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High incidence of subacute sclerosing panencephalitis in south India
1Department of Virology, Christian Medical College and Hospital, Vellore, India.
Abstract:
During 1983-7 a clinical diagnosis of subacute sclerosing panencephalitis (SSPE) was confirmed by the detection of measles virus haemagglutination inhibiting antibody in the cerebrospinal fluid (CSF) in 81 subjects resident in Tamilnadu. The antibody titre (reciprocol of the end-point dilution) in the CSF ranged from 2 to 32 and in the sera from 8 to 2048. The CSF:serum ratios of titres were 1:4-1:64 in 80 cases and 1:128 in one case. The median age at onset of SSPE was 10 years and 97% of cases were diagnosed at stage 2 and beyond. Based on the geographic distribution of 72 cases in an estimated population of 8.4 million, the annual incidence of SSPE was calculated to be 2.14 per million population, or 4.3 cases per million children below 20 years. Assuming that only 10% of all cases would have reached the level of laboratory diagnosis, the incidence may be as high as 21 cases per million population.
Insights
Subacute sclerosing panencephalitis (SSPE) diagnosis in Tamilnadu confirmed measles virus antibodies in cerebrospinal fluid (CSF). The study estimated a significant incidence of SSPE, potentially higher than initially diagnosed.
Area of Science:
- Neurology
- Virology
- Epidemiology
Background:
- Subacute sclerosing panencephalitis (SSPE) is a rare, progressive neurological complication of measles infection.
- Early and accurate diagnosis is crucial for understanding SSPE's impact and progression.
Purpose of the Study:
- To confirm SSPE diagnoses using measles virus antibody detection in cerebrospinal fluid (CSF).
- To determine the incidence of SSPE in Tamilnadu, India.
- To analyze demographic and clinical features of SSPE cases.
Main Methods:
- Clinical diagnosis of SSPE was confirmed by detecting measles virus haemagglutination inhibiting antibody in CSF.
- Antibody titers in CSF and serum were measured, and CSF:serum ratios were calculated.
- Geographic distribution and population data were used to estimate incidence rates.
Main Results:
- Eighty-one SSPE cases were confirmed via measles antibody detection in CSF between 1983-1987.
- Median age at onset was 10 years, with 97% diagnosed at stage 2 or later.
- Calculated annual incidence was 2.14 per million population, potentially reaching 21 per million if underdiagnosis is considered.
Conclusions:
- Measles virus antibody detection in CSF is a reliable method for confirming SSPE.
- The incidence of SSPE in Tamilnadu suggests a substantial public health burden.
- Further research is needed to understand the full scope of SSPE and improve diagnostic rates.