Journal Article

The Epidemiology, Clinical Features, and Long-Term Prognosis of Japanese Encephalitis in Central Sarawak, Malaysia, 1997–2005

Mong How Ooi, Penny Lewthwaite, Boon Foo Lai, Anand Mohan, Daniela Clear, Lina Lim, Shekhar Krishnan, Teresa Preston, Chae Hee Chieng, Phaik Hooi Tio, See Chang Wong, Jane Cardosa and Tom Solomon

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 47, issue 4, pages 458-468
Published in print August 2008 | ISSN: 1058-4838
Published online August 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/590008
The Epidemiology, Clinical Features, and Long-Term Prognosis of Japanese Encephalitis in Central Sarawak, Malaysia, 1997–2005

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Background. Japanese encephalitis is a major public health problem in Asia. However, there is little data on the long-term outcome of Japanese encephalitis survivors.

Methods. We prospectively evaluated children with serologically confirmed Japanese encephalitis over an 8.3-year period. The patients were assessed and their outcomes were graded with a functional outcome score at hospital discharge and at follow-up appointments. We examined how patient outcome at hospital discharge compared with that at long-term follow-up visits, when changes in outcome occurred, and the prognostic indicators of the eventual outcome.

Results. One hundred and eighteen patients were recruited into the study, and 10 (8%) died during the acute phase of illness. At hospital discharge, 44 (41%) of the 108 patients who survived had apparent full recovery; 3 (3%) had mild, 28 (26%) had moderate, and 33 (31%) had severe neurological sequelae. Eighty six of the 108 patients were followed up for a median duration of 52.9 months (range, 0.9–114.9 months). During follow-up, 31 patients experienced improvement, but 15 patients experienced deterioration in their outcome grade. In most cases, assessment during the first 3–6 months after hospital discharge was predictive of the long-term outcome. More than one-half of the patients continued to experience neuropsychological sequelae and behavioral disorders. A combination of poor perfusion, Glasgow coma score≤8, and ⩾2 witnessed seizures predicted a poor long-term outcome with 65% sensitivity and 92% specificity.

Conclusions. Neurological assessment of Japanese encephalitis survivors at hospital discharge does not predict long-term outcome. Seizures and shock are treatable risk factors for a poor outcome at hospital discharge and at long-term follow-up visits.

Journal Article.  4428 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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