Japanese encephalitis continues to claim lives; Odisha, UP worst-hit

Japanese encephalitis (JE) is an important public health concern in India that causes mortality and disability. While dengue and chikungunya cases have drawn ire of the people and the authorities were put to task for not taking swift and effective actions to control the spread of vector-borne diseases, JE and Acute Encephalitis Syndrome (AES) have been quietly taking lives of hundreds of children in eastern India. The spread of the poor man’s disease has almost gone unnoticed, let alone the official statistics indicating 5903 and 688 confirmed cases of AES and JE respectively with the death toll reaching close to 750 by the end of August.

The developments that took place in September are no better.

Bihar

AES and JE together have so far claimed 35 lives. Altogether, 114 patients with encephalitis symptoms were admitted to the Anugrah Narayan Memorial Magadh Medical College in Gaya this season. The rising cases of JE and AES have put district health officials in a fix. They had earlier claimed 100 per cent immunisation of children in the vulnerable age group (0-15).

Bihar is facing two major problems: defective mechanism for identifying the disease and locals' tendency to approach quacks and faith healers instead of doctors. Although there are no official reports on how many children are being left out on account of defective identification mechanism, the cases are undeniable.

Odisha

As of September 27, 19 children have died of JE in Malkangiri district alone. According to health officials, the main reason of deaths due to JE and AES is the rearing of pigs by villagers. Since pigs are carriers of the virus, the villagers find themselves at greater risk. Moreover, the affected villages are surrounded by ditches, pools, paddy fields and ponds: favourable breeding grounds for JE vector mosquito.

Current trends suggest that all deceased children were aged between two and eight years. The blood and cerebral fluid samples confirmed that their deaths were caused by JE. It is the first time that Japanese Encephalitis has been confirmed in the district. More samples are being collected from villages located in the periphery.

Much to the dismay of locals, the entire district has just one paediatric specialist and less than 50 per cent of the sanctioned strength of doctors. Under such circumstances, tackling the rise in cases has become a huge challenge. According to health officials, the vaccine for JE is likely to be administered to the children from next financial year.

Uttar Pradesh

Gorakhpur is one of the worst-hit districts in the state, with hundreds dying from acute encephalitis syndrome. Nine children at the city’s BRD Medical College died over two days in the third week of September. The death toll reached 254 since January this year. While AES outbreaks are common in eastern Uttar Pradesh every monsoon, over 10,000 children had died in the last four decades at the BRD Medical College alone. Unfortunately, it is the only medical college serving a nearly 10 million people spread over eastern UP, large swathes of Bihar and even Nepal. Lives of these patients can be saved if they receive immediate treatment from trained doctors. That’s why the peripheral health centres need to be strengthened and made well-equipped to begin the treatment. The UP government has lately opened 60 encephalitis treatment centres in Purvanchal to tackle the crisis.

The situation is no better in Assam and West Bengal—the two states that collectively shared 80 per cent of the disease burden in the country till August 31.

Facts about Japanese Encephalitis and AES

1. At least 24 countries in the Southeast Asia and Western Pacific regions have endemic JEV transmission, exposing over 3 billion people to risks of infection.
2. Open defecation and drinking contaminated water are the main causes behind spread of AES. While AES is an inflammatory disease of the brain caused by a number of bacteria, viruses or fungi, JE is caused by virus borne by mosquitoes: Culex tritaeniorhynchus and Culex vishnui.
3. The outbreak of AES and JE starts during post-monsoon period when the density of the Culex Vishnui mosquitoes increases.
4. JE causes headaches and vomiting and can lead to brain dysfunction, coma and seizure and inflammation of the heart and kidney.
5. Since the virus attacks the brain of the child, the chances of the child becoming mentally retarded are high.
6. In absence of any cure for JE, supportive therapy is offered focusing on relieving clinical signs.

The Union Health Ministry made JE ‘notifiable’ on September 21, which means health care providers will have to notify every JE case to the local authorities every week. This is likely to ensure early diagnosis and effective addressal of the problems of emergency. However, the need of the hour is to make the  Encephalitis Eradication Programme (NEEP) a national programme. Although such a programme was formulated in 2011 and again in 2014, an official road map is still elusive.

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