Ram Sundar Twayana, Neuberger Ami, Thapa Lekh Jung, Vir Singh Rana Pramendra, Shofty Ben, Schwartz Eli
Faculty of Internal Medicine, Kathmandu University Hospital, Dhulikhel, Nepal.
Unit of Infectious Diseases & Internal Medicine B, Rambam Medical Center, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
PLoS One. 2014 Jun 20;9(6):e99999. doi: 10.1371/journal.pone.0099999. eCollection 2014.
The reported incidence of JE among patients with acute encephalitic syndrome (AES) in Nepal ranges between 20% to 62%. In light of the lack of up-to-date data, we sought to describe the epidemiology of JE in Chitwan, Nepal.
A prospective observational study was conducted during 2010-2012 in the College of Medical Science in the Chitwan District. Patients with suspected JE were tested for anti-JE IgM in serum and cerebrospinal fluid (CSF).
Of 227 all patients tested, 18 (7.9%) were found positive for JE. 17/202 (8.4%) patients with AES had JE. All, with the exception of two patients, were diagnosed on the basis of positive a serologic test, both in serum and CSF samples. Patients with JE were significantly older (42.1±27.6 years) than patients without JE (25.6±25.2 years, p = 0.02). Half of JE cases occurred in adults older than 50. More of the JE cases (11/18, 61.1%) occurred during the rainy season when compared to the JE negative patients [71/209, (34%), p = 0.01]. None of the JE patients had a relevant travel history, and one recalled having been immunized against JE. There was a variation in the geographic distribution of cases across the districts of the central Terai.
In this cohort, the proportion of patients with AES who had JE was lower than in previous studies. In addition, most patients were adults, and cases were not distributed uniformly across the central Terai region. The risk of acquiring JE by short-term travelers in the area is likely to be low. Vector-control programs and the promotion of mosquito avoidance behavior in the Terai region should continue. The high proportions of adults among patients with JE may suggest recent changes in the epidemiology of JE in the central Terai region, and routine immunization of all adults should be considered.
据报道，尼泊尔急性脑炎综合征（AES）患者中日本脑炎（JE）的发病率在20%至62%之间。鉴于缺乏最新数据，我们试图描述尼泊尔奇旺地区日本脑炎的流行病学情况。
2010年至2012年期间，在奇旺地区医学科学学院进行了一项前瞻性观察研究。对疑似日本脑炎的患者进行血清和脑脊液（CSF）中抗日本脑炎IgM检测。
在所有227名接受检测的患者中，18例（7.9%）日本脑炎检测呈阳性。202例AES患者中有17例（8.4%）患有日本脑炎。除两名患者外，所有患者均根据血清和脑脊液样本的血清学检测呈阳性确诊。患有日本脑炎的患者（42.1±27.6岁）比未患日本脑炎的患者（25.6±25.2岁，p = 0.02）年龄显著更大。一半的日本脑炎病例发生在50岁以上的成年人中。与日本脑炎阴性患者相比，更多的日本脑炎病例（11/18，61.1%）发生在雨季[71/209，（34%），p = 0.01]。没有日本脑炎患者有相关旅行史，只有1人回忆曾接种过日本脑炎疫苗。病例在中部特莱地区各地区的地理分布存在差异。
在该队列中，患有日本脑炎的AES患者比例低于先前研究。此外，大多数患者为成年人，且病例在中部特莱地区分布不均。该地区短期旅行者感染日本脑炎的风险可能较低。应继续在特莱地区开展病媒控制项目并推广防蚊行为。日本脑炎患者中成年人比例较高可能表明中部特莱地区日本脑炎的流行病学最近发生了变化，应考虑对所有成年人进行常规免疫接种。
