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日本脑炎的流行病学、诊断、治疗和预防

Authors
Susan L Hills, MBBS, MTH
Marc Fischer, MD, MPH
Tom Solomon, FRCP, PhD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Elinor L Baron, MD, DTMH
Translators
徐评议, 主任医师，教授

引言

日本脑炎病毒(Japanese encephalitis virus, JEV)是一种由蚊子传播的黄病毒，从发病频率和严重性来看，这是亚洲病毒性脑炎的最重要原因。随着脊髓灰质炎的几近根除，JEV目前在亚洲成为了儿童病毒性神经系统感染和致残的首要原因[1]。JEV与西尼罗病毒、圣路易脑炎病毒及墨累谷脑炎(Murray Valley encephalitis)病毒密切相关[2]。

据估计，每年大约有68,000例日本脑炎(Japanese encephalitis, JE)发生。JEV在亚洲大部分地区和西太平洋部分地区呈地方性流行，但在非洲、欧洲或美洲地区尚未观察到本地传播。对于到亚洲旅行的人来说，发生日本脑炎的风险非常低，但因季节、目的地、停留时间和活动而异[3]。据估计，从非流行国家到亚洲旅行的人中，日本脑炎的发病率小于1/100万。对于留居流行地区的外籍人士、旅行时间较长的旅行者或旅行计划中包含在农村地区广泛户外活动的旅行者，其感染风险可能更高[3]。自1973年以来，在来自非流行国家的旅行者中仅有56例日本脑炎病例报道；自1992年日本脑炎疫苗在美国获得批准以来，在来自美国的旅行者中仅有8例日本脑炎病例报道[4,5]。

大多数人类JEV感染都是无症状的或是引起非特异性发热疾病。不到1%的JEV感染导致有症状的神经侵袭性疾病[6]。然而，当出现神经系统疾病时，通常会非常严重，病死率很高，而存活者中也常存在神经系统后遗症。应对所有到JEV流行国家旅行的旅行者提供预防日本脑炎的措施建议，并且最近从亚洲或西太平洋JEV流行国家旅行归来的患者如果怀疑有神经系统感染，鉴别诊断时应考虑日本脑炎。

流行病学

日本脑炎流行于亚洲大部分地区和西太平洋部分地区(图 1)。在其流行地区，有两种典型的传播方式：

●在温带气候地区(包括中国、日本、韩国、尼泊尔、越南北部和印度北部)，大多数病例发生在气候最暖和的几个月期间，通常是在进入季风期后或与强降雨有关[2,7,8]。不同地区的传播高峰期月份和传播季节长短有所不同。有时会出现大规模的剧烈暴发。

                  

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-22.
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