Earlier this month, the National Commission for Protection of Child Rights lambasted the Uttar Pradesh government for its ‘casual’ response to the rising death toll from Japanese Encephalitis (JE) and acute encephalitis (AES) in the eastern districts of the state.
This season alone, nearly 400 people have lost their lives to the disease.
The encephalitis outbreak occurs with frightening regularity in India. For decades now, thousands of children from some of the poorest regions of Uttar Pradesh, Bihar and Assam, have succumbed to the disease, although it is preventable.
Why has India failed so miserably to control the epidemic?
Firstpost spoke to Manish Kakkar, senior public health specialist at the Public Health Foundation of India (PHFI), on what he makes of the government’s response to the health crisis and what the way forward should be.
Kakkar is part of a team that is conducting a study on acute encephalitis and Japanese encephalitis in Uttar Pradesh’s Kushinagar district. The findings from the study could provide insights into more effective interventions by the government in the region.
Excerpts from the interview:
How grave is the situation of Japanese Encephalitis (JE) in India?
Well, it is an important cause of child mortality in the endemic areas where the disease breaks out every year with high fatality rates. Typically, of every 10 children that suffer from acute encephalitis syndrome (AES), 2-3 will die. And amongst those who survive, another 2-3 will end up with significant neurological damage.
Another point of concern is that the disease seems to be spreading to newer areas. It is a significant problem, especially in these areas. From a public health perspective, there are interventions possible to make it a preventable disease.
India has faced this epidemic for decades. Over the years, has the situation gotten worse, better or has it been status-quo? How would you assess India’s response to this crisis?
In the larger sense, it is status-quo. There were years when there was a major spike in the number of cases. And then, those cases came down in subsequent years. In 2005, for example, there was a large outbreak. There were interventions put in place, vaccinations rolled out, clinical management improved, inputs given. But again, the cases have started increasing.
What is more troubling is that earlier we were we focusing on JE as the most common specific etiology (cause of the disease) of acute encephalitis. While the ‘reported’ positivity for JE in AES cases has gone down in recent years following JE specific intervention, AES incidence continues to be unresponsive. In other words, the problem now also is that there are more and more cases reported as “unknown etiology AES.”
Unless you know the etiology—whether it is some other vector-borne virus or whether it is a water-borne disease— you cannot guide your intervention. This has made the situation really complex.
Is the phenomenon of increasing cases of acute encephalitis from unknown causes across states or restricted to parts of eastern Uttar Pradesh?
It is a mainly problem in the Gorakhpur belt, although similar reports of unknown etiology have been received from other endemic areas also. The point is also whether this is the reality or not. We need to look into that. Whether it is a case of unknown etiology or whether there is some problem in the way we are collecting and testing samples needs to be ascertained. South East Asian countries also face the problem of JE. Very specific local conditions such as expansion of rice fields and the resulting water-logging have been identified as contributing to the outbreak of JE.