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Investigations of seasonal outbreaks of acute encephalitis syndrome due to Orientia tsutsugamushi in Gorakhpur region, India: A One Health case study.
Indian J Med Res. 2021 Mar; 153(3):375-381.IJ

Abstract

Gorakhpur division consisting of Gorakhpur and neighboring districts Deoria, Kushinagar and Maharajganj in Uttar Pradesh, India, have been witnessing seasonal outbreaks of acute encephalitis syndrome (AES) among children for the last three decades. Investigations conducted during 2005 identified Japanese encephalitis (JE) virus as an aetiology of AES. With the introduction of JE vaccination and other control strategies, the incidence of JE in the region declined, however, outbreaks of acute febrile illness with neurological manifestations continued to occur. Subsequent investigations identified Orientia tsutsugamushi, as the major aetiology of AES outbreaks in the region. This review details clinical, epidemiological, animal and entomological investigations conducted for AES due to O. tsutsugamushi during 2015 and 2017 in Gorakhpur region. Surveillance of acute febrile illness among children attending peripheral health facilities identified scrub typhus as an important aetiology of febrile illness during monsoon and post-monsoon months. Population-based serosurveys indicated high endemicity of scrub typhus. Entomological studies demonstrated natural infection of O. tsutsugamushi in small animal hosts and vector mites. Children acquired this infection through recent exposure to outdoor environment, while playing, or visiting fields or defecating in open fields. A few of the children with scrub typhus progress to develop CNS manifestations. Hence, early administration of appropriate antibiotics is crucial in preventing progression of AFI due to scrub typhus to AES. The investigations conducted by the multi-disciplinary team helped understand the transmission dynamics of scrub typhus in Gorakhpur division and recommend strategies for its control.

Authors+Show Affiliations

ICMR-National Institute of Epidemiology, Chennai, India.ICMR-National Institute of Epidemiology, Chennai, India.ICMR-Vector Control Research Centre, Puducherry, India.All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India.Division of Epidemiology and Communicable Diseases Division , Indian Council of Medical Research, New Delhi, India.Christian Medical College, Vellore, Tamil Nadu, India.ICMR-National AIDS Research Institute, Pune, Maharashtra, India.ICMR-Regional Medical Research Centre, Gorakhpur, Uttar Pradesh, India.ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu; Division of Epidemiology and Communicable Diseases Division , Indian Council of Medical Research, New Delhi, India.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

33907001

Citation

Murhekar, Manoj V., et al. "Investigations of Seasonal Outbreaks of Acute Encephalitis Syndrome Due to Orientia Tsutsugamushi in Gorakhpur Region, India: a One Health Case Study." The Indian Journal of Medical Research, vol. 153, no. 3, 2021, pp. 375-381.
Murhekar MV, Vivian Thangaraj JW, Sadanandane C, et al. Investigations of seasonal outbreaks of acute encephalitis syndrome due to Orientia tsutsugamushi in Gorakhpur region, India: A One Health case study. Indian J Med Res. 2021;153(3):375-381.
Murhekar, M. V., Vivian Thangaraj, J. W., Sadanandane, C., Mittal, M., Gupta, N., Rose, W., Sahay, S., Kant, R., & Gupte, M. D. (2021). Investigations of seasonal outbreaks of acute encephalitis syndrome due to Orientia tsutsugamushi in Gorakhpur region, India: A One Health case study. The Indian Journal of Medical Research, 153(3), 375-381. https://doi.org/10.4103/ijmr.IJMR_625_21
Murhekar MV, et al. Investigations of Seasonal Outbreaks of Acute Encephalitis Syndrome Due to Orientia Tsutsugamushi in Gorakhpur Region, India: a One Health Case Study. Indian J Med Res. 2021;153(3):375-381. PubMed PMID: 33907001.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Investigations of seasonal outbreaks of acute encephalitis syndrome due to Orientia tsutsugamushi in Gorakhpur region, India: A One Health case study. AU - Murhekar,Manoj V, AU - Vivian Thangaraj,Jeromie Wesley, AU - Sadanandane,Candasamy, AU - Mittal,Mahima, AU - Gupta,Nivedita, AU - Rose,Winsley, AU - Sahay,Seema, AU - Kant,Rajni, AU - Gupte,Mohan D, PY - 2021/4/28/entrez PY - 2021/4/29/pubmed PY - 2021/6/1/medline KW - Acute encephalitis syndrome KW - One Health KW - acute febrile illness KW - scrub typhus KW - vector SP - 375 EP - 381 JF - The Indian journal of medical research JO - Indian J Med Res VL - 153 IS - 3 N2 - Gorakhpur division consisting of Gorakhpur and neighboring districts Deoria, Kushinagar and Maharajganj in Uttar Pradesh, India, have been witnessing seasonal outbreaks of acute encephalitis syndrome (AES) among children for the last three decades. Investigations conducted during 2005 identified Japanese encephalitis (JE) virus as an aetiology of AES. With the introduction of JE vaccination and other control strategies, the incidence of JE in the region declined, however, outbreaks of acute febrile illness with neurological manifestations continued to occur. Subsequent investigations identified Orientia tsutsugamushi, as the major aetiology of AES outbreaks in the region. This review details clinical, epidemiological, animal and entomological investigations conducted for AES due to O. tsutsugamushi during 2015 and 2017 in Gorakhpur region. Surveillance of acute febrile illness among children attending peripheral health facilities identified scrub typhus as an important aetiology of febrile illness during monsoon and post-monsoon months. Population-based serosurveys indicated high endemicity of scrub typhus. Entomological studies demonstrated natural infection of O. tsutsugamushi in small animal hosts and vector mites. Children acquired this infection through recent exposure to outdoor environment, while playing, or visiting fields or defecating in open fields. A few of the children with scrub typhus progress to develop CNS manifestations. Hence, early administration of appropriate antibiotics is crucial in preventing progression of AFI due to scrub typhus to AES. The investigations conducted by the multi-disciplinary team helped understand the transmission dynamics of scrub typhus in Gorakhpur division and recommend strategies for its control. SN - 0971-5916 UR - https://www.unboundmedicine.com/medline/citation/33907001/Investigations_of_seasonal_outbreaks_of_acute_encephalitis_syndrome_due_to_Orientia_tsutsugamushi_in_Gorakhpur_region_India:_A_One_Health_case_study_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=33907001.ui DB - PRIME DP - Unbound Medicine ER -