尼泊尔的日本脑炎流行病学情况。

Epidemiological situation of Japanese encephalitis in Nepal.

作者信息

Bista M B, Shrestha J M

机构信息

Epidemiology and Disease Control Division, DHS, MOHP, Teku, Kathmandu, Nepal.

出版信息

JNMA J Nepal Med Assoc. 2005 Apr-Jun;44(158):51-6.

DOI:
Abstract

A human Japanese encephalitis (JE) case is considered to have elevated temperature (over 380 C) along with altered consciousness or unconsciousness and is generally confirmed serologically by finding of specific anti-JE IgM in the cerebro spinal fluid. No specific treatment for JE is available. Only supportive treatment like meticulous nursing care, introduction of Ryle's tube if the patient is unconscious, dextrose solution if dehydration is present, manitol injection in case of raised cranial temperature and diazepam in case of convulsion. Intra venous fluids, indwelling catheter in conscious patient and corticosteroids unless indicated should be avoided. Pigs, wading birds and ducks have been incriminated as important vertebrate amplifying hosts for JE virus due to viremia in them. Man along with bovines, ovines and caprines is involved in transmission cycle as accidental hosts and plays no role in perpetuating the virus due to the lack of viremia in them. The species Cx tritaeniorhyncus is suspected to be the principal vector of JE in Nepal as the species is abundantly found in the rice-field ecosystem of the endemic areas during the transmission season and JE virus isolates have been obtained from a pool of Cx tritaeniorhyncus females. Mosquito vector become infective 14 days after acquiring the JR virus from the viremic host. The disease was first recorded in Nepal in 1978 as an epidemic in Rupandehi district of the Western Development Region (WDR) and Morang of the Eastern Region (EDR). At present the disease is endemic in 24 districts. Although JE as found endemic mainly in tropical climate areas, existence and proliferation of encephalitis causing viruses in temperate and cold climates of hills and valleys are possible. Total of 26,667 cases and 5,381 deaths have been reported with average case fatality rate of 20.2% in an aggregate since 1978. More than 50% of morbidity and 60% mortality occur in the age group below 15 years. Upsurge of cases take place after the rainy season (monsoon). Cases start to appear in the month of April - May and reach its peak during late August to early September and start to decline from October. There are four designated referral laboratories, namely National Public Health Laboratory (Teku), Vector Borne Diseases Research and Training Center (Hetauda), B.P. Koirala Institute of Medical Sciences (Dharan) and JE Laboratory (Nepalgunj), for confirmatory diagnosis of JE. For prevention of JE infection; chemical and biological control of vectors including environmental management at breeding sites are necessary. Segregate pigs from humans habitation. Wear long sleeved clothes and trousers and use repellent and bed net to avoid exposure to mosquitos. For the prevention of the disease in humans, safe and efficacious vaccines are available. Therefore immunize population at risk against JE. Immunize pigs at the surroundings against JE. 225,000 doses of live attenuated SA-14-14.2 JE vaccine were received in donation from Boran Pharmaceuticals, South Korea for the first time in Nepal. Altogether 224,000 children aged between 1 to 15 years were vaccinated in Banke, Bardiya and Kailali districts during 1999. From China also, 2,000,000 doses of inactivated vaccine were received in 2000 and a total of 481,421 children aged between 6m to 10 yrs were protected from JE during 2001/2002. Ministry of Agriculture, Department of Livestock Services has vaccinated around 200,000 pigs against JE in terai zone during February 2001.

摘要

人类日本脑炎(JE)病例被认为体温升高(超过38℃)并伴有意识改变或昏迷,一般通过在脑脊液中发现特异性抗JE IgM进行血清学确诊。目前尚无针对日本脑炎的特效治疗方法。仅采取支持性治疗,如精心护理,若患者昏迷则插入鼻胃管,若存在脱水则输入葡萄糖溶液,若颅内温度升高则注射甘露醇,若发生惊厥则使用地西泮。应避免静脉输液、对意识清醒的患者留置导尿管以及使用皮质类固醇,除非有明确指征。猪、涉禽和鸭因出现病毒血症而被认为是日本脑炎病毒重要的脊椎动物扩增宿主。人类以及牛、羊和山羊作为偶然宿主参与传播循环,由于它们不会出现病毒血症,因此在病毒持续传播中不起作用。在尼泊尔,三带喙库蚊被怀疑是日本脑炎的主要传播媒介,因为在传播季节,该物种大量存在于流行地区的稻田生态系统中,并已从一组三带喙库蚊雌蚊中分离出日本脑炎病毒。蚊虫从病毒血症宿主感染日本脑炎病毒14天后具有传染性。该病于1978年首次在尼泊尔被记录,当时是西部发展区鲁潘德希县和东部地区莫朗县的疫情。目前该病在24个县呈地方性流行。尽管日本脑炎主要在热带气候地区呈地方性流行,但在山区和山谷的温带和寒冷气候中,引起脑炎的病毒也可能存在和增殖。自1978年以来,共报告了26,667例病例和5,381例死亡,总体平均病死率为20.2%。超过50%的发病率和60%的死亡率发生在15岁以下年龄组。病例在雨季(季风)后激增。病例于4月至5月开始出现,8月下旬至9月初达到高峰,10月开始下降。有四个指定的转诊实验室,即国家公共卫生实验室(特库)、媒介传播疾病研究与培训中心(赫陶达)、B.P.柯伊拉腊医学科学研究所(达兰)和日本脑炎实验室(尼泊尔根杰),用于日本脑炎的确诊诊断。为预防日本脑炎感染,有必要对媒介进行化学和生物控制,包括对繁殖地进行环境管理。将猪与人类居住地隔离开。穿长袖衣服和长裤,使用驱虫剂和蚊帐以避免接触蚊子。为预防人类感染该病,有安全有效的疫苗。因此,应对高危人群接种日本脑炎疫苗。对周边地区的猪接种日本脑炎疫苗。尼泊尔首次从韩国保宁制药公司收到22.5万剂减毒活SA - 14 - 14.2日本脑炎疫苗。1999年期间,在班凯、巴迪亚和凯拉利县共为22.4万名1至15岁的儿童接种了疫苗。2000年,尼泊尔还从中国收到了200万剂灭活疫苗,在2001/2002年期间,共有481,421名6个月至10岁的儿童受到保护,免受日本脑炎感染。2001年2月,农业部畜牧服务司在特莱地区为约20万头猪接种了日本脑炎疫苗。

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