Back to haunt us??
India is currently in the middle of a Japanese Encephalitis epidemic, with 468 deaths so far in the Northern regions. Most fatalities have been children. So what on earth has that got to do with us here in Bali? Well firstly, if you are a traveler and you intend to take yourself backpacking through India, you might want to make sure that you have been vaccinated against this disease. Secondly you might like to ponder the thought that J.E. is spread by migratory birds and I am betting that it won’t be too long before this isolated epidemic spreads to other Asia countries.
What Is Japanese Encephalitis?
J.E. is a serious viral illness that affects the brain. It primarily affects children between the ages of 2 – 10 years, the elderly, or individuals with lowered immune systems. Case fatality rates range from 0.3 – 60% (average 30 %), and approximately 30% of those survivors will be brain damaged in some way.
How does Japanese Encephalitis present?
Some people that are exposed to the disease will have very mild, or no symptoms at all. Those people will not go on to develop serious consequences of the disease; indeed they will probably never know that they had the disease.
Those that suffer severe acute infection would show any or all of the following signs:
-Abrupt onset of high fever
-Headache
-Loss of appetite
-Pain behind the eyes
-Neck stiffness
-Disorientation or stupor
-Convulsions or twitches / tremors
-Coma
-Paralysis
PERSONS EXHIBITING ANY OF THE ABOVE SYMPTOMS MUST SEEK MEDICAL ATTENTION IMMEDIATELY
How do people get Japanese Encephalitis?
J.E. is spread by vector transmission, the Culex Mosquito being the carrier. It cannot be transmitted directly from one person to the next, (i.e. you cannot get it from touching or kissing an infected person).
Mosquitoes become infected by feeding on pigs or wild birds infected with the J.E. virus. Infected mosquitoes then transmit the virus to humans during the feeding process. The Culex mosquito typically inhabits rice paddies, and other waterways. This mosquito is essentially an outdoor mosquito, and they are most active in the late evenings or at night. Not all Culex Mozzies are carriers of the disease. Only mosquitoes that have been infected can infect you.
How do we prevent the spread of J.E.?
Firstly, don’t invite this troublesome insect into your area by providing it with ideal breeding grounds.
- Make sure that your garden and surrounding area are free of water catchments, or that water containers are covered.
- Keep larvae eating fish, such as guppies, in ponds.
- Use chemical larvicide’s in ponds, drains or other water catchments (e.g. Abate).
- Remove garbage or unnecessary pots, bottles, cans etc from the garden area.
- Lush garden areas should be fogged regularly in the monsoon season.
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and secondly, don’t get bitten!
- Mozzie coils, or vapor mats can be used indoors in the early mornings and late afternoons during the wet season.
- Mosquito nets and screens can be used in problem areas. Babies should always be protected by cot, or pram covers.
- Wear long sleeved, loose light colored clothing while walking in garden areas.
- Personal repellants may be used; however, they should be used with caution in the very young, or the elderly.
The Vaccine.
A vaccine is available against the J.E. virus; however there are a few problems with this. Firstly the vaccine is very expensive. A course of three vaccines can cost upwards of one million rupiah. If you have a large family to protect, or fall into the lower socioeconomic group, this can be quite an outlay. There have been nasty side effects reported following injection with the J.E. Vaccine. About 0.6 % of patients have developed severe rashes and swelling immediately after the vaccine and up to 10 days after receiving the vaccine. It is wise therefore to remain close to medical facilities for up to 10 days after the last dose. The good news is that the vaccine has a high efficacy. This means that once the course has been completed, it gives a high (almost 100%) immunogenic response. It is very effective. The current J.E. vaccine schedule is a course of 3 shots on days 0, 7 & 30. Protection following the primary course of the vaccine is said to last approximately 2 years, therefore most authorities recommend single booster shots at 2 year intervals following the primary course. Anyone considering vaccination should contact your travel health center before leaving on your travels, or if you are in Bali, I can give you advice on vaccination. Please text your query to 08123660000, or e-mail info@chcbali.com.
So…If I do get Japanese Encephalitis, how is it treated?
Firstly, there is no curative treatment for J.E. (i.e. No magic pill, injection etc. that will cure it). J.E. is treated symptomatically by reducing the fever, analgesics for headache, sedatives for seizures and specialized intravenous therapy to reduce cerebral swelling.
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Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com”.
