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Japanese Encephalitis in India

The idea that most cases of “acute encephalitis” in Uttar Pradesh are caused by diseases other than Japanese encephalitis is borne out by reporting statistics.  In the following chart, note the precipitous decline in “Japanese encephalitis” incidence which followed introduction of reporting for “Acute encephalitis” in 2008 (upper graph).  This phenomenon is even more striking for India as a whole (lower graph). [1,2]



  1. Berger S. Japanese Encephalitis: Global Status. 83 pages, 63 graphs, 1,034 references. Gideon e-books,
  2. Berger S. Infectious Diseases of India. 533 pages, 89 graphs, 5,763 references. Gideon e-books.

Note featured in ProMED


2 Responses to “Japanese Encephalitis in India”

  1. Nick Gerbino Says:

    I am just curious about the Middle East Respiratory Syndrome case that you reported on your website as happening in the United States…we have seen no reports of this…can you verify? If not, this is a serious mistake.

  2. Dr. Stephen Berger Says:

    Gideon note as follows:
    “2014 – Two American travelers were hospitalized for MERS-CoV infection after returning from Saudi Arabia.”

    1 First confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States, updated information on the epidemiology of MERS-CoV infection, and guidance for the public, clinicians, and public health authorities – May 2014. Close

    MMWR Morb Mortal Wkly Rep 2014 May 16;63(19):431-6.
    Bialek SR, Allen D, Alvarado-Ramy F, Arthur R, Balajee A, Bell D, Best S, Blackmore C, Breakwell L, Cannons A, Brown C, Cetron M, Chea N, Chommanard C, Cohen N, Conover C, Crespo A, Creviston J, Curns AT, Dahl R, Dearth S, DeMaria A, Echols F, Erdman DD, Feikin D, Frias M, Gerber SI, Gulati R, Hale C, Haynes LM, Heberlein-Larson L, Holton K, Ijaz K, Kapoor M, Kohl K, Kuhar DT, Kumar AM, Kundich M, Lippold S, Liu L, Lovchik JC, Madoff L, Martell S, Matthews S, Moore J, Murray LR, Onofrey S, Pallansch MA, Pesik N, Pham H, Pillai S, Pontones P, Pringle K, Pritchard S, Rasmussen S, Richards S, Sandoval M, Schneider E, Schuchat A, Sheedy K, Sherin K, Swerdlow DL, Tappero JW, Vernon MO, Watkins S, Watson J
    Since mid-March 2014, the frequency with which cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have been reported has increased, with the majority of recent cases reported from Saudi Arabia and United Arab Emirates (UAE). In addition, the frequency with which travel-associated MERS cases have been reported and the number of countries that have reported them to the World Health Organization (WHO) have also increased. The first case of MERS in the United States, identified in a traveler recently returned from Saudi Arabia, was reported to CDC by the Indiana State Department of Health on May 1, 2014, and confirmed by CDC on May 2. A second imported case of MERS in the United States, identified in a traveler from Saudi Arabia having no connection with the first case, was reported to CDC by the Florida Department of Health on May 11, 2014. The purpose of this report is to alert clinicians, health officials, and others to increase awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula. This report summarizes recent epidemiologic information, provides preliminary descriptions of the cases reported from Indiana and Florida, and updates CDC guidance about patient evaluation, home care and isolation, specimen collection, and travel as of May 13, 2014.

    2 EDs on heightened alert for MERS-CoV as first cases reach the US. Close
    ED Manag 2014 Jul ;26(7):73-7.
    The first cases of Middle East Respiratory Syndrome coronavirus (MERS-CoV) have turned up in the United States. First, in late April, a patient tested positive for the virus at a hospital in Munster, IN, and then shortly thereafter, a second patient tested positive at a hospital in Orlando, FL. While both patients have since recovered from the virus and been released, the cases have raised awareness of the infectious threat of MERS-CoV, and they have put EDs and other frontline providers on heightened alert for patients with severe respiratory symptoms and other risk factors. While MERS-CoV is not yet as contagious as seasonal influenza or the severe acute respiratory syndrome (SARS) that started in China and then swept around the globe in 2003, it is more deadly. The World Health Organization reports that roughly one-quarter of 514 people who have tested positive for the virus have died. Experts note that health care workers make up a large percentage of the documented cases of MERS-CoV, and they point out that most human-to-human transmissions of the virus occur in the hospital setting. Public health officials urge emergency personnel to pay strict attention to infection control practices, and to query patients who present with fever and respiratory distress about recent travel to the Arabian Peninsula and/or close contact with a person who has a confirmed or probable case of MERS-CoV.

    3 Clinical and laboratory findings of the first imported case of Middle East respiratory syndrome coronavirus to the United States. Close
    Clin Infect Dis 2014 Dec 01;59(11):1511-8.
    Kapoor M, Pringle K, Kumar A, Dearth S, Liu L, Lovchik J, Perez O, Pontones P, Richards S, Yeadon-Fagbohun J, Breakwell L, Chea N, Cohen NJ, Schneider E, Erdman D, Haynes L, Pallansch M, Tao Y, Tong S, Gerber S, Swerdlow D, Feikin DR
    This patient had a prolonged nonspecific prodromal illness before developing respiratory symptoms. Both sera and sputum were rRT-PCR positive when nasopharyngeal specimens were negative. US clinicians must be vigilant for MERS-CoV in patients with febrile and/or respiratory illness with recent travel to the Arabian Peninsula, especially among healthcare workers.

    4 Evaluation of Patients under Investigation for MERS-CoV Infection, United States, January 2013-October 2014. Close
    Emerg Infect Dis 2015 Jul ;21(7):1220-3.
    Schneider E, Chommanard C, Rudd J, Whitaker B, Lowe L, Gerber SI
    Middle East respiratory syndrome (MERS) cases continue to be reported from the Middle East. Evaluation and testing of patients under investigation (PUIs) for MERS are recommended. In 2013-2014, two imported cases were detected among 490 US PUIs. Continued awareness is needed for early case detection and implementation of infection control measures.

    5 Lack of Transmission among Close Contacts of Patient with Case of Middle East Respiratory Syndrome Imported into the United States, 2014. Close
    Emerg Infect Dis 2015 Jul ;21(7):1128-34.
    Breakwell L, Pringle K, Chea N, Allen D, Allen S, Richards S, Pantones P, Sandoval M, Liu L, Vernon M, Conover C, Chugh R, DeMaria A, Burns R, Smole S, Gerber SI, Cohen NJ, Kuhar D, Haynes LM, Schneider E, Kumar A, Kapoor M, Madrigal M, Swerdlow DL, Feikin DR
    In May 2014, a traveler from the Kingdom of Saudi Arabia was the first person identified with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in the United States. To evaluate transmission risk, we determined the type, duration, and frequency of patient contact among health care personnel (HCP), household, and community contacts by using standard questionnaires and, for HCP, global positioning system (GPS) tracer tag logs. Respiratory and serum samples from all contacts were tested for MERS-CoV. Of 61 identified contacts, 56 were interviewed. HCP exposures occurred most frequently in the emergency department (69%) and among nurses (47%); some HCP had contact with respiratory secretions. Household and community contacts had brief contact (e.g., hugging). All laboratory test results were negative for MERS-CoV. This contact investigation found no secondary cases, despite case-patient contact by 61 persons, and provides useful information about MERS-CoV transmission risk. Compared with GPS tracer tag recordings, self-reported contact may not be as accurate.

    6 Conveyance Contact Investigation for Imported Middle East Respiratory Syndrome Cases, United States, May 2014. Close
    Emerg Infect Dis 2017 Sep ;23(9):1585-1589.
    Lippold SA, Objio T, Vonnahme L, Washburn F, Cohen NJ, Chen TH, Edelson PJ, Gulati R, Hale C, Harcourt J, Haynes L, Jewett A, Jungerman R, Kohl KS, Miao C, Pesik N, Regan JJ, Roland E, Schembri C, Schneider E, Tamin A, Tatti K, Alvarado-Ramy F
    In 2014, the Centers for Disease Control and Prevention conducted conveyance contact investigations for 2 Middle East respiratory syndrome cases imported into the United States, comprising all passengers and crew on 4 international and domestic flights and 1 bus. Of 655 contacts, 78% were interviewed; 33% had serologic testing. No secondary cases were identified.

    ProMED-mail. ProMED-mail 2014; 02 May: 20140502.2445843 <>. Accessed 02 May 2014.

    8 Close
    ProMED-mail. ProMED-mail 2014; 04 May: 20140504.2449373 <>. Accessed 04 May 2014.

    9 Close
    ProMED-mail. ProMED-mail 2014; 12 May: 20140512.2466912 <>. Accessed 12 May 2014.