Surveillance Manual and Clinical Management Protocol of Acute Encephalitis Syndrome / Japanese Encephalitis 2025

Overview

The Government of Nepal, Ministry of Health and Population, Department of Health Services, Family Welfare Division, Teku, Kathmandu, has published a Protocol for the Clinical Management of Acute Encephalitis Syndrome (AES) / Japanese Encephalitis (JE).

Purpose

The purpose of this protocol is to support physicians and healthcare workers in managing cases of Acute Encephalitis Syndrome (AES) and/or Japanese Encephalitis (JE) by standardizing case management practices nationwide. It is not intended to replace clinical judgment, specialist consultation, or existing standard treatment protocols, but rather to harmonize clinical approaches, strengthen frontline care, and reduce JE-related morbidity and mortality.

Target audience: Intended target audience are physicians, nurses, healthcare personnel involved in the clinical management with referral mechanism and also FCHV at community level for early detection of AES.

Major contents

• Case Definition of AES
• Steps for management of Acute Encephalitis Syndrome/Japanese Encephalitis patients
• Empirical treatment
• Flow Chart of Management of Acute Encephalitis Syndrome/Japanese Encephalitis patients
• Management of AES case at Household level
• Management of AES cases at Basic Health Service Center
• One-Health Approach to JE Outbreak Response
• Care of patient during transportation
• List of Anti-convulsant drugs (commonly available in Nepal)
• Management at Hospital without ICU service
• Management at Hospital with ICU services
• Flow chart of Management of Shock
• Flow chart of Management of Seizure
• AES Case Investigation Form
• Acute Encephalitis Syndrome (AES) Lab Investigation Form
• VPD Weekly Reporting Form

Case definition of a AES: “A person of any age who, at any time of the year, develops Fever of acute onset AND at least one of the following: A change in mental status (including symptoms such as confusion, disorientation, coma or inability to talk); or New onset of seizures, excluding simple febrile seizures.”
A simple febrile seizure is defined as a seizure among children who are between 6 months and 6 years of age, in whom the only findings are fever and a single generalized convulsion lasting less than 15 minutes, and who recover consciousness within 60 minutes of the seizure.

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