Japanese encephalitis

What is Japanese encephalitis?

Japanese encephalitis is a viral disease spread by mosquitoes, which transfer the virus from infected animals - usually pigs and wading birds - to humans. Areas such as rice fields, where mosquitoes thrive and there is a lot of pig farming, are especially risky.
It was first recognised in Japan in the late 1800s (hence the name) and has since been found throughout most countries of east and South East Asia where it is the leading cause of viral encephalitis. Approximately 30,000 to 50,000 cases are reported every year, and there are about 10,000 deaths, mostly in children. In fact it’s now thought that many more people have the infection (research shows that by the age of 15 most people in South East Asia have had it) but symptoms are usually minimal so it doesn’t get reported.

Causes and risk factors

Japanese encephalitis is caused by a Flaviviridae virus (or flavivirus), which is transmitted by the bite of an infected mosquito.
Transmission of the disease is most likely during the summer months in temperate areas and during the rainy season and early dry season in tropical areas, when the mosquito populations are the highest.
Japanese encephalitis is rare in travellers and the risk to short-term visitors to the region is very low, especially if they are just visiting urban areas. However, it has a high fatality rate, and can cause chronic complications so it should be taken seriously.

Symptoms of Japanese encephalitis

Most people who are infected show only mild symptoms or no symptoms at all. However, in severe cases the disease may be fatal.
Japanese encephalitis begins like flu with headache, fever, and weakness. As it progresses to inflammation of the brain there may be confusion and delirium. Gastrointestinal problems, including vomiting, may also be present. About one third of these patients will die, and 25-30 per cent have neurological damage including paralysis, speech difficulties, Parkinson’s-like syndrome or psychological problems. Children are most vulnerable.

Treatment and prevention of Japanese encephalitis

At present, there is no medical ‘cure’ for Japanese encephalitis once infection has occurred although supportive care in hospital can help. A vaccine has been developed and is used in Asia to immunize children. It is licensed for use in the UK and the USA for people who plan to travel to South East Asia. Allergic reactions can occur in up to one in 100 people vaccinated but are mostly minor.

Reducing the risk

The best way to reduce the risk of contracting the disease is to reduce exposure to mosquitoes. This can be done by avoiding being outside in the cooler hours between dusk and dawn when mosquitoes are most actively feeding. The use of mosquito repellent, portable bednets, aerosol room insecticides and permethrin, which can be applied to clothing, is also recommended.
Related viruses
Scientists researching the Malaysian outbreak in 1998 have isolated a mysterious second virus, a member of the Paramyxovirus family, which is believed to have caused some of the deaths. The new virus is similar to the Hendra virus that killed two people and 15 horses during outbreaks in Australia in 1994 and 1995. The method of transmission is as yet unclear. Health experts believe it may be killed through the use of soap, detergent or disinfectant.
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Removal of wisdom teeth

Removal of painless wisdom teeth

Recent guidelines from the National Institute for Health and Clinical Excellence (NICE) recommend that impacted wisdom teeth (which haven't come through the gum normally) that are otherwise healthy shouldn't be removed. Only if the tooth is diseased or causing other problems in the mouth, such as severe pain, should it be taken out.
These recommendations are for the NHS. If a patient feels differently, teeth can be removed privately.
There are two main reasons behind the NICE recommendations:

• There's no reliable research to suggest the removal of disease-free impacted wisdom teeth has any benefit to the patient
• There is always some risk from surgery (including nerve damage, damage to other teeth, infection, bleeding and, rarely, death), which can't be justified if there are no benefits from the operation

People who might need the operation
Your dentist will be able to advise you whether surgery is necessary.
The problems that might mean it should go ahead include untreatable tooth decay, abscesses, cysts or tumours, disease of the gums and other tissues around the tooth, or when the tooth is in the way of other surgery or orthodontic work.
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Food poisoning

What is food poisoning?

It's estimated there are more than nine million cases of gastroenteritis each year in England. For an increasing number of people, it's due to food poisoning, something that's preventable.
Gastroenteritis describes symptoms affecting digestion, such as nausea, vomiting, diarrhoea and stomach pain. Food poisoning is the type of gastroenteritis caused by eating or drinking something contaminated with micro-organisms or germs, or by toxic substances produced by these germs.
These illnesses are often accompanied by fever, muscle aches, shivering and feeling exhausted.

Causes of food poisoning

Micro-organisms enter the body in one of two ways:

1. In the food - the food isn't cooked thoroughly, so the micro-organisms aren't killed off, often the case with barbecued food
2. On the food - the person preparing the food doesn't wash their hands before handling the food, for example

Campylobacter infection is the most common cause of food poisoning seen by GPs. It likes to live in milk and poultry.
Other common causes include salmonella, listeria, shigella and clostridia. Some take a few hours to cause symptoms, others a few days. Serious infections with E. coli are, fortunately, uncommon.

Preventing food poisoning

• Always wash your hands thoroughly before preparing food, after going to the toilet and after handling pets
• Keep kitchen work surfaces clean
• Make sure food is defrosted completely before cooking
• Keep pets away from food
• Ensure food is cooked thoroughly before eating. Meat shouldn't have any pink bits
• Serve reheated food piping hot
• Keep raw meat and fish covered and store at the bottom of the fridge
• Store all perishable foods at 5°C (41°F) or less
• Keep raw food covered
• Rinse fruit and vegetables under running water before eating
• Throw away any food that's past its use-by date, doesn't smell right and/or has fungus on it

Treatments for food poisoning

Most infections last 24 to 48 hours, during which time fluid is often lost from vomiting and diarrhoea. To prevent dehydration, drink plenty of cooled boiled water and use rehydration powders if the symptoms continue.
Sometimes antibiotic treatment is necessary; this can be determined by testing for the micro-organism responsible.
It's especially important anyone whose work involves handling or preparing food stays away from work while they have symptoms to avoid infecting others. They must also notify, and seek advice from, their local environmental health department.
If someone suspects that food bought from, or eaten in, a specific shop, takeaway or restaurant is responsible, they should also inform their local environmental health department, so food hygiene standards can be investigated.

Anal stenosis

Symptoms

The restriction of the anal canal prevents the normal expulsion of faeces, resulting in difficulty and pain when trying to open the bowels, and leading to constipation. Babies may also experience pain when trying to open their bowels.

Causes and risk factors

Anal stenosis may be present from birth, when it might be accompanied by malformations of the anal opening. This happens in one in several thousand births.
Sometimes the opening appears further forward than normal. In girls, it's usually immediately behind or inside the female genitalia. In boys, there may be no obvious opening at all or just a small area of bulging skin or a tiny channel under the skin.
More commonly, stenosis develops as a result of scarring from a tiny fissure, or crack, in the anal canal. This is usually the reason why adults develop anal stenosis, but it can also occur in babies.
Anal stenosis may also develop after surgery to the anus, for example after the removal of piles or haemorrhoidectomy.

Treatment and recovery

Low-risk treatments:
Laxatives, suppositories and other treatments are used to help loosen motions and lubricate the anal canal, to make it easier to empty the bowels. There's little risk the person affected will come to any harm from these treatments if they're used as prescribed and only for a matter of months while the problem settles. (It must be remembered that the risks are considerably less than those that might occur if the affected person becomes very constipated).
Individuals suffering from anal stenosis aren't likely to become dependent on the laxatives and suppositories.
However, its also important to make dietary changes (such as plenty of raw fruit and vegetables to provide natural fibre, and plenty of fluid to avoid dehydration) in order to keep the motions soft. Regular exercise also helps keep a regular bowel habit.
Surgical treatments:
In mild cases, gentle and gradual dilation by the regular passage of normal motions may be enough. But quite often surgery is needed, especially in more severe cases. The surgical treatment of anal stenosis depends on the extent of the problem. In most cases all that's needed is for the anal canal to be stretched. Often this can be done by the doctor in the hospital clinic, without the need for anaesthetic.
If the stenosis is severe, dilation may performed under anaesthesia. More major surgery is only needed if the anal canal needs reconstructing or (in small children with congenital anal stenosis) it needs repositioning or there are other malformations that require surgery.
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