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Japanese Encephalitis.

Definition of Disease...

Japanese encephalitis is a mosquito-borne viral disease that occurs chiefly in three areas: (1) China and Korea, (2) the Indian sub-continent consisting of India, parts of Bangladesh, southern Nepal, and Sri Lanka, and (3) the southeast Asian countries of Burma, Thailand, Cambodia, Laos, Vietnam, Malaysia, Indonesia and the Philippines. Japanese encephalitis also may occur with a lower frequency in Japan, Taiwan, Singapore, Hong Kong, and eastern Russia. In all areas, Japanese encephalitis is primarily a rural disease.

Transmission is usually seasonal, following the prevalence of mosquitoes. In China, Korea and other temperate areas, the transmission season extends through the summer and fall. In other subtropical and tropical regions, risk is associated with the rainy season, which varies in each country. For instance, recent epidemics have occurred in northern India, Nepal, and Sri Lanka, from October to December. However, in tropical areas, sporadic cases may occur at any time of the year.

The chance that a traveler to Asia will develop Japanese encephalitis is probably very small. Only 5 cases among Americans traveling or working in Asia are known to have occurred since 1981. Only certain mosquito species are capable of transmitting Japanese encephalitis. In areas infested with mosquitoes, usually, only a small portion of the mosquitoes are actually infected with Japanese encephalitis virus. Among persons who are infected by a mosquito bite, only 1 in 50 to 1 in 1000 persons will develop an illness.

The majority of infected persons develop mild symptoms or no symptoms at all. However, among persons who develop encephalitis, the consequences of the illness may be grave.

Japanese encephalitis begins clinically as a flu-like illness with headache, fever, and often gastrointestinal symptoms. Confusion and disturbances in behavior also may occur at an early stage. The illness may progress to a serious infection of the brain i.e. encephalitis, and in one third of cases, the illness may be fatal. Another one third of cases survive with serious neurologic after effects such as paralysis or other forms of brain damage, and the remaining one third of cases recover without further problems. After the onset of the infection, and until the illness has run its course, only supportive treatment is available. Infection in pregnant women during the first and second trimester have been associated with miscarriages.

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