Tandale Babasaheb V, Bondre Vijay P, Sapkal Gajanan N, Gopalkrishna Varanasi, Gurav Yogesh K, Rao R Kondal, Qazi Mohiuddin S, Narang Rahul, Guduru Vijay Kumar, Niswade Abhimanyu K, Jain Manish
ICMR - National Institute of Virology, Pune, Maharashtra, India.
ICMR - National Institute of Virology, Pune, Maharashtra, India.
J Clin Virol. 2021 Nov;144:104970. doi: 10.1016/j.jcv.2021.104970. Epub 2021 Sep 14.
Japanese encephalitis (JE) is the leading cause of childhood acute encephalitis syndrome (AES) in India. We enhanced the AES surveillance in sentinel hospitals to determine trends and virus etiologies in central India.
The neurological hospitalizations among children ≤15 years were tracked by using the AES case definition implemented by the national program. Acute and convalescent sera along with cerebrospinal fluid (CSF) specimens were collected and tested at the strengthened site hospital laboratories for anti-JE, anti-Dengue and anti-Chikungunya virus by IgM ELISA; along with Chandipura virus RT-PCR. Herpes simplex and enterovirus testing was undertaken at the reference laboratory.
Among 1619 pediatric neurological hospitalizations reported during 2015-16, AES case definition was fulfilled in 332 (20.5%) cases. After excluding 52 non-AES cases, 280 AES cases resident from study districts were considered eligible for study. The treating physicians diagnosed non-viral causes in 90 cases, therefore 190 (67.9%) of 280 AES cases were suspected with viral etiologies. We enrolled 140 (73.7%) of 190 eligible AES cases. Viral etiologies were confirmed in 31 (22.1%) of 140 enrolled AES cases. JE (n = 22) was the leading cause. Additional non-JE viral agents included Chikungunya (5), Dengue (2) and Chandipura (2). However, only 21 (9.4%) of 222 additional AES cases referred from peripheral hospitals were confirmed as JE.
Japanese encephalitis virus continues to be the leading cause of childhood acute encephalitis syndrome in central India despite vaccination program. Surveillance needs to be intensified for assessing the true disease burden of Japanese encephalitis following vaccination program implementation.
在印度，日本脑炎（JE）是儿童急性脑炎综合征（AES）的主要病因。我们加强了哨点医院的AES监测，以确定印度中部地区的发病趋势和病毒病因。
采用国家项目实施的AES病例定义，追踪15岁及以下儿童的神经科住院病例。采集急性和恢复期血清以及脑脊液（CSF）标本，并在强化后的现场医院实验室通过IgM ELISA检测抗JE、抗登革热和抗基孔肯雅病毒；同时进行钱迪普拉病毒RT-PCR检测。在参考实验室进行单纯疱疹病毒和肠道病毒检测。
在2015 - 16年报告的1619例儿科神经科住院病例中，332例（20.5%）符合AES病例定义。排除52例非AES病例后，来自研究地区的280例AES病例被认为符合研究条件。治疗医生诊断90例为非病毒病因，因此280例AES病例中有190例（67.9%）怀疑为病毒病因。我们纳入了190例符合条件的AES病例中的140例（73.7%）。在纳入的140例AES病例中，31例（22.1%）确诊为病毒病因。JE（n = 22）是主要病因。其他非JE病毒病原体包括基孔肯雅病毒（5例）、登革热病毒（2例）和钱迪普拉病毒（2例）。然而，在外围医院转诊的222例额外AES病例中，只有21例（9.4%）确诊为JE。
尽管实施了疫苗接种计划，但日本脑炎病毒仍是印度中部地区儿童急性脑炎综合征的主要病因。在疫苗接种计划实施后，需要加强监测以评估日本脑炎的真实疾病负担。
