Most people who have Japanese encephalitis have either no symptoms or mild, short-lived symptoms that are flu-like in presentation — mild-to-moderate fever, fatigue, headache and sometimes vomiting.As such, it's very difficult to identify most cases of Japanese encephalitis because it either causes no symptoms or mimics most other mild infections.


It's estimated that less than 1% of people infected with the Japanese encephalitis virus (JEV) develop noticeable symptoms.In people who do develop symptoms, the incubation period (time from initial infection until signs of illness) is typically between five to 15 days.;
, Although most JEV infections produce mild or no symptoms, about 1 in 250 cases result in severe illness, which often starts with a severe fever.A severe fever is a defense mechanism by your body to slow down or stop the production of invading viruses (or bacteria), but when they get much beyond 103 °F (39.4 °C) in adults or 101 °F (38.3 °C) in children, there is a risk of brain damage. The high fever and increased inflammation in the brain caused by JEV trigger other serious and life-threatening symptoms.


Once significant symptoms develop with Japanese encephalitis, usually in children with weakened immune systems, the chances of dying are about 30%.Mild cases of Japanese encephalitis can increase your temperature by a couple of degrees, but severe cases spike it by five or more degrees.
 Like other types of infections that affect the brain and/or spinal cord (such as meningitis), a stiff neck can develop with Japanese encephalitisThe neck suddenly feels stiff and is difficult to move in all directions, but it generates especially sharp, shooting or electric-like pain with neck flexion (trying to touch your chin to your chest).


When the spinal cord gets inflamed, the muscles closest to the spine get very tight in efforts to protect it, which is called guarding or splinting. As such, the neck muscles will be hard to the touch and feel like they are spasming.
Medication, massage or chiropractic care will not resolve a stiff neck from Japanese encephalitis, meningitis or other infections of the central nervous system.
 Another effect triggered by brain inflammation and a severe fever is mental changes, such as disorientation, confusion, difficulty focusing and even the inability to speak.Behavioral changes are often interrelated and include irritability and/or poor temper control, as well as wanting to be alone and avoiding social contact.The more serious symptoms of Japanese encephalitis, once they begin, usually only take a few days or so to become significant and serious.
The mental and behavioral changes associated with severe JEV infection can mimic a stroke or Alzheimer's disease. The person will change from a healthy, functioning individual to one with severe mental and physical deterioration.
Realizing the signs and symptoms and getting prompt treatment are imperative to improving your chances of survival.
 Once Japanese encephalitis takes a turn for the worse with increasing swelling and high temperatures, the neurons in the brain start to get damaged and die off. Once this happens, neurological symptoms begin to become obvious, such as uncontrollable shaking of body parts (tremors), muscle weakness or paralysis, difficulty walking and grasping things, and reduced coordination (clumsy looking).Muscle weakness and paralysis usually starts in the limbs (arms and legs) and progressively spreads around the body, but the face can also be affected initially.
Of those who survive a severe bout of Japanese encephalitis (which is about 70% of cases), about 1/4 suffer permanent neurological and/or behavioral problems and disabilities., The progression of a severe bout of Japanese encephalitis invariably ends with seizures, which are triggered by brain swelling, high fever and electrical disruption/discharge in the neurons of the brain.The seizures involve collapse, shaking, muscle spasms, jaw clenching and sometimes vomiting or frothing at the mouth.


Seizures triggered by encephalitis can mimic those of epilepsy but can be far more life-threatening due to brain damage.
Children with encephalitis are much more likely than adults to have seizures because their smaller brains are more susceptible to pressure and increased temperatures.Once seizures begin, becoming unconscious and slipping into a coma is not uncommon.
 According to the World Health Organization (WHO), the safest and most effective form of prevention from Japanese encephalitis is getting vaccinated against it.The four main types of vaccines currently in use to prevent JEV infection are an inactivated mouse brain-derived vaccine, an inactivated Vero cell-derived vaccine, a live attenuated vaccine, and a live recombinant vaccine. Get vaccinated at least six to eight weeks prior to your trip to Asia to allow your body enough time to build up protective antibodies.


The most widely used vaccine against JEV infection is the live attenuated SA14-14-2 vaccine made in China.The higher risk areas of Asia for Japanese encephalitis are the rural parts of Japan, China or Southeast Asia — get vaccinated before you go to these places to reduce your risk.
The Japanese encephalitis vaccination can require several doses over the course of a few weeks or months
Keep in mind that encephalitis can actually be caused or worsened by vaccination (any type of vaccine) due to an allergic reaction to the ingredients., Another form of protection against JEV infection is controlling mosquitoes and avoiding getting bit, as the insects are the main vector for the disease.As such, avoid or remove any sources of standing water where mosquitoes can breed and always use an insect repellent containing a chemical called DEET (Off!, Cutter, Sawyer, Ultrathon). In addition, sleep in beds with protective mosquito nets (or other coverings) and avoid going outside between dusk and dawn when more mosquitoes are active and airborne.


Most insect repellents last for up to six hours and some are water resistant.
DEET products shouldn't be used on infants younger than two months.
Natural forms of insect repellent include lemon oil and eucalyptus oil.
Preventing mosquitoes from biting you when traveling abroad will also reduce your risk of getting other serious diseases, such as malaria and West Nile virus.
 In addition to using insect repellent and mosquito netting, you should also wear appropriate protective clothing while traveling in Asia, particularly while in the rural countryside. As such, wear long-sleeved shirts and thin cotton gloves (popular in many Asian countries) to cover your entire arms and hands.For your legs, wear long pants with socks and shoes when you're outside, especially when walking in marshy or grassy areas.


Asia is very warm and humid for most of the year, so choose breathable pants and long-sleeved shirts so you don't get overheated.
However, keep in mind that mosquitoes can bite through thin clothing, so spray your clothes with insect repellent to be on the safe side. Don't apply insect repellents containing permethrin to your skin.
 If you're in Asia, avoid activities that significantly increase your risk of getting bit and infected by mosquitoes, such as outdoor camping, hiking and exploring on motorcycles or bicycles.Not only are these activities usually done in rural areas, but you're also vulnerable due to exposure. Choose sightseeing trips in enclosed vehicles (tour buses) while in rural areas and wear protective clothing, as noted above.


If you absolutely must sleep outside in rural areas of Asia, then it's essential to cover your tent or dwelling in mosquito nets that are impregnated with a strong insecticide.
While in the countryside, only sleep in hotel rooms with close-fitting gauze or screens over the windows and doors., Another form of prevention, albeit a drastic one, is to not travel to Asian countries that are known to be endemic for Japanese encephalitis — which is actually most countries in Asia. This is easy advice to follow for a curious traveler with no family ties or connections to Asia, but not practical for many people who must travel there for business or family reasons. In reality, the risk of getting infected is very, very small — it's estimated that less than one in a million travelers who travel to Asia develop Japanese encephalitis per year.More practical advice is to avoid the rural areas of Asia if you travel there, particularly farming areas that have lots of pigs and cows.
The people at greatest risk of JEV infection are those who live and work in rural areas where the disease is widespread, particularly children under the age of 15 years.If you have a choice, avoid traveling to Asian countries during their rainy seasons (it varies from place to place) when mosquito populations are larger and more of a threat.
Take notice of mild flu-like symptoms.
Be aware of a high fever.
Watch for a stiff neck.
Be alert to mental or behavioral changes.
Look for neurological damage.
Be ready for seizures.
Get vaccinated.
Avoid mosquito bites.
Wear protective clothing.
Avoid risky outdoor activities.
Don't travel to Asia.
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