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Dr Ajit Rayamajhi
Kanti Childrens Hospital, Kathmandu, NEPAL.
Study title - Screening for aetiologies of acute encephalitis syndrome in Nepal.
Duration and dates – June 2016 until December 2019.
Principal Investigator – Dr Ajit Rayamajhi, Janak Medical and Research Center, Balaju, Nepal & National Academy of Medical Sciences, Department of Paediatrics, Kanti Children’s Hospital, Maharajgunj, Kathmandu, Nepal.
1. Dr Shyam Raj Upreti- Director, Ministry of Health, Child Health Division, Department of Health, Teku, Kathmandu, Nepal
2. Dr Rajendra Bohora- World Health Organization –Immunization Preventable Diseases (WHO-IPD), Kathmandu, Nepal.
3. Prof Tom Solomon- Chair -Neurological Science, Head - Brain Infections Group, Director- Institute of Infection of Global Health, MRC Senior Clinical Fellow, University of Liverpool, Liverpool, UK
4. Dr Geeta Shakya- Director, Ministry of Health, National Public Health Laboratory, Teku, Nepal
1. Dr Michael Griffiths- Academic Clinical Lecturer in Neurosciences, Brain Infections Group, Institute of Infection of Global Health, University of Liverpool , Liverpool, UK
2. Dr Sagar Gurung- New Vaccine Officer, WHO-IPD, Kathmandu, Nepal
3. Dr Rupa Rajbhandari Singh- Professor of Pediatrics, B.P. Koirala Institute of Health Science, Dharan, Nepal
Funding (amount and funder/s) – USD 156,911 (Funders- World Health Organization- Immunization Preventable Diseases (WHO-IPD), Kathmandu, Nepal). The study will be implemented by Janak Medical and Research Center, with support from University of Liverpool. The study will be supervised by Ministry of Health and Population and WHO country office of Nepal.
Lay summary (up to 300 words) –
Acute encephalitis syndrome (AES) is associated with high morbidity and mortality in both children and adults. In Asian countries like Nepal, Japanese encephalitis virus (JEV) has been the main identified cause of AES in children. Although, in the >60% of cases no cause is identified, the economic, social and functional impact of AES on patients and their parents outweighs all the effort and costs. Hence, improved insight into the specific viral etiology and pathogen-specific clinical outcome of acute encephalitis is essential to guide national strategies for prevention and clinical management of AES. We planned to conduct a prospective descriptive study between 2016 – 2019 in all patients with AES recruited by national Surveillance Programme for AES as per World Health Organization (WHO) recommended standards for surveillance, through 5 surveillance sites across Nepal, estimating to recruit 120 AES patients until death/discharge. During the study we aim to improve laboratory procedures to detect pathogens and increase knowledge on the causes and outcomes of the different pathogens causing AES.
Following informed consent from the patient and/or parents, patient will be examined and findings recorded on a standardised proforma and blood and CSF samples collected according to age/weight. A trained staff from National Public Health Laboratory in Nepal will perform nucleic acid extraction and run the different primer sets. Once nucleic acid has been extracted, all of the patient’s samples will be tested by RT-PCR at NPHL for five viruses namely Enterovirus (generic), HSV (generic), Dengue (generic), Chikungunya, Influenza and five bacteria namely Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), Neisseria meningitides, Leptospira, Rickettsia through this project funding. IgM Elisa for JEV will also be conducted as part of surveillance in NPHL. The quality control will be performed at University of Liverpool.