Epidemic or arboviral encephalitis

A large number of small RNA viruses exist in the wild which alternate between blood-sucking insect vectors and a vertebrate host, most frequently birds or small mammals. Humans and horses are incidental hosts. Entry into the central nervous system occurs via hematological spread after a period of primary replication in subcutaneous tissues or muscle. Acute encephalitides associated with the arthropod-borne viruses (arboviruses) are highly variable in the extent to which they produce serious neurological damage. Higher morbidity and mortality have been consistently reported in association with eastern equine encephalitis (mortality rates over 50 per cent in some series), Japanese encephalitis, and St Louis encephalitis, in descending order of severity. Control of insect populations and containment of epizootics are the central focus of management. Reflecting its contemporary epidemiological importance, trials of vaccination against Japanese encephalitis are under way in several regions throughout Asia. Therapy for arboviral encephalitis is supportive, since no specific antiviral therapy is available for Japanese encephalitis. During the 1933 epidemic in St Louis, Missouri, St Louis encephalitis was associated with a mortality of 20 per cent. Mortality has been 2 to 12 per cent in subsequent epidemics, probably reflecting improvements in supportive care.

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