HEALTH MATTERS: Acute Encephalitis Syndrome (AES) – A growing Health concern

File photo-PTI

File photo-PTI

Health continues to pose a major risk for the public in India. Across many states in India, infectious diseases which continues to be life threatening are Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE), commonly known as brain fever. Both are killer diseases.

Acute encephalitis is the clinical manifestation of JE virus. This virus is transmitted by Culex mosquitoes, which breed in water borne areas. Those who reside in the areas where flowing water is not contained, which help breed these mosquitoes, are exposed to the disease.

The states that reported the highest number of cases were Uttar Pradesh, Bihar, Assam and West Bengal. While UP reported 110 cases of Acute Encephalitis Syndrome, Assam reported 70 cases, West Bengal reported 60 cases. While Bihar reported 23 cases, since many affected areas were not covered so the overall case numbers were not available.

However, the disease has spread rapidly across the country and has now emerged in many other states as well. Many JE cases are being reported from as many as 20 states. In Telengana, in northern Andhra Pradesh, reported 25 cases Karnataka reported 22 cases of Acute Encephalitis Syndrome and Japanese Encephalitis.

Between 2001 and 2015, about 35000 Acute Encephalitis Syndrome and 500 Japanese Encephalitis cases were reported in UP, Assam, Bihar and West Bengal, while sixteen other states reported 70000 cases, which are much higher. Apart from the rising numbers of JE cases, death rates are also high. Between 2001 and 2015, more than 6500 children have died due to AES and JE.

The impact of Acute Encephalitis Syndrome and Japanese Encephalitis infectious is severe since it is neurological disease caused not only by viruses but also bacteria, parasites, chemicals and toxins that are widespread across the country. Children who are exposed to these are the most affected and face the highest risk of death.

File photo of Union Health Minister J P Nadda. Photo - PTI

File photo of Union Health Minister J P Nadda.
Photo – PTI

To control and prevent Japanese Encephalitis, the Ministry of Health created a JE vaccine especially for 119 endemic districts in nineteen states. The Centre provided JE vaccines to the States.

Initially, Andhra Pradesh and West Bengal, which were identified as high risk States were provided the JE vaccine.

The JE vaccine was developed by CRI Kasuali by using a live mouse brain to identify the disease, similar to the Chinese mouse brain study. Three doses of vaccines were developed.

Since 2013, routine doses of two JE vaccines were provided to states. In 21 districts in Bengal, Assam and UP, adults were provided with the vaccine. Between the age of 15 to 65, one time vaccine was provided by the State. For children routine immunization was provided for children initially between one to fifteen years through campaigns, which helped to identify the cohort. Currently, based on the data, routine vaccination is provided in two doses.

The need for appropriate vaccination for those who are the most affected, especially in unreached areas where the underprivileged communities reside is critical since the environment they reside in puts them at risk of getting Japanese Encephalitis. These areas are drought prone, besides the seasonal changes also has an impact on their health.

In these states, the government has opened vaccination campaigns, sentinel laboratories, treatment facilities among others. However, since the vaccination programme is not national, it is the states responsibility to provide adequate care and vaccination at the district level. Currently, 1097 districts across the country are meant to oversee vaccination in these affected districts.

Therefore it is imperative that states provide timely care, treatment and vaccination for the population since it has been found that there is discrimination due to which many affected people drop out from getting overall care. Also, there is a policy articulation deficit. For comprehensive implementation there is a need for better policy articulation.

Way forward

Communities across all states must be provided adequate treatment and care as well. To prevent people from being infected with AES and JE, the state governments need to provide comprehensive support to ensure that all families, especially the marginalized one have safe drinking water, access to health services and proper sanitation, so that infants, children, youth as well as adults and especially the elderly family members are not exposed to this infectious diseases.

Mohuya Chaudhuri is a senior journalist and researcher