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                      A83.2 Eastern Equine Encephalitis



Eastern equine encephalitis (EEE), is a rare disease that causes inflammation of the brain (encephalitis). It is caused by an arbovirus, which means it is spread through the bite of infected mosquitoes. It was first seen in horses (equine) in the 1830s and first diagnosed in a human along the east coast in the 1930s. The virus can only be spread to humans through a mosquito bite. It cannot be spread from human to human or from horse or other animal to a human.

Eastern equine encephalitis (EEE) is one of the most severe arboviral encephalitis affecting America. Currently considered an emerging disease showing consistently increase incidence across a wider population. In the United States, between six to eight cases are annually reported, predominantly between May through October, mostly in Florida, Georgia, Maryland, Wisconsin, and New Jersey. This virus has also been considered a potential bioterrorism weapon given its airborne transmission. The case-fatality rate described is 30%, with neurologic sequelae seen in 50% of survivors. This activity describes the epidemiology pathophysiology, diagnosis, treatment, and outcome of Eastern equine encephalitis. It highlights the importance of an interprofessional team in detecting outbreaks and also in managing this complex and uncommon condition.

Some people bitten by a mosquito infected with eastern equine encephalitis (EEE) virus may not develop any symptoms at all. For those who do develop symptoms, symptoms usually appear four to 10 days after being bitten.

Symptoms of mild, general EEE infection include:

  • Muscle aches.
  • Fever.
  • General feeling of discomfort.
  • Weakness
  • Joint pain.
  • Neck stiffness.
  • Chills.

Symptoms can last one to two weeks. However, tiredness and weakness may last for weeks to months.

Symptoms of severe infection – encephalitis (inflammation of the brain) – include:

  • High fever.
  • Headache.
  • Drowsiness.
  • Vomiting.
  • Diarrhea.
  • Loss of appetite.
  • Irritability/restlessness.
  • Confusion.
  • Seizures.
  • Coma.

Recovery from severe infection may take several weeks or months.Eastern equine encephalitis (EEE) virus is diagnosed based on the results of blood or spinal fluid tests. These tests look for antibodies your body makes in a defense response to being attacked by the virus.






There are no vaccines or anti-viral medications to treat eastern equine encephalitis (EEE). Antibiotics are not used to treat viruses. Serious cases of EEE are treated in the hospital. Patients receive “supportive care,” which consists of IV fluids, breathing assistance, and prevention of other infections.

People most at risk include:

  • People who live in the areas of the country where virus-infected mosquitos are found, which are mostly wetland/swamp or woodland areas.
  • People who work or spend a lot of time outside and especially during dawn and dusk – times when mosquitoes are most active.
  • Adolescents (age 15 and under) and adults over the age of 50.
  • People with weakened immune systems due to cancer treatment, organ transplantation or presence of other diseases (including diabetes, high blood pressure, kidney disease) or infections.
Prevention 
  • Cover all exposed skin and/or clothing with an insect repellent containing DEET, picaridin, IR3535 or oil of lemon eucalyptus. Carefully read instructions for use of these products in children under age 3.
  • Wear long sleeves, pants and hat when outside and especially when hiking in wooded areas or enjoying time near water.
  • Empty all standing water that collects outside your home – from birdbaths, buckets/pots, sprinkling cans, trash containers, flower pots, toys and kiddie pools. Standing water is a breeding ground for mosquitos.
  • Use screens on doors and windows. Make sure screens are intact; repair any holes.
  • Avoid outside time at dawn and dusk if possible (or follow tips above). These are the times when mosquitos are most active.


Location: Rahath Towers Tc 48/48 (2),By Pass Road Ambalathara Junction, opp. BM Convention Centre, Ambalathara, Thiruvananthapuram, Kerala 695026, India

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