A Cohort Study to Assess the New WHO Japanese Encephalitis Surveillance Standards

To assess the field-test version of the new WHO Japanese encephalitis (JE) surveillance standards. We applied the clinical case definition of acute encephalitis syndrome (AES), laboratory diagnostic criteria and case classifications to patients with suspected central nervous system (CNS) infections...

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Main Authors: Solomon, Tom, Thao, T. Thu, Lewthwaite, Penny, Ooi, M.H., Kneen, Rachel, Dung, Minh N., White, N.
Format: E-Article
Language:English
Published: World Health Organization 2008
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Online Access:http://ir.unimas.my/id/eprint/17683/1/A%20Cohort%20Study%20to%20Assess%20the%20New%20WHO%20Japanese%20%28abstract%29.pdf
http://ir.unimas.my/id/eprint/17683/
https://www.researchgate.net/publication/5484707
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spelling my.unimas.ir.176832017-09-20T06:53:46Z http://ir.unimas.my/id/eprint/17683/ A Cohort Study to Assess the New WHO Japanese Encephalitis Surveillance Standards Solomon, Tom Thao, T. Thu Lewthwaite, Penny Ooi, M.H. Kneen, Rachel Dung, Minh N. White, N. R Medicine (General) To assess the field-test version of the new WHO Japanese encephalitis (JE) surveillance standards. We applied the clinical case definition of acute encephalitis syndrome (AES), laboratory diagnostic criteria and case classifications to patients with suspected central nervous system (CNS) infections in southern Viet Nam. Of the 380 patients (149 children) recruited with suspected CNS infections, 296 (96 children) met the AES case definition. 54 children were infected with JE virus (JEV), of whom 35 (65%) had AES, giving a sensitivity of 65% (95% CI: 56-73) and specificity of 39% (95% CI: 30-48). Nine adults with JEV presented with AES. 19 JEV-infected children missed by surveillance included 10 with acute flaccid paralysis, two with flaccid hemiparesis and six with meningism only. Altering the case definition to include limb paralysis and meningism improved sensitivity to 89% (95% CI: 83-95), while reducing specificity to 23% (95% CI: 15-30). Six children that did not have AES on admission had reduced consciousness after admission. Cerebrospinal fluid (CSF) analysis diagnosed seven patients negative on serum analysis. Five patients with neurological manifestations of dengue infection had JEV antibodies in serum and would have been misdiagnosed had we not tested for dengue antibodies in parallel. Children infected with JEV that presented with acute limb paralysis or neck stiffness only were missed by the surveillance standards, although some of them subsequently became encephalopathic. A footnote in the surveillance standards drawing attention to these presentations would be helpful. An acute CSF sample is more sensitive and specific than an acute serum sample. World Health Organization 2008 E-Article PeerReviewed text en http://ir.unimas.my/id/eprint/17683/1/A%20Cohort%20Study%20to%20Assess%20the%20New%20WHO%20Japanese%20%28abstract%29.pdf Solomon, Tom and Thao, T. Thu and Lewthwaite, Penny and Ooi, M.H. and Kneen, Rachel and Dung, Minh N. and White, N. (2008) A Cohort Study to Assess the New WHO Japanese Encephalitis Surveillance Standards. Bulletin of the World Health Organization, 86 (178). p. 186. ISSN 1564-0604 https://www.researchgate.net/publication/5484707 DOI: 10.1016/j.ijid.2008.05.262
institution Universiti Malaysia Sarawak
building Centre for Academic Information Services (CAIS)
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaysia Sarawak
content_source UNIMAS Institutional Repository
url_provider http://ir.unimas.my/
language English
topic R Medicine (General)
spellingShingle R Medicine (General)
Solomon, Tom
Thao, T. Thu
Lewthwaite, Penny
Ooi, M.H.
Kneen, Rachel
Dung, Minh N.
White, N.
A Cohort Study to Assess the New WHO Japanese Encephalitis Surveillance Standards
description To assess the field-test version of the new WHO Japanese encephalitis (JE) surveillance standards. We applied the clinical case definition of acute encephalitis syndrome (AES), laboratory diagnostic criteria and case classifications to patients with suspected central nervous system (CNS) infections in southern Viet Nam. Of the 380 patients (149 children) recruited with suspected CNS infections, 296 (96 children) met the AES case definition. 54 children were infected with JE virus (JEV), of whom 35 (65%) had AES, giving a sensitivity of 65% (95% CI: 56-73) and specificity of 39% (95% CI: 30-48). Nine adults with JEV presented with AES. 19 JEV-infected children missed by surveillance included 10 with acute flaccid paralysis, two with flaccid hemiparesis and six with meningism only. Altering the case definition to include limb paralysis and meningism improved sensitivity to 89% (95% CI: 83-95), while reducing specificity to 23% (95% CI: 15-30). Six children that did not have AES on admission had reduced consciousness after admission. Cerebrospinal fluid (CSF) analysis diagnosed seven patients negative on serum analysis. Five patients with neurological manifestations of dengue infection had JEV antibodies in serum and would have been misdiagnosed had we not tested for dengue antibodies in parallel. Children infected with JEV that presented with acute limb paralysis or neck stiffness only were missed by the surveillance standards, although some of them subsequently became encephalopathic. A footnote in the surveillance standards drawing attention to these presentations would be helpful. An acute CSF sample is more sensitive and specific than an acute serum sample.
format E-Article
author Solomon, Tom
Thao, T. Thu
Lewthwaite, Penny
Ooi, M.H.
Kneen, Rachel
Dung, Minh N.
White, N.
author_facet Solomon, Tom
Thao, T. Thu
Lewthwaite, Penny
Ooi, M.H.
Kneen, Rachel
Dung, Minh N.
White, N.
author_sort Solomon, Tom
title A Cohort Study to Assess the New WHO Japanese Encephalitis Surveillance Standards
title_short A Cohort Study to Assess the New WHO Japanese Encephalitis Surveillance Standards
title_full A Cohort Study to Assess the New WHO Japanese Encephalitis Surveillance Standards
title_fullStr A Cohort Study to Assess the New WHO Japanese Encephalitis Surveillance Standards
title_full_unstemmed A Cohort Study to Assess the New WHO Japanese Encephalitis Surveillance Standards
title_sort cohort study to assess the new who japanese encephalitis surveillance standards
publisher World Health Organization
publishDate 2008
url http://ir.unimas.my/id/eprint/17683/1/A%20Cohort%20Study%20to%20Assess%20the%20New%20WHO%20Japanese%20%28abstract%29.pdf
http://ir.unimas.my/id/eprint/17683/
https://www.researchgate.net/publication/5484707
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score 13.222552