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Japanese encephalitis in southeastern Nepal: clinical aspects in the 1986 epidemic
12nd Battalion 52nd Lowland Volunteers, Edinburgh.
Abstract:
A multi disciplinary team furthered the collaborative study of acute encephalitis in southeastern Nepal during a major epidemic which occurred in the monsoon period of 1986. Viral studies of serum and cerebro-spinal fluid (CSF) confirmed Japanese Encephalitis Virus (JEV) as the causative agent. Analysis of epidemiologic data suggests recent introduction of the virus to the regional population. Children accounted for the majority of all hospital admissions and had a markedly lower fatality rate from the infection than adults. Unfavourable prognostic indicators identified include a reduced conscious level on admission to hospital and a low serum or CSF IgM response to JEV.
Insights
Japanese Encephalitis Virus (JEV) caused a 1986 epidemic in Nepal. Children had better outcomes than adults, with poor prognostic signs including low consciousness and weak IgM response.
Area of Science:
- Epidemiology
- Virology
- Neurology
Background:
- A significant outbreak of acute encephalitis occurred in southeastern Nepal during the 1986 monsoon season.
- This event prompted a multidisciplinary investigation into the causative agent and disease characteristics.
Purpose of the Study:
- To identify the viral cause of the acute encephalitis epidemic in Nepal.
- To analyze epidemiological factors, clinical presentation, and outcomes associated with the outbreak.
- To determine prognostic indicators for Japanese Encephalitis Virus (JEV) infection.
Main Methods:
- Viral isolation and serological studies were performed on patient serum and cerebrospinal fluid (CSF).
- Epidemiological data, including patient demographics and clinical outcomes, were collected and analyzed.
- Prognostic indicators were assessed based on clinical presentation and laboratory findings.
Main Results:
- Japanese Encephalitis Virus (JEV) was confirmed as the etiological agent responsible for the epidemic.
- Epidemiological analysis indicated a recent introduction of JEV into the local population.
- Children constituted the majority of cases but exhibited a lower fatality rate compared to adults.
- Reduced consciousness level upon hospital admission and a low serum or CSF IgM response to JEV were identified as unfavorable prognostic indicators.
Conclusions:
- JEV was the primary cause of the 1986 acute encephalitis epidemic in southeastern Nepal.
- The study highlights age-related differences in JEV fatality rates and identifies key indicators for predicting patient outcomes.