Chandipura virus encephalitis: an emerging pediatric neurotropic threat in india-virology, epidemiology, pathogenesis, and public health challenges.

Chandipura virus (CHPV) is an emerging neurotropic RNA virus and member of the Rhabdoviridae family, causing outbreaks of acute encephalitis in India, mostly in children under 15 years of age. The manuscript reviews in detail the virology, genetics, clinical features, epidemiology, transmission, immunopathogenesis, and treatment of CHPV. CHPV rapidly infects neuronal tissue and activates the extrinsic pathways of neuronal apoptosis through Fas-mediated apoptosis, resulting in rapid neuronal degeneration within 24-48 h. The recent re-emergence of CHPV is another significant re-emergence in Gujarat in 2024, with the distribution of cases by space and time further suggesting CHPV is seasonal, adds new districts, and is still a threat to children. Outbreaks of CHPV typically coincide with monsoonal flooding, and Phlebotomus sandflies primarily spread the disease. The monsoonal flooding and environmental degradation that occurred during the breeding season, rendering sandflies more susceptible to outbreaks, are remarkable. Differentiation of other encephalitic viruses, such as Japanese encephalitis, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and dengue, is important for clinical diagnosis and also because of the rapid progression of CHPV. Several points to consider are low CSF pleocytosis and the neuroimaging characteristics that are identifiable. The immune response after infection is marked by a cytokine storm, followed by lymphocyte apoptosis and reduction in CNS viral clearance. Over the past decade, laboratories in India have developed in the realm of diagnosis and treatment of CHPV with the advent of molecular diagnostics such as real-time RT-PCR and IgM ELISA. However, a lack of a licensed vaccine and antivirals would make this new infectious disease more difficult to manage. This review highlights the critical importance of further surveillance, vector control, public health preparedness, and vaccine development/therapeutics for CHPV.