Encephalitis strikes Bihar again: 29 deaths within fortnight!
The AES cycle and the source
Patna: according to latest reports, within a matter of two weeks, twenty-nine children have died of Acute Encephalitis Syndrome (AES) and Japanese Encephalitis in Bihar while 41 remained ill. Reports mention that AES claimed seven lives, Japanese Encephalitis has accounted for two deaths in Anugrah Narayan Medical College and Hospital in Gayawhile six patients were undergoing treatment with symptoms of AES in the hospital.
In Muzaffarpur’s Kejriwal hospital, 20 children died due to AES, while 35 others are undergoing treatment for the same disease. Even as the educated public in Bihar is getting tired of the ‘mysterious disease’ label used in the press, Centre has agreed in principle to undertake mass vaccination campaign in six districts of Bihar, including Gaya and Muzaffarpur.
Principal secretary, health, Amarjeet Sinha said, “We had earlier requested the Centre to carry out a mass vaccination programme against Japanese Encephalitis (JE) in Gaya and other affected districts. However, the Centre had expressed its inability due to shortage of vaccines. But, keeping in view the urgency of situation, it has now decided to launch mass vaccination campaign in affected regions. The regions include Gaya and Muzaffarpur, the two most severely affected districts.”
Strongly refuting the reports of children dying due to suspected encephalitis in Patna Medical College and Hospital (PMCH), Sinha said, “Not a single death has occurred at the PMCH. The casualties were due to heatstroke and dehydration coupled with convulsion syndrome.” With regard to Gaya and Muzaffarpur, he said even samples tested by Rajendra Memorial Research Institute (RMRI) for suspected JE were negative.
AES & JE [Background information]:
Management of Acute Encephalitis Syndrome including Japanese Encephalitis is essentially symptomatic. To reduce severe morbidity and mortality, it is important to identify early warning signs and refer patents to health facility and educate the health workers about the first line if management at the grassroots level.
Japanese Encephalitis (JE) is caused by a virus which is transmitted through the bite of infected mosquitoes. The main reservoirs of the JE virus are pigs and water birds Ardeidae) and, in its natural cycle, virus is maintained through certain mosquito species in these animals. Man is an accidental host and does not play a role in JE transmission. JE outbreaks occur in human populations where there is close interaction between these animals and human beings. The vectors of JE breed in large water bodies such as paddy fields. The vector mosquitoes are outdoor resters and therefore vector control measures such as indoor residual spray has its limitation in effecting reduction in vector population. Vaccination against JE has been effective in prevention and control of JE in many countries where the coverage has been high and the programme was sustained. Since there is no specific treatment for this disease, early symptomatic management is important. Analysis of data of various JE outbreaks in the country reveals that a vast majority of cases occur in children. However, in areas where JE had not been reported earlier, all age groups may be affected during an outbreak. Though both sexes are affected, males usually out number females. In apparent infections out number the symptomatic JE cases; the ratio may range in between 250:1 to 1000:1. The disease shows a scattered distribution with not more than 1-2 cases being reported per village, on an average.
Treatment by symptoms only!
The management of critically ill children with JE and other viral encephalitis is directed at minimizing the risk of death and neurological complications. However, for prevention of the disease, various public health measures such as control of mosquitoes, protection from mosquito bites by using mosquito nets, protective clothing and keeping the pigs (the animal reservoir of JE) away from human dwellings are advocated, besides JE immunization. Strong surveillance system is an integral part and a pre-requisite for any disease control programme especially in a disease like JE, which has epidemic potential and high case fatality. Though the ultimate objective of surveillance is prevention of occurrence of the disease, the immediate objective is to detect early warning signals for any potential JE outbreak and initiate timely effective control measures. This would be possible only if appropriate surveillance system is in place.
Where JE immunization is already ongoing, the primary purpose of surveillance is to determine if cases continue to occur in vaccinated children. Surveillance will also help in identifying the geographic areas in need of improved vaccination coverage as well as the areas with signs of onset of a new disease transmission, and to document the impact of control measures. In summary, JE surveillance is critical to characterize the epidemiology and burden of the disease, identify high risk areas for appropriate public health intervention and document the impact of control measures.