaths of a unknown viral encephalitis which was later awarded to be JEV; just nearer to Chandrapur reporting the present catastrophes.3

It is endemic with recurrent dispersal in parts of China, Russia and South-East Asia.4 There are informed 30,000 to 50, 000 clinical cases of JEV per annum, with an probable mortality extending from 10,000 to 15,000 deaths each year.5

It is more common in rural areas like Chandrapur district and nearby geographical dwellings where regular rice cultivation is taking place which endorses natural cultivation of causative vectors for JE. Three mosquitoes have been convicted for transmission of JEV cycles, the most important one is Culex followed by Anopheles and Mansoni.6

But the natural reservoir for the JE virus is known to be the Pigs which act as an amplifier of the virus and Humans are supposed to be the ‘dead end’ hosts of the disease. In some developed peculiarly, Asian countries use of the JE vaccine has affectedly declined cases of the disease found in children. Though, JE is still seen in adults, particularly the elderly.7

There is no treatment for JEV. Vector-control measures are not operationally realistic, are overpriced and of restricted significance. It causes substantial sickness with mortality in about one-third patients and similar number of recovered experience disability.8

Hence we have undertaken present study to make a countable move not only towards the diagnosis of the diseases but also to restrict its future spread in Indian continent. Which will also aid medical practitioners to combat with this metazoonotic disorder.

Materials and Methods

The present retrospective study was carried out in the dept. of Microbiology, Govt. Medical College, Chandrapur (MH). All serum samples of clinically suspected JE patients received from GMC and Hospital Chandrapur and from periphery of Chandrapur district were considered for the present study.

Demographic details like age, gender, address, and patient’s details like date of admission, clinical history, signs, symptoms, collection of sample were noted.

Received samples were processed for IgG and IgM anti JEV antibody by JEVIgG-IgM capture ELISA (Mac ELISA), and required kits and test results were provided by National Institute of Pune (MH). The test was run and analysed as per guidelines given by World Health organisation.9, 10

The ELISA machine used was mindray micro plate reader model: MR-96A by Shenzhen Mindray bio-medical electronics, Shenzhen, China. Test results were read as per provided literature and the data obtained was utilised for knowing sero-prevalence of JEV in Chandrapur district.

Results

A sum 149 samples from suspected JEV patients were processed in Microbiology laboratory. Out of all these tested samples 42 were found to be positive and 43 were equivocal for JEV on ELISA as depicted in ? Table 1. Considering the total population under study 92 were males and 57 were females. Amongst these 20 males and 22 females were positive. Considering monthly distribution most number of suspected cases were seen in the month of July and were amounting to 107 cases.

Table 1

Distribution of JEV reports amongst males and females in the year 2018-19 at tertiary care centre, Chandrapur

Month

No. of Sample Tested

Male

Female

Tot

+ve

-ve

Equivocal

Tot

+ve

-ve

Equivocal

Tot

+ve

-ve

Equivocal

Oct 2018-Dec 2018

00

00

00

00

00

00

00

00

00

00

00

00

Jan

00

00

00

00

00

00

00

00

00

00

00

00

Feb

00

00

00

00

00

00

00

00

00

00

00

00

Mar

00

00

00

00

00

00

00

00

00

00

00

00

Apr

00

00

00

00

00

00

00

00

00

00

00

00

May

00

00

00

00

00

00

00

00

00

00

00

00

Jun

7

3

3

1

5

3

1

1

2

0

2

0

Jul

107

28

48

31

68

14

32

22

39

14

19

6

Aug

9

3

2

4

5

1

1

3

4

2

1

1

Sept

21

8

11

7

14

2

8

4

15

6

3

3

Tot

149

42

64

43

92

20

42

30

57

22

22

13

With the present scenario Prevalence of JEV amongst the population of Chandrapur district could be calculated as:

Prevalence of JEV = total number of positive cases ÷ sample size under observation × 100.

Hence prevalence of JEV for a period of 12 months (that is period prevalence) is 28.18%.

Considering male population prevalence was 21.73% and in female population it was observed to be 38.59%

Table 2

Age wise distribution of JEV affected population in tertiary care centre at Chandrapur

Age group

No. of Patients

JEV Positive cases

JEV Negative cases

1 to 5 years

78

24

54

6 to 10 years

49

10

39

11 to 15 years

8

5

3

16 to 25 years

7

3

4

26 to 50 years

6

0

6

>50 years

1

0

1

As depicted in Table 2 most number of JEV affected population was seen more in the age group of 1 to 5 years of children and with advancement of the age reduction in the number of seropositive cases were observed.

Discussion

A vector born deadly disease JEV is mainly found to be spread mainly because of Culex mosquitos which was confirmed by taking history of the admitted patients or their parents; this effect could be attributed to the open sewage systems of Chandrapur city and surroundings of paddy fields which promotes growth of the mosquitos. The solutions to the problem could be found by doing smogging, maintaining and strong pest control in the epidemic areas.2

As seen in present study eruption of JEV was first recognized in Nagpur city claiming more than a dozen of Death sand later a catastrophe in serological survey in the 1950s.11, 12

The next JEV outburst was informed in West Bengal in 1973, trailed by several states in the country.13, 14, 15, 16

After 1978 North India incidence, a severe outbreak of JE occurred with 5,700 cases and 1,315 deaths in Uttar Pradesh again in 2005.17, 18

Even though viruses being the most important pathogens which cause infectious frequencies reported higher in children of age group 1to 3 years, which are supposed to be easy prey of mosquitos Similar results were observed by Phukan AC, Sarkar A and Bandopadhyay B.2, 19, 20

Hospital-based acute encephalitis syndrome (AES) surveillance in north and northeast India showed that ~25% of cases were positive for JE, which were prevalent mainly in children. The estimated JE incidence rate was 15 per 100,000 in 5–9-year-olds in Tamil Nadu, a state in southern India. The JEV infection rate reached as high as 70.7% of the cases. Similar results were observed in present study.

Prevalence of JEV was found to be 28.18% in the present study which could be a positive risk factor for ‘summer abortion’, which could be due to bore wells as a water cradle’, ‘reported presence of mosquitoes’ and ‘lower elevation’ as found by Thakur KK. Further they have added that JEV is likely circulating in the mountain districts of Nepal, and to be considered risk for citizens of the country and travelers.21

Human blood or CSF to be the reservoir source from which isolated appropriate management of opportunistic infections is as important as most of the infections in our study were observed in patients who were not given vaccinations.22 Hence it is strongly recommended to include JE Vaccine in routine vaccination programme in JEV epidemic areas so as to reduce the mortality related to the disease.

Source(s) of Support

Nil

Conflicting Interest

None.

References

1 

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2 

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4 

Japanese encephalitis: status of surveillance and immunization in Asia and the Western PacificWkly Epidemiol Rec2012883435764

5 

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8 

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9 

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10 

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K C Smithburn J A Kerr P B Gatne Neutralizing antibodies against certain viruses in the sera of residents of IndiaJ Immunol195472424857

12 

Lalitha Kabilan R. Rajendran N. Arunachalam S. Ramesh S. Srinivasan P. Philip Samuel Japanese encephalitis in India: An overviewIndian J Pediatr20047176091510.1007/bf02724120

13 

S K Chakravarty J K Sarkar M S Chakravarty M K Mukherjee K K Mukherjee B C Das The first epidemic of Japanese encephalitis studied in India – virological studiesIndian J Med Res19756317782

14 

V Dhanda V Thenmozhi N P Kumar J Hiriyan N Arunachalam A Balasubramanian Virus isolation from wildcaught mosquitoes during a Japanese encephalitis outbreak in Kerala in 1996Indian J Med Res199710646

15 

R C Mohan S R Prasad J J Rodrigues N G Sharma B H Shaikh K M Pavri The first laboratory proven outbreak of Japanese encephalitis in GoaIndian J Med Res19837874550

16 

S N Sharma B S Panwar An epidemic of Japanese encephalitis in Haryana in the year 1990J Commun Dis19912332045

17 

J Lawrence Japanese encephalitis outbreak in India and NepalEuro Surveill2005109509224

18 

G Mudur Japanese encephalitis outbreak kills 1300 children in IndiaBMJ200533175281288

19 

A Sarkar D Taraphdar S K Mukhopadhyay S Chakrabarti S Chatterjee Serological and molecular diagnosis of Japanese encephalitis reveals an increasing public health problem in the state of West Bengal, IndiaTrans R Soc Trop Med Hyg2012106115910.1016/j.trstmh.2011.08.011

20 

B Bandyopadhyay I Bhattacharyya S Adhikary S Mondal J Konar N Dawar Incidence of Japanese Encephalitis among Acute Encephalitis Syndrome Cases in West Bengal, IndiaBioMed Res Int201320131510.1155/2013/896749

21 

K. K. Thakur G. R. Pant L. Wang C. A. Hill R. M. Pogranichniy S. Manandhar Seroprevalence of Japanese Encephalitis Virus and Risk Factors Associated with Seropositivity in Pigs in Four Mountain Districts in Nepal*Zoonoses Public Health201259639340010.1111/j.1863-2378.2012.01456.x

22 

S Hills A Dabbagh J Jacobson Evidence and rationale for the World Health Organization recommended standards for Japanese encephalitis surveillanceBMC Infect Dis20099214



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