Acute Encephalitic Syndrome

Surveillance
 AES

• A case of AES
 A person of any age, at any time of year
 Acute onset of fever and a change in mental status
 Confusion
 Disorientation
 Coma, or Inability to talk
AND/OR
 New onset of seizures (excluding simple febrile seizures*).
 Early clinical findings may include an increase in
 Irritability
 Somnolence or abnormal behaviour greater than that seen
with usual febrile illness.

WHO Manual for the Laboratory Diagnosis of Japanese Encephalitis Virus Infection
FINAL DRAFT 30 March 2007
Classification scheme for AES
Surveillance

WHO Manual for the Laboratory Diagnosis of Japanese Encephalitis Virus Infection
FINAL DRAFT 30 March 2007
Antibody Responses in JE
Infection

(after Solomon et al 33)

 Specimens...1

• Special Inv. sample

 Cerebrospinal Fluid
 Blood
 Incase of death Cerebral autopsy
• Routine sample
 Blood slide for MP and or Blood for Rapid
Diagnostic Kit test
 Routine CSF
 Specimens...2

• Blood samples
• It is mandatory to collect CSF Specimens from all 
AES cases with neurological symptoms
• In case CSF collection is not possible at PHC level,
the DIO should ensure that that the CSF is collected
by specialist from the district hospital or elsewhere
• If CSF is not collected then paired blood samples
o Ist. on the day of the admission
o IInd. on 10th. day or the day of discharge in case of death immediately after death-
which ever is earlier

WHO Manual for the Laboratory Diagnosis of Japanese Encephalitis Virus Infection
FINAL DRAFT 30 March 2007
 Specimens...3

• Routine: urine, serum, blood and CSF

• If the child dies-Autopsy and brain

specimens collection

• All specimens should be collected and

transported in reverse cold chain to the
designated laboratory (NIV,PUNE)
under the supervision of the DIO
 Routine Investigations

• CSF – Should not be refrigerated

 Cells
 Biochemistry
 Proteins
 Sugar
 Microbiology
 Physical Examination
 Coagulum
 Transparency (Turbidity)
• BS for MP / Blood for rdk Test

Am. J. Trop. Med. Hyg., 77(6), 2007, pp. 1139-1145

JE Specific Investigations

• Cerebral autopsy (In case of

death probe biopsy through nose)
• CSF, Serum and Blood Clot for
apex laboratory
 For detection of JE virus-specific IgM
antibodies from serum and CSF (IgM
capture ELISA)
 Isolation of JE virus from WBCs
separated from Blood clot and CSF

WHO Manual for the Laboratory Diagnosis of Japanese Encephalitis Virus Infection
FINAL DRAFT 30 March 2007
Sample Collection, Shipment
& Testing

WHO Manual for the Laboratory Diagnosis of Japanese Encephalitis Virus Infection
FINAL DRAFT 30 March 2007
 Collection, Storage & Shipment

• Samples
o CSF – 1-2ml (0.5 ml for virology)
o Blood - 5 ml (Centrifuge and segregate Serum and
Cells)
• Reverse Cold Chain:
o CSF - Vaccine Carrier/ILR/DF/Cold Box (up to 4-20 C
For longer periods freeze the specimen)
 Transport within 72 Hrs. of collection
o Blood - Vaccine Carrier/ILR/Cold Box (4-8 C)
 Transport within 24 Hrs. of collection

WHO Manual for the Laboratory Diagnosis of Japanese Encephalitis Virus Infection
FINAL DRAFT 30 March 2007
Packaging for Transportation
 APEX LABORATORY

Dr Milind Gore, Director I/C

National Institute of Virology,
Sus Road Campus, Pashan,
Pune 411021, India
Tel: 91-20-25880982,
Fax: 91-20-25883595
 Communicate

• Civil Surgeon

• ACMO

• DIO

• DMO
Muito Obrigado!
Thank You
Dr Dhananjay Singh
Consultant
PATH
New Delhi
Cell:94311 05617