GORAKHPUR: With 3,000 cases of encephalitis reported in eastern India so far this year, the bulk of future government efforts will be centred around prevention through better water and sanitation. In the interim, though, it is medical science that is at the forefront of the fight against encephalitis, but is unfortunately sorely compromised.
For one, the central government appears unable to make up its mind about how to go about administering the vaccine against Japanese Encephalitis. JE, which is a vector-borne disease that spreads primarily through mosquitoes, was before 2005 estimated to be the source of at least 40-50% of the region's encephalitis cases, says Dr K P Kushwaha, principal of the BRD Medical College and Hospital in Gorakhpur, ground zero for the fight against the disease.
So in 2006, the central government conducted a mass vaccination drive, using a Chinese-made vaccine. "The proportion of JE in the total cases fell to 28% in 2006, 14% in 2007 and 18-19% in 2009-10," says Dr Kushwaha.
In 2010, there was another round of mass immunization and the proportion of JE has further fallen. But there has been no further mass immunization in the last two years, something public health campaigners decry.
"The vial of the vaccine clearly says that three doses need to be administered 365 days apart," says Dr R N Singh, a Gorakhpur-based paediatrician, and a long-time campaigner for a stronger governmental response to the disease.
"Even the WHO says that two doses need to be given. It is just unacceptable that the government hasn't taken up JE vaccination the way polio was taken up," he adds.
In 2010, JE vaccination was made part of routine immunization, at least on paper. In practice, the government does not buy and supply even a fraction of the quantity needed for the affected districts, said a public health official familiar with the process, who spoke on condition of anonymity.
None of the parents of the children admitted in the hospital said that their child had been vaccinated in the last two years. Gorakhpur DM Ravi Kumar NG said that another mass immunization round could be held later this year.
"A Hyderabad-based pharmaceutical company is in the process of developing an Indian JE vaccine," says Dr Milind Gore who heads the National Institute of Virology's Gorakhpur research unit. "It should be available soon."
The NIV is also working at isolating a few of the hundreds of enteric viruses that could potentially be causing Acute Encephalitis Syndrome (AES), now responsible for close to 95% of encephalitis cases. While Thailand now has a vaccine against one enterovirus (EV71), this virus has not been found in Indian cases, says Dr Kushwaha, meaning that India will likely have to develop its own vaccine for its endemic enteroviruses.
Simultaneously, while a new 100-bed encephalitis hospital is coming up at the BRD Medical College, the volume of cases the hospital deals with every day means that the government is involved in a hopeless game of catch-up.
"Even if people come forward to donate ventilators or beds, I will have to turn them away because I do not have enough staff to man even the number I have right now," says Dr Kushwaha.
Overworked postgraduate medical students, some of them on hour 20 of their shifts, and two children sharing beds even in the ICUs are proof of the acute shortage of medical and para-medical staff that the hospital faces.
The hospital technically has enough specialists for 60 beds only, as opposed to the 222 beds it has, and the 4-500 patients on them.