In the ICU today, a young girl lies unconscious. Oblivious to the crowd of doctors in the room, she is being kept alive by a ventilator and a feeding tube. She looks very peaceful, as sleeping children often do, but this belies the events going on in her head.
About 14 days ago, she was bitten by a mosquito of the Culex family. Young girls are not normally the target of Culex mosquitoes: they tend to go more for pigs and wading birds, which are the main reservoirs for Japanese Encephalitis Virus (JEV). However, every now and then, humans get bitten. This particular mosquito was carrying JEV and unwittingly transmitted it to our patient. She subsequently developed a fever, headaches and became nauseous. She fitted and then began to lapse into a coma. And now she is in our ICU, fighting for her life.
Only 1% of JEV infections cause encephalitis, accounting for some 50,000 cases annually. Unfortunately though, the outcome when it happens is terrible: 30% die; 30-50% survive, but with irreversible brain damage; and less than 30% make a complete recovery. The only antiviral treatments which exist have been shown to be useless in Japanese encephalitis - all we can do is wait and hope that she is in the minority which pull through.
It is terrible to see a young girl who may well die or be left brain-damaged by a childhood infection. What makes it worse is that Japanese encephalitis is a preventable disease. While the two vaccines offered to travellers are not ideally suited to mass immunisation programmes in the region, a Chinese vaccine has shown great promise. Several trials have shown it to be particularly effective in children, who are the main victims of JEV. Why it has not yet been incorporated into regional vaccination programmes is not clear to me, but it certainly appears to be a missed opportunity.
There are plenty of excellent vaccines out there which have the potential to prevent millions of childhood deaths every year. Most of them are not expensive to produce: the main challenge is making them available to the people who need them, and ensuring that as many people are immunised as possible. At the moment it seems we're investing far more in inventing new treatments than we are in using those that already exist.
About 14 days ago, she was bitten by a mosquito of the Culex family. Young girls are not normally the target of Culex mosquitoes: they tend to go more for pigs and wading birds, which are the main reservoirs for Japanese Encephalitis Virus (JEV). However, every now and then, humans get bitten. This particular mosquito was carrying JEV and unwittingly transmitted it to our patient. She subsequently developed a fever, headaches and became nauseous. She fitted and then began to lapse into a coma. And now she is in our ICU, fighting for her life.
Only 1% of JEV infections cause encephalitis, accounting for some 50,000 cases annually. Unfortunately though, the outcome when it happens is terrible: 30% die; 30-50% survive, but with irreversible brain damage; and less than 30% make a complete recovery. The only antiviral treatments which exist have been shown to be useless in Japanese encephalitis - all we can do is wait and hope that she is in the minority which pull through.
It is terrible to see a young girl who may well die or be left brain-damaged by a childhood infection. What makes it worse is that Japanese encephalitis is a preventable disease. While the two vaccines offered to travellers are not ideally suited to mass immunisation programmes in the region, a Chinese vaccine has shown great promise. Several trials have shown it to be particularly effective in children, who are the main victims of JEV. Why it has not yet been incorporated into regional vaccination programmes is not clear to me, but it certainly appears to be a missed opportunity.
There are plenty of excellent vaccines out there which have the potential to prevent millions of childhood deaths every year. Most of them are not expensive to produce: the main challenge is making them available to the people who need them, and ensuring that as many people are immunised as possible. At the moment it seems we're investing far more in inventing new treatments than we are in using those that already exist.
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