Kabilan Lalitha, Vrati Sudhanshu, Ramesh S, Srinivasan S, Appaiahgari Mohan Babu, Arunachalam N, Thenmozhi V, Kumaravel S Muthu, Samuel P Philip, Rajendran R
Centre for Research in Medical Entomology (Indian Council of Medical Research), 4 Sarojini Street, Chinna Chokkikulam, Madurai-625002, India.
J Clin Virol. 2004 Oct;31(2):153-9. doi: 10.1016/j.jcv.2004.03.011.
Japanese encephalitis (JE) is endemic in Cuddalore district, Tamil Nadu (TN), Southern India. The reports of JE cases from the local hospitals did not reflect the actual disease burden. It is likely that these cases were attending the nearby referral hospitals, for want of better treatment facilities.
Between July 2002 and February 2003, a pilot study was undertaken to examine whether JE was a component of paediatric acute encephalitis syndrome (AES) reported to two major referral hospitals adjacent to Cuddalore, and to map the distribution of the JE cases.
A total of 58 hospitalized children [0-15 years] with AES were investigated. Other than the routine laboratory investigations, either CSF or sera or both [depending on the availability] collected from these children were analyzed at Center for Research in Medical Entomology, Madurai (TN) for JEV-antigen, antibody detection, virus isolation and virus genome detection by indirect immunofluorescence, MAC enzyme linked immunosorbent assay (ELISA), insect bioassay and by reverse transcriptase polymerase chain reaction (RT-PCR), respectively.
JE was established in 17 (29%) of 58 AES cases; half of the AES cases [31/58, 53%] and 59% [10/17] of JE cases were confined to JE-endemic areas in Cuddalore district. The JE confirmation scored by different assays varied according to the clinical phase of the illness. The attack rate was high among the children aged 3-8 years. The monthly distribution of acute encephalitic syndrome cases followed the distribution of JE cases [coinciding with the rainy season in this region] suggesting encephalitis of JE origin.
In JE-endemic areas, the actual JE burden can be estimated by the collection of JE case reports from the local hospitals and from the referral hospitals. Building of diagnostic facilities in hospitals for JE is necessary to achieve this goal.
日本脑炎（乙脑）在印度南部泰米尔纳德邦（TN）的库达洛尔地区呈地方性流行。当地医院报告的乙脑病例数并未反映实际的疾病负担。由于缺乏更好的治疗设施，这些病例很可能前往了附近的转诊医院就诊。
2002年7月至2003年2月期间，开展了一项试点研究，以调查乙脑是否为向库达洛尔附近两家主要转诊医院报告的小儿急性脑炎综合征（AES）的组成部分，并绘制乙脑病例的分布图。
对58例[0 - 15岁]因AES住院的儿童进行了调查。除常规实验室检查外，从这些儿童身上采集的脑脊液或血清或两者[视情况而定]，分别在马杜赖（TN）的医学昆虫学研究中心通过间接免疫荧光法、MAC酶联免疫吸附测定（ELISA）、昆虫生物测定法以及逆转录聚合酶链反应（RT-PCR）分析乙脑病毒抗原、抗体检测、病毒分离和病毒基因组检测。
58例AES病例中有17例（29%）确诊为乙脑；一半的AES病例[31/58，53%]和59%[10/17]的乙脑病例局限于库达洛尔地区的乙脑流行区。不同检测方法对乙脑的确诊率因疾病临床阶段而异。3 - 8岁儿童的发病率较高。急性脑炎综合征病例的月度分布与乙脑病例分布一致[与该地区雨季相符]，提示为乙脑源性脑炎。
在乙脑流行地区，通过收集当地医院和转诊医院的乙脑病例报告可估算实际的乙脑负担。为实现这一目标，有必要在医院建立乙脑诊断设施。
