GOVERNMENT OF ANDHRA PRADESH

HEALTH, MEDICAL AND FAMILY WELFAE (J1) DEPARTMENT

Memo.No.18585/J1/2002, Dt.21.7.2003

Sub:- Outbreak of suspected viral encephalitis – record of case Sheets – Follow up action – Reg.

Ref:- 1. G.O.Ms.No.357, HM&FW dt.9.7.2003

2. Govt. Memo.No.18585/J1/2003, HM&FW dt.11.7.2003

3. Tele. Conference

- o- o-

In view of the outbreak of suspected viral encephalitis cases, guidelines on a case management protocol and a case sheet prepared by the concerned specialists mainly from Niloufer hospital was since communicated as guidelines to be followed with appropriate modifications as may be required, to all the hospitals in the State vide Memo 2^nd cited the concerned HODs were requested to direct the concerned to record all the information of suspected viral encephalitis cases in the case record sheet so adopt. As the discussions with various with various specialists reveals the prevalence of JE / Viral Encephalitis / Dengue like hemorrhagic fever and possibility of Reyes Syndrome and as there is no categorical diagnosis of the viral encephalitis as on date, the Director of Medical Education and Commissioner, A.P.Vaidya Vidhana Parishad are requested to take immediate action as follows:

v Review first at hospital level and then state level each of the suspected encephalitis cases analyse and undertake appropriate diagnostic tests.

v The DGHS shall coordinate and ensure a detailed case-wise analysis by allotting districts to his senior officers if required apart from giving guidance to the hospitals concerned.

v The DGHS shall coordinate and monitor the findings and ensure sharing of information between the teaching hospitals the APVVP institutions and PHCs concerned by using the telemedicine facility, video conferencing,
teleconferencing etc.

v All the supervisory Officers including Prog. Officers, DM&HOs, DCHSs, Other Senior Officer who are allotted districts by the Director Health, shall take immediate steps accordingly including analysis / investigation as per format enclosed part E of which should be filled up by investigation team / Programme Officer and forwarded to concerned hospital for filling up rest of the particulars.

v DGHS may modify the format if required in consultation wish specialists concerned the above analysis will help us to diagnose the current epidemic.

M. CHAYA RATAN

PRINCIPAL SECRETARY TO GOVENMENT

To

The DGHS & Commissioner, A.P. Vaidya Vidhana Parishad, Hyderabad.

The Director of Medical Education, Hyderabad.

Copy to All District Collectors.

Copy to All District Medical and Health Officers.

Copy to All District Co-ordinate Health Services.

SF/Scs.

// FORWARDED :: BY ORDER //

SECTION OFFICER

FORMAT FOR INVESTIGATION OF SUSPECTED ENCEPHALITIS CASE

1. CASE LOCATION DETAILS

District_________________ PHC______________________ Mandal ___________ Village_______________ Population________ House No.__________

Head of Family ______________________ Date of investigation ____________

Name of the Investigating Officer ______________

2. PATIENT INFORMATION:

Name_________________________Age (Years) _____Sex: M / F

Name of the Father / Mother ___________________Date of onset of illness________________

Symptoms____________________________________________________________________

Socio Economic information : Education ______________ Occupation __________________

Income________________ , Caste _________________Recovered / Still suffering / Died on ____________________

Whether received : i) Measles Vaccination Yes ð No ð ii) JE Vaccination Yes ð No ð

Nutritional Status (Wt. in Kgs Ht in Cm) BMI ______________________________

3. ENVIRONMENTAL DATA OF THE HOUSE

House : Kacha / Pacca / Hut

Hygine : Good / Poor

Type of peridomestic Mosquito breeding : Desert coolers / Over head tanks / discarded tyres

/ Buckets / ______________________________

Animals present : Pigs / Cattle / Buffalo / Goat / Hens / Ducks /

Horses etc.

Protected Water : Yes ð No ð

Water source : ________________________________________

Surroundings : ð Pits , ð Water Stagnation, ð Cisterns,

ð Tanks, ð Any Water Storage containers

Sleeping Habit : Outside / Same room with Animals / Separate

room

Agriculture : Paddy Fields Yes ð No ð ( or ) Any other

Crops Grown _________________________

Contact with insecticides / Pesticides : Yes ð No ð Specify _________

4. Vector Control Measures taken:

Residual Spray : Yes ð No ð ; Fogging operations : Yes ð No ð ;

Anti larval : Yes ð No ð If not Who is the responsible person : __________

5. FAMILY HISTORY : Similar complaints ð Present / Absent ð

Any other Diseases ð Present / Absent ð

Sl. No.	Name of the member of the Family	Age	Sex	History of Fever Yes / No	History of any consanguine marriages	If child is below 15 years
						Weight Wt. Kgs	Height Ht. in Cm

6. TREATMENT HISTORY

Whether the patient taken treatment, prior to the admission in to Hospital or coming to the Medical Officer? Yes ð No ð If yes Name of the institution _____________ Whether the Doctor is Qualified - Yes ð No ð If No. How many bottles of Fluids were given? Specify the Number ____________. Any other relevant information: (Drugs / Medicines Taken, Other Treatment if any.) ________________________________

7. CLINICAL INFORMATION

Name of the Hospital admitted ________________________ Date of admission ____________

Date of Discharge_______________________

Signs & Symptoms

1. Fever Yes ð No ð 2. Muscle Weakness Yes ð No ð 3. Headache Yes ð No ð 4. Joint pains Yes ð No ð 5. Cold extremities Yes ð No ð 6. Rash Yes ð No ð 7. Vomiting Yes ð No ð 8. Bleeding Yes ð No ð

9. Stiffness in Neck Yes ð No ð 10. Seizures Yes ð No ð 11. Unconsciousness Yes ð No ð If yes since _______ days 12. Other neurological signs Yes ð No ð 13. Tourniquet test Positive / Negative 14. Enlarged Liver ____________ 14. Others specify _______________

History of post illness:

Has the patient suffered from same type of Symptoms in last one year Yes ð No ð

REPORTED BY Name ___________________________________________________

Designation____________________ Tel. No.___________________

8. LAB INVESTIGATIONS :	Result
CBP, PCV
ESR
Smear for M.P.
Blood Sugar
Blood Urea
Serum Creatinine
Electrolytes
Chest X-Ray
C.S.F. Analysis
A.B.G.
Skin Scraping for Meningococcus
VDRL
LFT

9. SPECIFIC INVESTIGATIONS:	Result
P.T & A.P.T.T
F.D.P.
Parasite ‘F’ Test
CSF & Blood IgM Antimeasles Virus Antibodies
Anti Dengue IgM Antibodies
J.E. & West Nile Fever Serology
Throat, Rectal Swabs, Urine, Stool, Blood, CSF Viral Cultures for Virus Isolation
MRI
EEG
CT
Liver Biopsy
Brain Biopsy

10. SPECIMENS COLLECTED FOR TESTING

1. Sera sample collected	first sample (acute Phase)	Date of Collection ______________ Result
	Second sample (Convalscent Phase)	Date of Collection ______________ Result
2. CSF Sample		Date of Collection ______________ Result
3. Sample sent for testing at