![]() Treatment is supportive to relieve symptoms and stabilize the patient. There is no antiviral treatment for patients with JE. Case-based surveillance is established in countries that effectively control JE through vaccination. Confirmatory laboratory testing is often conducted in dedicated sentinel sites, and efforts are undertaken to expand laboratory-based surveillance. Surveillance of the disease is mostly syndromic for acute encephalitis syndrome. Testing of CSF sample is preferred to reduce false-positivity rates from previous infection or vaccination WHO recommends testing for JEV-specific IgM antibody in a single sample of cerebrospinal fluid (CSF) or serum, using an IgM-capture ELISA. A laboratory test is required in order to confirm JEV infection and to rule out other causes of encephalitis. Individuals who live in or have travelled to a JE-endemic area and experience encephalitis are considered a suspected JE case. In the tropics and subtropics, transmission can occur year-round but often intensifies during the rainy season and pre-harvest period in rice-cultivating regions. ![]() In most temperate areas of Asia, JEV is transmitted mainly during the warm season, when large epidemics can occur. The disease is predominantly found in rural and periurban settings, where humans live in closer proximity to these vertebrate hosts. The virus exists in a transmission cycle between mosquitoes, pigs and/or water birds (enzootic cycle). Humans, once infected, do not develop sufficient viraemia to infect feeding mosquitoes. JEV is transmitted to humans through bites from infected mosquitoes of the Culex species (mainly Culex tritaeniorhynchus). TransmissionĢ4 countries in the WHO South-East Asia and Western Pacific regions have JEV transmission risk, which includes more than 3 billion people. Of those who survive, 20%–30% suffer permanent intellectual, behavioural or neurological sequelae such as paralysis, recurrent seizures or the inability to speak. The case-fatality rate can be as high as 30% among those with disease symptoms. Severe disease is characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and ultimately death. In children, gastrointestinal pain and vomiting may be the dominant initial symptoms. The incubation period is between 4-14 days. Most JEV infections are mild (fever and headache) or without apparent symptoms, but approximately 1 in 250 infections results in severe clinical illness. Most adults in endemic countries have natural immunity after childhood infection, but individuals of any age may be affected. A literature review estimates nearly 68 000 clinical cases of JE globally each year, with approximately 13 600 to 20 400 deaths. The annual incidence of clinical disease varies both across and within endemic countries, ranging from 10 per 100 000 population or higher during outbreaks. The first case of Japanese encephalitis viral disease (JE) was documented in 1871 in Japan. ![]() It is a mosquito-borne flavivirus, and belongs to the same genus as dengue, yellow fever and West Nile viruses. Japanese encephalitis virus JEV is the most important cause of viral encephalitis in Asia. WHO recommends that JE vaccination be integrated into national immunization schedules in all areas where JE disease is recognized as a public health issue.
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