Acute encephalitis syndrome in Rakhine State
Transcript of Acute encephalitis syndrome in Rakhine State
![Page 2: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/2.jpg)
Photo by Ashin Kumara
![Page 3: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/3.jpg)
Rakhine State
![Page 4: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/4.jpg)
Mission clinics conducted in Mrauk Oo and Sittwe
![Page 5: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/5.jpg)
Photo by Ashin Kumara
![Page 6: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/6.jpg)
Dr. Eddie Lim, Photo by Ashin Kumara
![Page 7: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/7.jpg)
Dr. Tin Htun Aung, neurosurgeon. Photo by Ashin Kumara
![Page 8: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/8.jpg)
Dr. William Myatt fitting prosthetic hand. Photo by Ashin Kumara
![Page 9: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/9.jpg)
Dr. Hla, psychiatry; Dr. Danny Khine, IM. Photo by Ashin Kumara
![Page 10: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/10.jpg)
Dr. Josephine Waite, IM; Dr. Vernon Ansdell, tropical medicine. Photo by Ashin Kumara
![Page 11: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/11.jpg)
Dr. Peter Soe Wynn, pediatrician, Dr. Tin Mu. Photo by Michael Mead.
![Page 12: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/12.jpg)
Clinic at Sittwe Alodawpyei Monastery. Photo by Michael Mead
![Page 13: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/13.jpg)
Clinic at Sittwe Alodawpyei Monastery. Photo by Michael Mead
![Page 14: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/14.jpg)
Waiting outside of Sittwe Alodawpyei Monastery Photo by Michael Mead
![Page 15: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/15.jpg)
![Page 16: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/16.jpg)
Children with neurological deficits Convenience sample
3 clinic days: 2 in Mrauk Oo, 1 in Sittwe Simple histories & physical information via
an interpreter 17 cases of neurological deficits
Out of 48 children seen
![Page 17: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/17.jpg)
Children with neurological deficits Mild cases
Hand or foot weakness Severe cases
Global developmental delay Speech/language deficits Intellectual deficits Gross motor deficits
![Page 18: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/18.jpg)
Children with neurological deficits Generally described as developing
normally prior to illness History of febrile illness
7 – 10 days duration “unconscious” during illness
Neurological deficits subsequently
![Page 19: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/19.jpg)
Children with neurological deficits Mild cases
Hand or foot weakness Severe cases
Global developmental delay Speech/language deficits Intellectual deficits Gross motor deficits
![Page 20: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/20.jpg)
Boy with weakness, muscle wasting. Photo by Ashin Kumara
![Page 21: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/21.jpg)
Boy with weakness, muscle wasting
![Page 22: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/22.jpg)
3yo girl with hydrocephalus
![Page 23: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/23.jpg)
17yo girl. Hx febrile illness, encephalitis at age 7. With ophthalmoplegia, ptosis, eye-bobbing
![Page 24: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/24.jpg)
13yo girl Hx ? cerebral malaria, uncontrolled seizures
![Page 25: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/25.jpg)
Health services in rural areas of Rakhine State Rudimentary to non-existent
Most parents described caring for children during acute encephalitis (brain infection) syndrome at home
Diagnostic capabilities limited Specific diagnoses not made
![Page 26: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/26.jpg)
Acute encephalitis syndrome WHO definition: acute onset of fever and
altered mental status new onset of seizures, or both
Literature from India
![Page 27: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/27.jpg)
1,578 enrolled patients, Japanese encephalitis virus JEV (16.2%) dengue virus DV (10.8%) herpes simplex virus HSV (9.3%) measles virus (8.9%) mumps virus (8.7%) varicella zoster virus VZV (4.4%) enterovirus (0%)
![Page 28: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/28.jpg)
In Assam 223 hospitalized AES cases: 30% JE positive Among the JE patients: 15% died before discharge 64% complete recoveries 21% had some sort of disability at the time of discharge.
http://www.cepf.net/news/top_stories/Pages/himalayas_journal5.aspx
![Page 29: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/29.jpg)
From: Richard Yanagihara Date: Thu, Jan 29, 2015 at 9:19 AM Subject: Re: neurologic sequelae of febrile illness among children in Western Myanmar To: Seiji Yamada <[email protected]> Cc: Vivek Nerurkar, Pamela Bullard, Sandra Chang The situation you mention has dogged clinicians for many years in southeast Asia. Clearly better diagnostics are needed to find the causative agent for acute neurological diseases of unknown etiology. Japanese encephalitis virus is a possibility, but other yet-to-be-discovered neurotropic viruses should also be explored.
![Page 30: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/30.jpg)
![Page 31: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/31.jpg)
A mosquito-borne disease 20%–30% case-fatality rate 30%–50% of survivors neurologic or psychiatric sequelae
Risk is highest in rural, agricultural areas
Occurs mainly among children aged ≤15 years No specific treatment for JE is available. Vaccination is the single most important preventive measure
![Page 32: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/32.jpg)
Myanmar does not have an immunization program. WHO recommends that JE vaccination be extended to all areas where JE is a public health problem The most effective immunization strategy is a one-time campaign in the target population . . . followed by incorporation of JE vaccine into routine childhood immunization
![Page 33: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/33.jpg)
Live attenuated SA14-14-2 vaccine simple schedule good safety profile improved international availability
Chengdu Institute of Biological Products
has guaranteed a low public sector price for lower-income countries
![Page 34: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/34.jpg)
Rakhine State children with neurological deficits Large numbers of children with
neurological deficits A consequence of acute encephalitis
syndrome Causative agents not understood Needs to be studied from microbiological,
epidemiological perspectives
![Page 35: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/35.jpg)
Rakhine State children with neurological deficits
Regional literature points to some role played by Japanese encephalitis
Vaccination for Japanese encephalitis should be instituted in Myanmar
![Page 37: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/37.jpg)
Burma, Bangladesh,
Climate Change
![Page 38: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/38.jpg)
Burma (Myanmar) Population: 51.5 million Area: 261,000 sq mi Density 197/sq mi.
![Page 39: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/39.jpg)
![Page 40: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/40.jpg)
Burma Population:
51.5 million Area: 261,000 sq mi Density: 197/sq mi.
Bangladesh Population:
156.6 million Area: 57,000 sq mi Density: 2677/sq mi
![Page 41: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/41.jpg)
Bangladesh nearly a quarter of Bangladesh is less than
seven feet above sea level by 2050, rising sea levels
will inundate some 17 percent of the land displace about 18 million people
Facing Rising Seas, Bangladesh Confronts the Consequences of Climate Change By GARDINER HARRIS, New York Times, MARCH 28, 2014
![Page 42: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/42.jpg)
![Page 43: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/43.jpg)
Ethnic Conflict
Western Myanmar
![Page 44: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/44.jpg)
![Page 45: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/45.jpg)
Ethnic violence June 2012: four townships October 2012: nine more townships At least 4862 structures, 348 acres
destroyed More than 125,000 displaced
![Page 46: Acute encephalitis syndrome in Rakhine State](https://reader031.fdocuments.in/reader031/viewer/2022012504/617e1afb1b5c8a41412261d3/html5/thumbnails/46.jpg)