Japanese encephalitis virus (JEV) is an important cause of encephalitis among children in Cuddalore district, Tamil Nadu, India.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Kabilan
Lalitha
L
Centre for Research in Medical Entomology (Indian Council of Medical Research), 4 Sarojini Street, Chinna Chokkikulam, Madurai-625002, India. lalithakabilan@sify.com
Vrati
Sudhanshu
S
Vrati
Sudhansu
S
Ramesh
S
S
Srinivasan
S
S
Appaiahgari
Mohan Babu
MB
Arunachalam
N
N
Thenmozhi
V
V
Kumaravel
S Muthu
SM
Samuel
P Philip
PP
Rajendran
R
R
D000208:Acute Disease; D000293:Adolescent; D001483:Base Sequence; D002648:Child; D002675:Child, Preschool; D004664:Encephalitis Virus, Japanese / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D004672:Encephalitis, Japanese / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D010865:Pilot Projects; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D012621:Seasons; D013577:Syndrome; D014773:Virology / Q000379:methods
D012367:RNA, Viral