JE virus encephalitis: 1988 epidemic at Gorakhpur
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A K Rathi1, K P Kushwaha, Y D Singh
1Department of Pediatrics, Biochemistry and Microbiology, Medical College, Gorakhpur.
Insights
The 1988 Japanese encephalitis (JE) outbreak in Gorakhpur affected 875 children, with nearly half aged 7-10. Symptomatic management was used, but mortality remained high at 31.8%.
Area of Science:
- Pediatrics
- Virology
- Epidemiology
Background:
- The 1988 Japanese encephalitis (JE) outbreak in Gorakhpur, India, led to 875 pediatric admissions.
- Key symptoms included convulsions, altered sensorium, headache, and hypertonia, particularly in children aged 7-10 years.
Purpose of the Study:
- To analyze the clinical features, diagnosis, management, and outcomes of children affected by the 1988 JE outbreak.
- To evaluate the efficacy of symptomatic treatments and the impact of corticosteroids on patient outcomes.
Main Methods:
- Retrospective analysis of 875 pediatric cases admitted during the 1988 JE outbreak.
- Diagnostic confirmation through IgM antibody detection in cerebrospinal fluid (CSF) and serum, and Hemagglutination Inhibition (HI) antibody titers.
- Clinical management involved symptomatic treatment; corticosteroids and dopamine were administered selectively.
Main Results:
- JE virus IgM antibodies were detected in 18/25 CSF and 27/53 sera samples.
- Significant HI antibody titers against JE were found in 498/670 patients.
- Mortality rate was 31.8%, with 51.4% complete recovery and 10.7% partial recovery. Corticosteroids did not improve outcomes.
- Recurrence of symptoms occurred in 24 patients, leading to two deaths and neurological deficits in five.
Conclusions:
- The 1988 Gorakhpur JE outbreak had a significant impact on children, characterized by severe neurological symptoms and high mortality.
- Symptomatic management is crucial, but outcomes remain challenging, with a notable rate of recurrence and long-term deficits.
- Corticosteroids showed no benefit in improving outcomes for JE patients during this outbreak.
Abstract:
Gorakhpur region experienced the most serious outbreak of Japanese encephalitis (JE) in 1988 in which 875 children were admitted in the Department of Pediatrics, BRD Medical College, Gorakhpur. Children between 7-10 years age group constituted half (49.3%) of these cases, convulsions (83.8%), altered sensorium (78.2%), headache (68.8%) and hypertonia (77.0%) were the main presenting features. IgM against JE virus was demonstrated in 18/25 CSF and 27/53 sera collected from these children. Significant titres of HI antibodies against JE were present in 498/670 patients. Patients were managed symptomatically. Dexamethasone and dopamine were given to only 137 (15.7%) children admitted with shock and peripheral circulatory failure. Almost a third (31.8%) of the patients expired, 51.4% recovered completely and 10.7% recovered partially. Corticosteroids did not improve the outcome. Twenty four patients had recurrence of symptoms after excellent recovery from acute attack of whom two died and 5 developed neurological deficits.