The encephalitis season has peaked again in eastern Uttar Pradesh and Bihar,the Centre has stepped up research and the UP government has sanctioned funds for a long-term treatment plan. Yet the original problem remains identifying the exact virus behind a syndrome that sees patients testing negative for Japanese encephalitis,but which has been killing thousands,mostly children,year after year since 2006.
The season usually continues till the middle of October. Around 300 patients,260 of them children,have already died in UP due to what has come to be known as acute encephalitis syndrome,or AES. Over 2,100 cases of patients with such symptoms have been registered from eastern Uttar Pradesh; 125 of these later turned out to be of Japanese encephalitis,which has caused 14 of the 300 deaths. Bihar has had 130 cases with 33 deaths. There have been 800 cases and 130 deaths of patients from Assam,too,but about half those cases have been of Japanese encephalitis,which is preventable by vaccination.
Experts of the National Institute of Mental Health and Neuro Sciences,Bangalore,have taken samples of cerebral spinal fluid from AES patients from all three states.
For UP,Chief Minister Mayawati has announced the construction of a separate,100-bed special ward for Japanese encephalitis at BRD Medical College in Gorakhpur,sanctioning Rs 18 crore. For now,an 80-bed ward at the hospital has been reserved for AES/JE cases,eight ventilators worth Rs 2 crore will be acquired,and Rs 2 crore has been sanctioned for strengthening of the pediatric ward,with diploma seats in the medical colleges child health department raised from three to ten. The government has also ordered installation of more hand-pumps for clean water in affected areas.
The hosptals pediatric ward is overcrowded,with about 470 patients on 180 beds till the weekend. The proportion of lab-confirmed Japanese encephalitis cases is less that six per cent of the total that have been registered as AES.
Till 2006,Japanese encephalitis had been taken to be the primary killer. After the introduction of a vaccine in 2006,JE appeared to have been brought under control but patients continued to show encephalitis-type symptoms,the syndrome often leading to death,though very few of them tested positive for JE.
There is no specific medicine yet for AES. Preventive vaccination is available only for JE and doctors continue to give symptomatic treatment to AES patients against convulsions and kidney failure,and to help keep their respiratory track clear since most patients are admitted in a semi-conscious state.
All experts now feel that the need is to bring about changes in the lifestyle and basic hygiene among people because a majority of the patients are affected with entero-viruses,which are contagious. Installation of some hand-pumps will not help because the population coverage would remain small. Still,a large population depends on contaminated sources of drinking water and defecate in the open. Until these practices are stopped,it would be difficult to control the spread of the disease, said K P Kushwaha,head of the pediatric department at the medical college. He has been handling encephalitis patients for three decades.
The health department has deputed five extra doctors at the medical college to manage just encephalitis cases. The NIMHANS experts have told us that they have developed some new technique,where they can test a sample for over five-six viruses at a time within eight hours. We are hopeful that some results will come this time, Kushwaha said.
Dr R N Singh,a private practitioner who has written letters in blood to the President and the Prime Minister on the subject,stressed the need for a national eradication program for encephalitis. With Assembly elections approaching,he said he would urge parties to include this in their agendas.
A senior state health official said the percentage of deaths is down slightly this year and the positivity of JE cases has decreased. The best preventive measures are being planned and we hope they will be effective. An awareness drive has been taken up,even pradhans have been educated about basic hygiene; new handpumps have been provided. Chlorine tablets are being distributed and fogging is taking place.
However,some experts say that such efforts start after the peak season begins in the end of July,and are not continued round the year.
From Bihar,state surveillance officer A K Tiwari said,Central officers have visited affected districts like Gaya,Aurangabad and Nawada and collected some samples. But they have been doing similar exercises for many years without any results. We cannot be sure about the preventive measures that we can take because we are not sure about the virus.
2005: First major outbreak
Across 10 states,6,594 cases and 1,665 deaths . Outbreak massive in eastern UP (6,011 cases and 1,472 deaths,Japanese encephalitis found to be main cause) and Bihar
Live attenuated SA 14-14-2 JE vaccine,manufactured in China. Five-year,phased mass vaccination programme for 104 districts in 11 states. In first year,135 lakh doses procured at Rs 13 crore for one-dose programme targeting children in high-risk districts; seven districts of Gorakhpur and Basti covered.
2007: New terminology
Acute encephalitis syndrome,or AES,became an expression widely used by doctors. Not all cases,it was found,were caused by JE virus. As per WHO,Clinically,a case of AES is defined as a person of any age,at any time of year with the acute onset of fever and 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).
2008: New laboratory
NIV established a field laboratory on premises of BRD Medical College,Gorakhpur. NIV senior scientist Dr M M Gore researching there since. The same year,AES cases showed rising presence of entero-viruses that enter through oral-faecal route; research began to identify the exact entero-virus causing this from among hundreds.
2009: Vaccine controversy
State refused to use about 16 lakh doses of encephalitis vaccine meant for routine immunisation,saying their efficacy was doubtful. The previous year,6 lakh doses had been wasted over allegations that they were ineffective after heat exposure. Dr R N Singh,private practitioner,wrote in blood to the Prime Minister to draw his attention to the outbreak.
2010: Fresh round
This time,it was vaccines meant for a special campaign. Centre asked UP to use previous year’s leftovers,UP refused. Later,Centre agreed to send 25 lakh fresh doses and special vaccination took place seven districts in November 2010,after the JE season had ended.
2011: No let-up
In eastern UP so far,over 2,000 cases,over 300 deaths; only 125 confirmed JE cases and 14 such deaths. Of 1,925 deep-bore hand-pumps to ensure clean water,promised in Gorakhpur,Mahrajganj,Deoria and Kushinagar,only 375 installed.