Health in the News

Both Japanese Encephalitis (JE) and Listeriosis have hit the local news this week, with 2 infants on the West of the Island in a critical condition after contracting JE, and batches of imported apples from the USA being taken from the shelves after the have been found to be contaminated by Listeriosis.
So why are we worried?

JAPANESE ENCEPHALITIS.
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 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). Feeding on pigs or wild birds infected with the J.E virus infects mosquitoes; the virus is then transmitted 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.Don’t invite this troublesome insect into your area by providing it with ideal breeding grounds.
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. 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.

Should everyone in Bali get this vaccine? Hmmm. Questionable, however if you live next door to a pig farm or a bird sanctuary I would consider it.

LISTERIOSIS.
What is listeriosis?
Listeriosis, or listeria infection, is an illness that may result from eating food contaminated with bacteria known as listeria monocytogenes.
Who is at risk?
Most people eat foods every day, which contain very small amounts of listeria without apparent adverse effects. Good hygienic food practices in the home and commercial food premises can minimize the risk from these bacteria. The infection may cause few or no symptoms in healthy people, but can cause serious illness to an unborn child. The death rate in foetuses and newborn babies affected by listeria has ranged from 30 to 50 per cent.

Other people at risk include the elderly and those whose immune system has been weakened by disease or drug treatment, for example diabetics, cancer and transplant patients and people who are HIV positive. People with a history of alcohol abuse are also at risk. The risk of infection is greatest when foods are not adequately heat-treated or are stored for long periods in a refrigerator. Listeriosis can be successfully treated with antibiotics if treatment is commenced early.

What are the symptoms?
Healthy people, including pregnant woman, may show few or no symptoms vary from minor complaints such as fever, headache, aches and pains, vomiting and diarrhea to more serious forms of the illness such as meningitis (brain infection) and septicaemia (blood poisoning).

Where is listeria found?
Listeria is widespread in nature and is commonly found in soil, vegetation and sewage. It has also been found in raw meat, raw vegetables and unpasteurized milk & milk products. Some exposure to these bacteria is unavoidable.

Good Food Hygiene
You can reduce the risk of listeriosis and other food-borne illness by taking appropriate precautions.
• Keep uncooked meats covered and separate from cooked food and ready-to-eat food.
• Always store raw meat and poultry below other foods in your refrigerator to prevent it dripping onto cooked and ready-to-eat food.
• Wash hands, knives and cutting boards after handling uncooked foods to avoid cross contamination of cooked and ready to eat foods.
• Thoroughly wash raw vegetables before eating.
• Thoroughly cook all food of animal origin, including eggs.
• Keep hot foods hot (above 60 C) and cold foods cold (at or below 5 C)
• Strictly observe “ use by “ or “ best by “ dates on refrigerated foods.
• Keep the refrigerator clean and ensure the temperature is maintained below 5 C
• Thoroughly reheat food till piping hot.
• Avoid raw (unpasteurized) milk or food made from raw milk.

Kim Patra is a qualified Midwife & Nurse Practioner who has been living and working in Bali for over 30 years. She now runs her own Private Practice & Mothers & Babies center at her Community Health Care office in Sanur.
Kim is happy to discuss any health concerns that you have and may be contacted via email at info@chcbali.com or office phone number 0361-2775666