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Acute Encephalitic Syndrome
Surveillance
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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 InfectionFINAL DRAFT 30 March 2007
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Classification scheme for AESSurveillance
WHO Manual for the Laboratory Diagnosis of Japanese Encephalitis Virus InfectionFINAL DRAFT 30 March 2007
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Antibody Responses in JEInfection
(after Solomon et al33)
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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
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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 collectedby specialist from the district hospital or elsewhere
If CSF is not collected then paired blood sampleso Ist. on the day of the admissiono 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 InfectionFINAL DRAFT 30 March 2007
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Specimens...3
Routine: urine, serum, blood and CSF
If the child dies-Autopsy and brainspecimens collection
All specimens should be collected and
transported in reverse cold chain to thedesignated laboratory (NIV,PUNE)under the supervision of the DIO
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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
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JE Specific Investigations
Cerebral autopsy (In case ofdeath probe biopsy through nose)
CSF, Serum and Blood Clot forapex laboratory
For detection of JE virus-specific IgMantibodies 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 InfectionFINAL DRAFT 30 March 2007
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Sample Collection, Shipment& Testing
WHO Manual for the Laboratory Diagnosis of Japanese Encephalitis Virus InfectionFINAL DRAFT 30 March 2007
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Collection, Storage & Shipment
Sampleso CSF 1-2ml (0.5 ml forvirology)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 CFor 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 InfectionFINAL DRAFT 30 March 2007
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Packaging for Transportation
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APEX LABORATORY
Dr Milind Gore, Director I/CNational Institute of Virology,
Sus Road Campus, Pashan,Pune 411021, IndiaTel: 91-20-25880982,Fax: 91-20-25883595
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Communicate
Civil Surgeon
ACMO
DIO
DMO
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Muito Obrigado!Thank You
Dr Dhananjay Singh
Consultant
PATHNew Delhi
Cell:94311 05617
