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VPH 122 > 3. Japanese Encephalitis > Flashcards

3. Japanese Encephalitis Flashcards

1
Q

Enveloped
single-stranded RNA
with a cubic nucleocapsid

A

flavivirus

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2
Q

(3) structural proteins of Flavivirus

[ CME ]

A

C - capsid protein
M - matrix protein
E - envelope protein

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3
Q

the receptor binding protein

A

envelope protein (E)

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4
Q

Zoonotic mosquito
borne flavivirus (family Flaviviridae)

The first case documented in 1871 in Japan.

A

Japanese Encephalitis

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5
Q

JE is closely related with what disease?

A

West Nile virus

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6
Q

JE (epidemiology)

Clinical case (each year):
Deaths (each year):
# Countries:

A

Clinical case (each year): 68,000
Deaths (each year): 13,600 - 20,400
# Countries: 25

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7
Q

Is JE identified in the Philippines?

A

Yes

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8
Q

What region is JE predominant in the Philippines?

A

Northern Region (I, II, etc)

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9
Q

JE has been part of the list of notifiable diseases under the Philippine Integrated Disease Surveillance and Response (PIDSR) surveillance since _______

A

2009

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10
Q

Peak of JE cases
a. months
b. season

A

a. July - October
b. wet season

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11
Q

Vector of JE

A

Culex gelid
Culex tritaeniorhynchus

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12
Q

Where is JE predominant? Give the type of place

A

agricultural areas
- rice paddies
- farms

urban areas (sometimes)

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13
Q

The natural maintenance
reservoir for JE virus

A

birds of family Ardeidae

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14
Q

Has high viral load of JE but no clinical signs

A

Ardeidae birds

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15
Q

Act as important amplifiers of the virus producing high viraemia that infect mosquito vectors

A

Pigs

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16
Q

Pigs has high viremia that lasts for __-__ days.

A

2-4 days

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17
Q

____________ are the primary affected domestic animals of JE

although other equids (donkeys) are also susceptible

A

Horses

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18
Q

Other “subclinically infected” animals which likely do not contribute to spread include: (10)

A

cattle
sheep
goats
dogs
cats
chickens
ducks
wild mammals
reptiles
amphibians

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19
Q

Season when JE is predominant in Northern temperate areas

A

Late summer / Early autumn

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20
Q

In SPRING season, Ardeid birds migrate between ____ & ___, introducing JE virus

A

rural & urban

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21
Q

Season when JE is predominant in Southern tropical areas

A

Year-round

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22
Q

In southern tropical areas, JE is a continual cycle between (3)

A
  1. birds
  2. swine
  3. mosquitoes
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23
Q

Incubation period of JE

A

4-15 days
(ave: 6-8 days)

24
Q

Severe disease of JE (signs)

A

rapid onset of high fever,
headache,
neck stiffness,
disorientation,
coma,
seizures,
spastic paralysis,
ultimately death

25
Q

(2) Dominant initial symptoms in children (JE)

A
  1. gastrointestinal pain
  2. vomiting
26
Q

Of those who survive, 20% - 30% suffer (3)

A
  1. permanent intellectual
  2. behavioral or neurological sequelae

( e.g. paralysis,
recurrent seizures or
the inability to speak)

27
Q

Defined as a person of any age, at any time of year with the acute onset of fever and at least one of
- change in mental status
- new onset of seizures

A

Acute Encephalitis Syndrome (AES)

28
Q

defined as case that meets the clinical case definition for AES

A

AES (suspected JE) case

29
Q

an AES case with JEV-specific IgM antibody in a sample of CSF or serum detected by IgM-capture ELISA

A

Laboratory-confirmed JE

30
Q

seizure that occurs in a child aged 6 months to less than 6 years old, whose only finding is fever and a single generalized convulsion lasting less than 15 mins, and who recovers consciousness within 60 min of seizure

A

simple febrile seizure

31
Q

The JE virus was found to be the causative agent in 7 - 18% of ___ & encephalitis cases in PH

A

clinical meningitis

32
Q

JE virus was found to be the causative agent in 16-40% of ____ ____

A

clinical encephalitis

33
Q

Majority of JE cases occurred in children ____ age.

A

below 15 years of age

34
Q

Individuals ____ comprised 15% of cases

A

older than 18 years

35
Q

Infection with JEV before _____ days of gestation can cause:
abortion,
fetal mummification or
stillbirth,
or the birth of weak piglets

A

60-70 days

36
Q

___ ___ ___ most often demonstrate neurologic signs of “tremors” and “convulsions” and may die soon after birth

A

live born piglets

37
Q

Mortality in non
immune, infected piglets can approach

A

100%

38
Q

Natural infection of JE results in ______

A

long lasting immunity

39
Q

mortality rate in adult swine

A

near ZERO

40
Q

Three (3) syndromic manifestations of JE

[ TLH ]

A
  1. Transitory type syndrome
  2. Lethargic type syndrome
  3. Hyperexcitable type syndrome
41
Q

Syndromic manifestation:

moderate fever
lasting 2-4 days accompanied by:
- inappetence,
- impaired locomotion,
- congested
- jaundiced mucosa

most commonly with swift recovery of 2-3 days

A

Transitory type syndrome

42
Q

Syndromic manifestation:

variable febrile periods (as high as 41 C), with a
- pronounced stupor,
- bruxism
- chewing motions,
- difficulty in swallowing,
- petechiation of mucosa,
- advanced incoordination,
- evidence of neck rigidity,
- impaired vision,
- paresis andralysis

recovery usually occurs within about a week

A

Lethargic type syndrome

43
Q

high fevers (41 C or higher) accompanied by:
- profuse sweating
- muscle tremors
- aimless wandering
- behavioral changes

manifested by:
- aggression
- loss of vision
- collapse
- coma
- death

neurologic sequelae may result

A

Hyperexcitable type syndrome

44
Q

What type of clinico-pathological feature is most common in JE

A

Subclinical disease

45
Q

mortality rate of JE in horses

A

5-15% (up to 30%)

46
Q

Morbidity rates reported from field cases vary from

A

less than 1% to 1.4 %

47
Q

Identification of JE agents (4)

[ BSCB ]

A
  1. Brain
  2. Spinal cord
  3. Cerebrospinal fluid (CSF)
  4. Blood**
48
Q

this is obtained from
aborted fetuses up to 70 days of age

A

thoracic fluid

49
Q

where to store JE tissue from recently dead animals

A

10% formalin

50
Q

Diagnosis of JE

A
  1. Virus isolation in laboratory animals
  2. Virus isolation in cell culture
  3. Real time RT-PCR***
  4. Antigen detection
  5. Serology
51
Q

Recommended diagnosis of JE in humans

A

JE virus-specific IgM capture ELISA on CSF/serum

52
Q

JE virus specific IgM can be measured (after onset of symptoms) in the:
CSF: ___ days
serum: ___ days

A

CSF: 4 days
serum: 7 days

53
Q

Test that can be performed to confirm the presence of JE virus specific neutralizing antibodies and discriminate between cross-reacting antibodies from closely related flaviviruses (such as dengue and West Nile viruses).

A

Plaque reduction neutralization tests

54
Q

Prevention and control of JE (4)

A
  1. PPE against mosquito bites
  2. Vaccine
  3. Mosquito vector control
  4. Surveillance
55
Q

Types of vaccine for JE (4)

A
  1. modified live
  2. inactivated
  3. live attenuated
  4. live recombinant (chimeric)
56
Q

vaccine produced in hamster or swine kidney tissue culture or hamster lung (HmLu) cell line

A

modified live vaccine

57
Q

vaccine prepared in mouse brain, chick embryo or cell lines,

(e.g. Vero cells)

A

inactivated vaccine

VPH 122 (15 decks)

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