Whose failure? Encephalitis kills 50,000 in 30 years

[Ronan Kelly]

Gates foundation to invest in UP’s health, agri sectors
Lucknow, May 30, 2012, DHNS:
Co-chairman of Bill and Melinda Gates Foundation, Bill Gates assured Uttar Pradesh  Chief Minister Akhilesh Yadav on Wednesday that the Foundation will work in partnership with the state to develop the latter’s health and agriculture sectors.

Official sources said the issue of health occupied centre stage of the discussions. The problem of Japanese Encephalitis (JE) and TB, which have afflicted large parts of the state, were discussed.
...
http://www.deccanherald.com/content/...ps-health.html

Akhilesh ropes in Gates Foundation for healthcare

SPECIAL CORRESPONDENT

The Akhilesh Yadav government and the Bill & Melinda Gates Foundation have agreed to work in tandem on maternal, neonatal and child health care, as well as in agriculture-related programmes in Uttar Pradesh. The Foundation will provide technical management and programme design support.
...
According to an official spokesman, Mr. Yadav apprised Mr. Gates of the poor health indicators, particularly the maternal mortality rate, the infant mortality rate, low level of immunisation and malnutrition among children. He also mentioned about the incidence of vector-borne tuberculosis, Japanese encephalitis and the Acquired Encephalitis Syndrome in some regions.

...

Mr. Gates assured the Chief Minister of full support in developing innovative solutions. Catalytic, technical, managerial and advocacy support would be provided. He indicated the Foundation's keenness to develop partnership in the priority areas of maternal and neonatal health, nutrition, routine immunisation, introduction of new life-saving vaccines, consolidating the gains of polio immunisation and family planning through access to modern contraceptive methods.
...
http://www.thehindu.com/news/states/...cle3474078.ece

[Ronan Kelly]

Uttar Pradesh:

JE in the war were unarmed innocent
Jun 11, 10:47 pm

Gorakhpur: Purvanchal during the war of the Japanese Encephalitis again innocent will be unarmed. To be the most effective way to combat the disease by vaccination has been deprived Purvanchal this time. JE vaccination in May this year, the government said, but he has put paid to this plan. This area has once again increased risk of disease.
This year, 34 districts in the province, including Gorakhpur Medical College, all 5581 patients admitted to public hospitals, of which the number of mosquito-borne Japanese encephalitis patients in 1042 (around 19 per cent) of these patients in which three-quarters of more than just Purvanchal
Gorakhpur - the township board. JE vaccine the first time the government decided in May 2006 - June Gorakhpur Purvanchal - Township Board has seven districts vaccination. The effect of vaccination, the number of patients this year compared to 2005 saw the half fell down. The 2007 and 2008 were lower in patients of Japanese Encephalitis. Vaccination reduced the number of patients after the government closed in Purvanchal. The result is that once again the number of patients of Japanese Encephalitis in 2009 reached 11 percent. The 2010 also are not looking at the number of patients with JE, the government in November, Gorakhpur - Basti on the board once again be vaccinated. Showing the effect of the campaign last year, down only ½ the number of JE patients, six per cent.
Given the impact of vaccination for control of JE vaccine in May this year the figure spoke. Purvanchal people expected the government to move once again get relief from this deadly disease, but this time for the government to make up.
http://in.jagran.yahoo.com/news/loca...1_9359227.html

[Ronan Kelly]

Plan for potable water in 15 encephalitis-hit districts
Faizan Ahmad, TNN | Jun 18, 2012, 05.08AM IST

SITAMARHI: The Union rural development ministry has identified 60 districts in five states, including 15 in Bihar, hit by Japanese Encephalitis (JE) or Acute Encephalitis Syndrome (AES). Hundreds of children die due to the disease in these states every year.

The medical experts have suggested that this disease is largely because of unhealthy drinking water supply and lack of cleanliness in rural areas, said Union rural development minister Jairam Ramesh on Sunday. "If the state governments give proper attention to supply of potable water, this epidemic can be checked to a great extent," he said, adding that he has asked the state governments to send proposal to his ministry for additional assistance.
...
The JE or AES affected 15 districts identified by the centre are: Araria, Darbhanga, Gaya, Gopalganj, Jehanabad, Muzaffarpur, Nalanda, Nawada, West Champaran, Patna, East Champaran, Saran, Siwan, Vaishali and Samastipur. The other states to be benefited are: UP (20 districts), Assam and West Bengal (10 each) and Tamil Nadu (5).
...
http://timesofindia.indiatimes.com/c...w/14222649.cms

[Ronan Kelly]

INDIA: An ode to 'lesser' people's death

July 10, 2012

Avinash Pandey

Come June, and Indian media has a welcome break from the dearth of positive news. They do not need to repeat telecast the same scams, neither they are forced to fill their 'news programs' with this soap opera or that comedy show running on countless entertainment channels. They get their OB vans chasing monsoons right from Kerala all the way down to foothills of Himalaya with their young and chirpy reporters getting drenched in the pours.

In a country where most of the agriculture is rain-fed, the obsession with the onset of Monsoon is completely understandable. Here, monsoon cannot be anything other than most welcome. Unfortunately, that is not the case everywhere. In some parts of the country, any news of its onset makes people tremble with fear. That is despite the fact that even their agriculture is dependent upon monsoons. Monsoon, for them, is harbinger of death and destruction. In these parts of the country, it does never come alone. It brings in Acute Encephalitis Syndrome (AES) and the Japanese Encephalitis and takes their children away.

It had killed more than a thousand children last year, 884 of them by 15 November, as admitted by the minister of state for health and family welfare Mr. Sudeep Bandhopadhyay in the Rajya Sabha. 501 of them are from Uttar Pradesh alone. The government, on its part, made all the noises it had made the year before, and the year before that. It promised to develop an 'indigenous' vaccine that would reach areas where the disease is endemic, by February this year. Just that the vaccines did not reach all the needy children and death count was pegged at 492 by 30 June. That is well before the monsoon reaching eastern Uttar Pradesh, the area worst affected by the disease.

That a curable disease could kill more than thousand children every year should in it be enough to shame the governments, both at the provincial and central level? The fact that it is one that has a vaccine makes government's inaction nothing less than criminal. Seen in this light, the children are not dying, they are getting killed. And the government of India is complicit in the crime on account of its failure in providing the affected areas with vaccination and quality medical service to save the lives it is duty bound to protect.

Worse even, the story is going on unabashedly for 34 years now and even the most conservative estimates put the number of total deaths at nothing less than 34000. And these estimates are really conservative as they do not factor in the massive underreporting of cases for many of the victims do not even get to reach the hospitals. Neither do they take inaccessibility of many villages during rainy season into account. This is why that social activists and local media put the estimates on a staggering high 50000, and then add a note of caution. For them, even this figure is a conservative estimate though not the most conservative one.

All this happens when the government has all that takes to control this annual dance of death. It has 54 Sentinel and 12 Apex Referral Laboratories dedicated for maintaining surveillance and prevent deaths scattered across the country. That the set up has failed terribly is evidenced by the sheer volume of deaths this year, 492 to repeat, that too by 30 June, or before the onset of proper rains. Getting to why of this failure, opens up a Pandora box of apathy, inaction and ignorance of those in power. All their initiates do not fail after all. There had been instances of outbreaks of diseases where the powers of the Indian state had much to not only control such outbreaks but also almost eradicate it.

The recurrent outbreaks of Dengue in Delhi in the last decade are proof to this. The government went on an overdrive to control the menace and brought down instances of Dengue to a considerable extent in a short span. It has kept itself prepared ever since. There are regular cleanliness drives with a team of dedicated officers to deal with the disease. There are mobile squads to check sources where mosquitoes could breed. These mobile squads go even inside private houses to check the electric coolers, flower pots and all that could contain stagnant water and are authorized to fine the household if they could find mosquitoes.

Why do, then, the authorities not show the same enthusiasm for controlling the disease in places like Gorakhpur, Deoria or Kushinagar? Are these places any less part of the Union of India than Delhi? Or the people living in such poor and impoverished places any 'less citizen' than those who live in flashy metropolitan cities? What then explain the authorities' overzealous reaction to the woes of one of them and an almost criminal negligence of the other? The point begets another question about the media's silence over the issue.

Well, nothing to deny that media does report this. In fact, all the data I have here is found through media reports. But then, there is a definite pattern in the way media reports this issue. They would run a stray editorial in the print. All those channels would run a few stories. And then they will bury it all to run it roughly the same time next year. All that would change would be the names of the victims with even the theaters of this tragedy remaining the same.

Compare this with the same media reporting cases that are close to its heart. Remember all those Justice for Jessica campaigns that the same media ran. Or the outrage it carried in its reports while Delhi was slowly becoming the rape capital of India. Or the anger that resonated through our television sets when a top cop found guilty of sexually molesting a young player to the extent of driving her to commit suicide was let off with almost no punishment. The media do not get silent over these cases, it should not, either.

Everyone deserves justice in a country where the rule of law prevails. All just causes should be taken up with the same intensity and media is well within its rights to shape a national conscience against such injustice, such ghastly violations of our fundamental rights.

Why does, though, the same media get so eerily silent over these deaths, killings to be precise? Why does it not shame the authorities into action? Why does it not organize panel discussions with experts debating the issue and the middle classes watching it with all that horror on their faces that the enormity of the issue generates? Are these people any less than the one the media is concerned about? Perhaps yes, for these people are not the ones who become 'us' to the media. They are not their people. They are neither from their class nor their caste. Their deaths should still concern the media as killings in faraway places like Syria bother it, does not it? Why does it remain silent on this one then?

The answer lies in the fundamental flaws that define our deficient democracy. It lays in those structures of inequality that have produced a political culture where some people are more equal than the others. It lies in that phantom limb of caste that has gotten engrained into the façade of all those democratic mechanisms, which form the base of our claims of being the largest democracy of the world.

It lies in the idea of hierarchy that dehumanizes certain sections of our society to the extent that they become easily expendable. They remain invisible for all practical purposes. Their lives come real cheap. The only thing that matters about them is their labour that this future super power needs. The problem is that even this labour comes in abundant supply. Death of a few thousand every year does not matter much; there is always plenty of replacement. That is why a state like Uttar Pradesh can afford to spends 685 crores on a park and 18 crores on Japanese Encephalitis.

For the authorities they are not human beings, they are population. Have they not been taught, then, all their lives that population is a problem, in fact the biggest problem of India? And if they are the population, then they are the biggest problem and dispensable therefore. That explains the silence and the absence of all that anger that should be generated by such criminal loss of human lives. The explanations, though, do not absolve anyone. The media, the civil society and the government, all remain complicit in these murders most foul.

Mr. Pandey, alias Samar is Programme Coordinator, Right to Food Programme, AHRC. He can be contacted at avinash.pandey@ahrc.asia
http://www.humanrights.asia/news/ahr...C-ART-066-2012

[Ronan Kelly]

Government releases more funds to fight Japanese Encephalitis


New Delhi, Aug 28 (IBNS) The Ministry of Drinking Water and Sanitation has allocated additional Rs 525 crore ($94.5 million - Ro) in 2012-2013 to the states facing the problems of chemical contamination in drinking water and which have Japanese Encephalitis and Acute Encephalitis Syndrome(JE/AES) affected high priority districts.

Rural Development Minister and the Minister of Drinking Water and Sanitation Jairam Ramesh said in reply to a question in the Rajya Sabha on Tuesday that this allocation is in addition to the normal allocation under NRDWP to the States including Uttar Pradesh and Bihar from which upto 67% of the budget can be used for provision of safe drinking water, including in these districts.

The Minister said, in JE/AES affected districts, states can take up activities like conversion of public shallow hand pumps to India Mark 11/111 hand pumps, provision of mini-water supply through Stand posts, regular chlorination of affected sources, providing proper platforms for hand pumps/ borewells, soakage pits etc, apart from awareness generation and solid and liquid waste management.


2012-08-28
http://www.newswala.com/Internationa...tis-15850.html

[Ronan Kelly]

Uttar Pradesh fails to tame encephalitis
TNN | Sep 2, 2012, 04.14AM IST


LUCKNOW: It seems that the Uttar Pradesh government has failed to save children in eastern districts of the state from the clutches of the deadly encephalitis this year too. And if, official figures of the state health department are to be believed, then since January, 210 lives have been lost to the disease this year. Out of this as many as 189 are children, while rest are adults. The count of those taken ill has crossed 1,000 and has settled at 1,023.

Interestingly, the arrangements promised to curb the disease and deaths are yet to see light of the day.
...

Sample this: The government had directed to procure 102 ventilators to set up ten-bed intensive care unit in district hospital of the affected districts. But, the procurement is still underway. Then, the state government directed officials in the Panchyati Raj department to re-bore 13,950 India Mark-II hand pumps to ensure that the drinking water supplied to the people is safe. But, so far only half the target has been achieved.

...

The facts came to fore at a meeting to review state's preparedness to fight encephalitis. Chief secretary Jawed Usmani, who presided over the meeting, pulled up officials for showing insensitivity and laxity towards the problem. On May 22, state government cleared projects worth Rs 602 crore to check the dreaded encephalitis, which has claimed more than 5,000 lives in the past seven years. The government acted after Centre agreed in principle to allocate funds generously to save children from the Acute Encephalitis Syndrome (AES) and Japanese Encephalitis. A month later, funds came but officials in UP failed to implement plans and deliver results. What ever little has happened is because of the efforts undertaken by local administration for vector control.

"The peak season when ambulances can actually play a life-saving role would be over in October. This shows poor planning," said Dr RN Singh, Gorakhpur-based paediatrician who has been working to eliminate encephalitis for the last 32 years.

...

http://timesofindia.indiatimes.com/c...w/16169474.cms

[Ronan Kelly]

Encephalitis deaths in India - The same story of poverty, neglect, disaster and disease, but for how long?
Submitted by aarti on December 2, 2011 - 10:15
Guest post by : Aarti Kelkar-Khambete

The encephalitis episode aptly indicates that temporary solutions that do not seek to address the root of the problem cannot help and that there is a risk that one problem gets replaced by another, like Japanese encephalitis being followed by viral encephalitis. The time has certainly come to end the long wait and the plight of the poor who continue to be deprived of basic health and sanitation needs in the area
Following the news on extensive rainfall in the north and south of the country and reports of heavy flooding in the north and the east, the story that has been making headlines has been that of the rapid spread of viral encephalitis in the northern parts of the country, with the most severely affected being Gorakhpur district in Uttar Pradesh, which has witnessed one of the worst outbreaks.
Current figures indicate that the cumulative death toll of encephalitis in Purvhanchal and adjoining regions of Gorakhpur, Uttar Pradesh has reached 488 with a majority of them being children [9] according to the October 25th 2011 figures while, 3088 patients have been admitted to the hospital since January this year [9] with between 30 to 40 patients being brought in for treatment everyday [11].
At present, over 280 encephalitis patients are undergoing treatment at Baba Raghav Das (BRD) Medical College and in the nearby district hospitals [9]. 10 deaths have been reported in the last four days [9] according to the 25th October 2011 figures.
What is encephalitis?
Encephalitis is an acute inflammation or swelling up of the brain caused mostly due to a viral infection. Acute encephalitis syndrome generally includes two types of infections, Japanese encephalitis, which occurs due to mosquitoes, and enteroviral encephalitis [1]. Enteroviruses include various viruses that enter the body through the gastrointestinal tract. They account for between 10 - 20% of viral encephalitis cases. Enteroviruses can spread through food or water contaminated by trace amounts of faecal material and through sneezing and coughing [4] The viral encephalitis infections that have been reported in Gorakhpur in Uttar Pradesh have been suspected to be due to contaminated water.

Encephalitis can begin with flu-like symptoms such as:
High temperature
Headache
Nausea and vomiting
Joint pain
More serious symptoms can include:
Changes in mental state, such as confusion, drowsiness or disorientation
Seizures (fits)
Changes in personality and behaviour
Other symptoms of encephalitis can include:
Sensitivity to bright lights
Inability to speak
Inability to control physical movements
Stiff neck
Hallucinations – seeing and hearing things that are not actually there
Loss of sensation in certain parts of the body
Partial or total vision loss
Involuntary eye movements, such as moving the eyes from side to side
Involuntary movements of the face, arms and legs [5]
Infants and the elderly are particularly at risk of severe illness [6]. The severity of viral encephalitis depends on the particular virus and how quickly treatment is given. The acute phase of the illness lasts around one or two weeks, and the symptoms either disappear quickly or subside slowly over a period of time. However, if the person does not get prompt treatment, then he or she can be left with varying degrees of brain damage, which may require long-term supportive care and therapy [7].

Encephalitis in Gorakhpur: The context

There are three peculiarities in the context of encephalitis in Gorakhpur. Firstly, this is not the first time that cases of encephalitis have been detected in Gorakhpur. The first case was detected as far behind as 1978 and nearly 6,000 children have died of encephalitis in the hospital since then.
However, until 2005, the majority of deaths were caused by Japanese encephalitis, caused by a mosquito-borne virus. But in the past six years, these cases have dropped and children have been dying of another form of viral encephalitis, which has been feared to be transmitted through contaminated water. Thus, the type of virus and the mode of transmission have changed.

Secondly, children in the age group of six months to 15 years are the worst affected and most of the victims have been found to be from poor economic backgrounds and from rural areas [2]. Also, most of the deaths this year have happened since July. The disease occurs regularly during the monsoon in the Gorakhpur region bordering Nepal in the foothills of the Himalayas. The low-lying areas are prone to floods and water-logging.
Lack of adequate sanitation facilities coupled with the regular habits of defecating out in the open often leads to the possibility of water getting contaminated with faecal matter. This increases the possibility of drinking water getting contaminated where water is consumed by people in the village using shallow hand pumps [8]

It has proved to be a tough challenge to deal with viral encephalitis as compared to Japanese encephalitis, since controlling it will require a vast improvement in sanitation and drinking water supply in rural areas [2]. The collapse of the health system and water and sanitation mechanism in the area has further complicated matters making it necessary to deal with the situation on an urgent basis [1].
Experts inform that around 30,000 people may have been left disabled by the diseases since they were first detected in 1978 and government records show that 15,000 have died, and another 15,000 are permanently disabled [10].

Concerns raised by the epidemic

The intensity of the epidemic this year has raised a number of uncomfortable questions that shed light on the government apathy towards dealing with the problem in a systematic manner. For example, the very fact that the problem is not a new one and that it has been repeating every year during the monsoons indicates the lack of efforts made at understanding the problem and planning coping mechanisms to deal with the problems due to flooding and water logging in the area.

Lack of existing water and sanitation systems have been found to exacerbate the problem in an area that is already a rural, poor and neglected one, where people still continue to practice open defecation. Flooding has been found to worsen the situation where water contaminated with faecal matter contaminates water sources used for drinking purposes by people in the area. This calls for a need to improve the existing water and sanitation systems in the area with plans in place to deal with the situation in cases of disasters such as floods.

Efforts made by the government to tackle the situation have been found to be equally ineffective and directionless. For example, the state government had disbursed millions of rupees from a federal (central government) health programme for treatment of patients at the state-run BRD Medical College in 2009. Part of this money was spent in hiring 135 researchers, doctors and paramedical staff to beef up treatment. However, most of the money ran out by August, leaving only 36 of them receiving regular salaries, say authorities [2].
Recent news indicates that following criticism from the National Disaster Management Authority (NDMA), a high-level committee of experts has now been constituted in the Ministry to deal with the encephalitis problem. Following discussions between the Union Health and Family Welfare Minister who visited the site and the State and Central government officials, it has been realised that the acute encephalitis syndrome (AES) needs to be dealt through a multi-pronged strategy that would require involvement of mainly the Ministries like Drinking Water and Sanitation as well as Social Justice and Empowerment and Women and Child Development [12]. The Ministry of Drinking Water and Sanitation has recently released guidelines on the course of action to be undertaken for Provision of safe drinking water in districts affected with Japaneses encephalitis in the state. According to the latest information, an Inter-departmental panel chaired by the Union Health Secretary has been constituted to monitor the Japanese encephalitis prevention plan [13].
The encephalitis episode thus calls upon an urgent need to set right a number of lacunae in the public health system in the area that include:
Setting right the already broken down systems such as sanitation and provision of pure drinking water in the area
Dealing with the regular problem of water logging and flooding in the area by establishing and planning of disaster management systems to cope with problems arising in case of such events
Establishing regular monitoring systems to take care of and deal with the epidemics arising during the floods
Strengthening the already existing public health system to deal with such emergency situations, better preparation against water-borne and vector-borne diseases
Time and again, evidence has indicated that providing temporary fixes to deal with situations such as this epidemic in Gorakhpur cannot help in finding long term solutions because they often do not address the root cause of the problem. For example, vaccines cannot be found to be the only solution to the problem in the area where long term efforts should also focus on mechanisms to take care of the poor water and sanitation situation in the area, which gets exacerbated during natural events such as floods.

This case amply indicates that temporary solutions that do not seek to address the root of the problem cannot help and one problem gets replaced by another, like Japaneses encephalitis being followed by viral encephalitis. The time has certainly come to end the long wait and the plight of the poor who continue to be deprived of basic health and sanitation needs in the area, but for how long?
(The author is a public health researcher based in Trivandrum, and also works with the India Water Portal)
The author is grateful to Dr Shiraj Wajih, President, Gorakhpur Environmental Action Group (GEAG), for his valuable insights, while writing this article.
References
1. Asia Calling (2011) India Encephalitis Outbreak Kills Hundreds of Children . Downloaded from the site http://www.asiacalling.org/en/news/i...ds-of-children on 19th October 2011
2. Biswas Soutik (2011) India encephalitis outbreak kills 400, mainly children, BBC News, South Asia. Downloaded from the site: http://www.bbc.co.uk/news/world-south-asia-15269441 on 19th October 2011
3. Yahoo News (2011) Encephalitis kills at least 430 in India.
Downloaded from the site: http://news.yahoo.com/encephalitis-k...004959246.html on 19th October 2011.

4.University of Maryland Medical Centre (2011) Viral Encephalitis: Causes. Downloaded from the site: http://www.umm.edu/patiented/article...s_000096_2.htm on 19th October 2011.

5. NHS Choices Information (2011) Encephalitis Information: Downloaded from the site : http://www.nhs.uk/Conditions/Encepha.../Symptoms.aspx on 19th October 2011.

6. World Health Organisation (2011) Encepahlitis, Viral. Downloaded from the site: http://www.who.int/topics/encephalitis_viral/en/ on 19th October 2011.

7. Better Health Channel (2011) Viral Encephalitis. Downloaded from the site: http://www.betterhealth.vic.gov.au/b...ephalitis?open on 19th October 2011.
8. Midnight Watchers Bligspot (2011) India: Encephalitis Outbreak Kills 400, Mainly Children. Downloaded from the site:
http://midnightwatcher.wordpress.com...inly-children/ on 19th October 2011.
9. Deccan Herald (2011) Encephalitis toll climbs to 488. Downloaded from the site: http://www.deccanherald.com/content/...limbs-488.html on 1st November 2011
10. Dhar Aarti (2011) In eastern Uttar Pradesh, a season of death. The Hindu, 29th October 2011, p 12. Downloaded from the site: http://www.thehindu.com/news/nationa...cle2577631.ece on 29th October 2011
11.Medical Express (2011) Encephalitis kills at least 430 in India. Downloaded from the site: http://medicalxpress.com/news/2011-1...tis-india.html on 1st November 2011.
12. The Hindu (2011) Azad for GoM to deal with Japanese encephalitis. Downloaded from the site: http://www.thehindu.com/news/nationa...cle2568496.ece on 1st November 2011.
13. Dhar, Aarti (2011) Inter-departmental panel to monitor Japanese encephalitis prevention plan. The Hindu, 25th December 2011. Downloaded from the site:http://www.thehindu.com/health/polic...cle2745198.ece on 26th December 2011.


Source: http://www.indiawaterportal.org/post/20838

[Ronan Kelly]

Implementation of Intervention/ Activities for Prevention and Control of Japanese Encephalitis (JE)/ Acute Encephalitis Syndrome (AES)

The Cabinet today approved a proposal for a comprehensive multi pronged strategy for the prevention and control of Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES).
The proposal of the Ministry of Health and Family Welfare for the implementation of the intervention/activities recommended by the Group of Ministers (GoM) for prevention and control of Japanese Encephalitis (JE) / Acute Encephalitis Syndrome (AES) will be implemented in 60 priority districts for a period of 5 years from 2012-13 to 2016-17 by the Ministries of Health & Family Welfare, Drinking Water & Sanitation, Social Justice & Empowerment, Housing & Urban Poverty Alleviation and Women & Child Development. Focussed interventions will be done in five States namely Assam, Bihar, Tamil Nadu, Uttar Pradesh and West Bengal.
The major activities include public health interventions, expansion of JE vaccination, improved case management, medical and social rehabilitation, improved provisions of drinking water and sanitation in rural and urban areas and improved nutrition.

The Cabinet approved the implementation of interventions/activities for JE/AES for the following Ministries out of the budget available during the 12lh Plan. Ministry-wise estimated costs of interventions/activities as approved by the Cabinet are summarized below:

Sl.
No.
Ministry / Department
Estimated Cost (Rs. in crore)
1.
Ministry of Health and Family Welfare
1131.49
2.
Ministry of Drinking Water and Sanitation
2301.57

(Drinking Water - 750.23 Sanitation- 1551.34)
3.
Ministry of Social Justice and Empowerment
9.19
The Ministries of Housing & Urban Poverty Alleviation and Women & Child Development will obtain requisite additional funding as per table below for implementing the interventions as per GoM recommendations within two months of the Cabinet approval.

Sl.
No.
Ministry/ Department
Estimated Cost (Rs. in crore)
1.
Ministry of Housing and Urban Poverty Alleviation
418.00
2.
Ministry of Women and Child Development
177.85
The implementation of the proposal will substantially reduce the cases of JE through strengthening of JE vaccination and vector control. It will also reduce AES cases by checking the transmission of entero-virus in children through the supply of safe drinking water and enhanced nutritional status of children. This will also reduce burden of disabilities due to AES in young children.

Background:
With the approval of the Prime Minister of India, a Group of Ministers (GoM) was constituted to evolve a multi-pronged strategy encompassing preventive, case management and rehabilitation measures to address the problems relating to Japanese Encephalitis (JE)/ Acute Encephalitis Syndrome (AES). The members of GoM included Minister of Health and Family Welfare, Minister of Urban Development, Minister of Social Justice & Empowerment, Minister of Rural Development, Minister of Drinking Water & Sanitation and Minister of State (Independent Charge) of the Ministry of Women & Child Development. Vice Chairman, National Disaster Management Authority (NDMA) was included as a Special Invitee.
***
SH/SK

(Release ID :88512)
http://pib.nic.in/newsite/erelease.aspx?relid=88512

Govt earmarks Rs 4,000 crore for encephalitis
TNN | Oct 19, 2012, 03.09AM IST


NEW DELHI: The government on on Thursday cleared a Rs 4,000 crore multi-pronged plan for prevention and control of Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES), which have claimed nearly 1,000 lives so far in 2012.

The Union Cabinet cleared the proposal of the Ministry of Health and Family Welfare for implementation of the activities recommended by a ministerial panel for prevention and control of the disease. Initially, the plan will be rolled out in 60 priority districts.

The plan will implemented in Uttar Pradesh, West Bengal, Tamil Nadu, Bihar and Assam within five years from 2012-13 to 2016-17, the government said in a statement.
...
http://timesofindia.indiatimes.com/i...w/16871813.cms

[Ronan Kelly]

Incidence Rate of Acute Encephalitis Syndrome without Specific Treatment in India and Nepal

Nagabhushana Rao Potharaju
Department of Neurology, Osmania Medical College/ Niloufer Hospital/Osmania General Hospital, Hyderabad, India

Date of Submission 14-Mar-2011
Date of Acceptance 15-Jun-2012
Date of Web Publication 15-Nov-2012
Correspondence Address:
Nagabhushana Rao Potharaju
10-3-185, St. John's Road, Secunderabad, Andhra Pradesh - 500025
India


DOI: 10.4103/0970-0218.103473




Abstract
Background: A performance target (PT) for the incidence rate (IR) of acute encephalitis syndrome (AES) was not defined by the World Health Organization (WHO) due to lack of data. There is no specific treatment for ~90% of the AES cases. Objectives: (1) To determine the IR of AES not having specific treatment (AESn) in two countries, India and Nepal. (2) To suggest the PT. Subjects and Methods: This was a record-based study of the entire population of India and Nepal from 1978 to 2011. The WHO definition was used for inclusion of cases. Cases that had specific treatment were excluded. IR was calculated per 100,000 population per annum. Forecast IR was generated from 2010 to 2013 using time-series analysis. Results: There were 165,461 cases from 1978 to 2011, of which 125,030 cases were from India and 40,431 were from Nepal. The mean IR of India was 0.42 (s 0.24) and that of Nepal was 5.23 (s 3.03). IRs of 2010 and 2011 of India and that of 2011 of Nepal were closer to the mean IR rather than the forecast IR. IR of 2010 of Nepal was closer to the forecast IR. The forecast IR for India for 2012 was 0.49 (0.19-1.06), for 2013 was 0.42 (0.15-0.97) and for Nepal for both 2012 and 2013 was 5.62 (1.53-15.05). Conclusions: IRs were considerably different for India and Nepal. Using the current mean IR as PT for the next year was simple and practical. Using forecasting was complex and, less frequently, useful.
...
Potharaju NR. Incidence Rate of Acute Encephalitis Syndrome without Specific Treatment in India and Nepal. Indian J Community Med [serial online] 2012 [cited 2012 Nov 16];37:240-51. Available from: http://www.ijcm.org.in/text.asp?2012/37/4/240/103473

[Ronan Kelly]

Encephalitis battle: Tied in reams of red tape
Last Updated: Sunday, November 18, 2012,16:42
IANS

Lucknow: Has the battle of the Uttar Pradesh government against Japanese Encephalitis (JE) and AES (Acute Encephalitis Syndrome) in its eastern part been lost to red tape? The answer, shockingly, seems to be yes.

Even as the death toll of kids falling to the deadly viral disease mounted to 555 up to Saturday, the health department has been busily engaging in `processes,` admitting that "lots of things still need to be done."

Sources reveal that while the state government had ordered the construction of a 100-bed hospital for AES patients - to be built at a cost of Rs.18 crore - the tendering for the same is still on. According to government timelines, the "lenter of the ward" would be up by March 2013.

The story is the same with paediatric wards to be set up in the nine districts affected by AES. The wards are still not complete. There is thus no place where ventilators (124 of them, according to an announcement by the Samajwadi Party government in June) can be installed.

Of the 22 ventilators installed at the Baba Ram Das Medical College in Gorakhpur, most are on lease from other medical colleges of the state, said principal secretary (Health) Sanjay Agarwal, who also candidly admitted that apart from statistics which show a marginal decrease in JE deaths from 5.97 percent last year to 4.02 percent in the corresponding period till November this year, a lot was still to be done.
...
http://zeenews.india.com/news/health...ape_19692.html

[Ronan Kelly]

Brazilian Journal of Infectious Diseases
Print version ISSN 1413-8670
Braz J Infect Dis vol.16 no.6 Salvador Nov./Dec. 2012
http://dx.doi.org/10.1590/S1413-86702012000600011


Japanese encephalitis: a review of the Indian perspective

Sarika Tiwari; Rishi Kumar Singh; Ruchi Tiwari; Tapan N. Dhole*
Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Uttar Pradesh, India

ABSTRACT

Japanese encephalitis virus (JEV) causes Japanese encephalitis, which is a leading form of viral encephalitis in Asia, with around 50,000 cases and 10,000 deaths per year in children below 15 years of age. The JEV has shown a tendency to extend to other geographic regions. Case fatality averages 30% and a high percentage of the survivors are left with permanent neuropsychiatric sequelae. Currently, there is no cure for JEV, and treatment is mainly supportive. Patients are not infectious, but should avoid further mosquito bites. A number of antiviral agents have been investigated; however, none of these have convincingly been shown to improve the outcome of JEV. In this review, the current knowledge of the epidemiology and the pathogenesis of this deadly disease have been summarized.


Introduction

Japanese encephalitis (JE) is a common mosquito borne flaviviral encephalitis. It is one of the leading forms of viral encephalitis worldwide, mostly prevalent in eastern and southern Asia, covering a region with a population of over three billion.1 Most infections of JE are asymptomatic, but if clinical illness develops, it causes significant morbidity and mortality. Though underreported, JE causes an estimated 50,000 cases and 15,000 deaths annually.2 JE is a disease of public health importance because of its epidemic potential and high fatality rate. In endemic areas, the highest age-specific attack rates occur in children of 3 to 6 years of age.3,4 Approximately one third of patients die, and half of the survivors suffer severe neuropsychiatric sequelae from the disease.5

Japanese encephalitis virus (JEV) belongs to the family flaviviridae and genus Flavivirus.6 It is a single stranded, positive-sense polarity RNA genome of approximately 11 kb in length. The virion of JEV contains three structural proteins - nucleocapsid or core protein (C), non-glycosylated membrane protein (M), and glycosylated envelope protein (E), as well as seven non-structural (NS) proteins - NS1, NS2A, NS2B, NS3, NS4A, NS4B, and NS.7 J EV exists in a zoonotic cycle between mosquitoes and pigs and/or water birds. This study reviewed JEV literature from 2000 to 2010, outlining the Indian scenario, clinical depictions, diagnosis, and the prevention of this deadly disease.

Historical perspective

The first outbreak of encephalitis attributed to JEV was reported in Japan in 1871. Major epidemics have been reported about every ten years; in 1924, over 6,000 cases were documented in a severe epidemic in Japan.8 In 1935, the prototype Nakayama strain was isolated from the brain of a patient suffering from encephalitis. Thereafter, the virus had been classified with other flaviviruses as a group B arbovirus in the family Togaviridae, Originally the term "type B" encephalitis was used to distinguish this summer epidemic from von Economo's lethargica/sleepy sickness, commonly known as type A encephalitis,5 which occurs in winter with a different clinical presentation. Later on, the designation "type B" was abandoned, and in 1985, JEV was designated under a separate family Flaviviridae, as a member of genus Flavivirus.9 The genus Flavivirus has been named after the prototype yellow fever virus (from the Latin word flavi,), and is comprised of 70 small, enveloped viruses with single stranded positive-sense RNA.5



Epidemiological features

Global outlook

Japanese encephalitis is one of the most important forms of epidemic and sporadic encephalitis in the tropical regions of Asia, including Japan, China, Taiwan, Korea, Philippines, all of Southeastern Asia, and India; however, related neurotropic viruses are spread across the globe.10 Countries with proven epidemics of JE include India, Pakistan, Nepal, Sri Lanka, Burma, Laos, Vietnam, Malaysia, Singapore, Philippines, Indonesia, China, maritime Siberia, Korea, and Japan.11 In the past 50 years, the geographic areas affected by JEV have expanded (Fig. 1). Epidemic activity in Northern India, Central India, and Nepal has increased since the early 1970s. In the 1990s, the virus continued to spread in Pakistan,12 in the Kath mandu valley of Nepal,13 and also in continental Australia.14 JE is primarily found in Southeast Asian countries. Three epidemiological regions can be distinguished. First, the endemic region composed of Southern India, Southern Vietnam, Southern Thailand, the Philippines, Malaysia, and Indonesia. Secondly, the intermediary subtropical region, which includes Northern India, Nepal, North and Central Burma, Northern Thailand, Northern Vietnam, Southern China, and Bangladesh. Thirdly, the temperate epidemic region, spanning Northern China, Korea, Japan, Taiwan, and the southern extremities of Russia. Transmission is variable, and is coupled with environmental temperature. During winter, mosquitoes are inactive, but huge epidemics can happen during summer and autumn. The geographical area of this disease is showing a trend towards expansion. Postulated explanations are bird migration, certain irrigation projects, animal smuggling, and global warming. Development of rice plantations is theoretically foreseeable in other regions (Pakistan, Afghanistan, Nile Valley, Madagascar, and Oriental Africa), creating a favorable environment for further vector proliferation.15



Problem in India

In India, epidemics of JE are reported from many parts of the country, and it is considered a major pediatric problem. The first recognition of JE based on serological surveys was in 1955, in Tamil Nadu, India.16 A total of approximately 65 cases were reported between 1955 and 1966 in Southern India.17 Subsequent surveys carried out by the National Institute of Virology of Pune indicated that approximately half of the population in Southern India has neutralizing antibodies to the virus. Since 1955, many major outbreaks in different parts of the country have been reported. A major outbreak resulting in a 42.6% fatality rate was reported in the Bankura District of West Bengal in 1973. Subsequently, the disease spread to other states and caused a series of outbreaks in different parts of the country. In 1978, cases were reported from 21 states and union territories.15 In Uttar Pradesh, the first major JE epidemic occurred in Gorakhpur in 1978, with 1,002 cases and 297 deaths reported. Many outbreaks were reported in Gorakhpur after the 1978 JE outbreak, with varying intensity and magnitude. Since 1978 to 2005, this encephalitis has taken more than 10,000 lives in the state.18 The 2005 epidemic surpassed all previous reported outbreaks in the country. In that year, Uttar Pradesh faced a devastating outbreak of JE, mostly confined to Gorakhpur, with 6,061 cases and 1,500 deaths; another outbreak occurred in 2006, with 2,320 cases and 528 deaths. Similarly, JE cases in Uttar Pradesh were confined predominantly to Gorakhpur during 2007, with 3,024 cases and 645 deaths,18 and then onwards till 2007 there have been 103,389 reported cases in India, and 33,729 deaths.19 Approximately 597,542,000 people in India live in JE-endemic regions, and 1,500 to 4,000 cases are reported every year.20 These figures are based on total reported cases; it is possible that many cases are unreported and hence the actual magnitude of the threat of JE may be considerably higher, both in the Indian and in the global context. JE incidence during the past few years is given in Table 1.21 The trend of JE suggests that the problem in Northern India is escalating, and larger epidemics may occur in the future.22

Vector and transmission

The JEV is transmitted to vertebrates by mosquitoes. Mosquito transmission was suspected during the early 1930s; in 1938, Mitamura et al. reported isolation from Culex tritaeniorynchus.23 The ecology of JEV has come from various studies carried out in Japan by Scherer et al.,24 and JEV ecology has been the subject of several reviews.11,25,26 Many species of Culex mosquitoes can transmit JE. For Southern Asia, Eastern Asia, and Southeastern Asia, the main vector of JE is C. tritaeniorhynchus. For Northern Australia, the main vector is C. annulirostris. However, various other secondary vectors may be important. Indian studies in particular have revealed a number of secondary vectors, including Mansonia indiana, C. pseudovishnui, C. whitmorei, C. gelidus, C. epidesmus, Anopheles subpictus, A. peditaeniatus, and M. uniform.27 The natural cycle of JE virus in Asia involves water birds and Culex mosquitoes. However, unlike many other mosquito-borne diseases, an amplifying host is important in the epidemiology of human JE. In Asia, pigs are considered to be the most important amplifying host, providing a link to humans through their proximity to housing.28 The life cycle of the virus is illustrated in Fig. 2. There are two epidemiological patterns of transmission: an endemic pattern in tropical areas with viral circulation in most months of the year, but with a broad seasonal peak, probably resulting from irrigation practices; and an epidemic pattern in more temperate areas with clear summer seasonality.11,29


Mortality and morbidity

JE's mortality rate is approximately 25% to 30%.1,29 Although intensive care support can reduce the mortality rate, patients often suffer significant long-term morbidity. Some effects, such as learning difficulties and behavioral problems, can be subtle and may remain undetected for several years.30,31 50% of those who recover suffer from neurological deficit.32 Over the past 60 years, it has been estimated that JEV has infected more than ten million people, of whom three million died and four million suffered long-term disabilities.29
...
continues in full at; http://www.scielo.br/scielo.php?scri...rm=iso&tlng=en

[Ronan Kelly]

From the website of PHARMACIENS SANS FRONTIERES. http://pharmaciens-sans-frontieres.lu/?p=191

Encephalitis Project (Phase 2) – Gorakhpur
10 février 2013 | Auteur: Marc
Report of Activities for the period 17-19th December 2012
1. Current Situation
The encephalitis project enters its 5th year with a change of leadership from Father Gibi to Father Varghese.
The first phase covered 50 villages in Chargawan Block (Gorakhpur) and now encompasses 75 villages.
This is the third project update visit by PSF.


2. Principal Activities
Discussion with facilitators, team leaders and trainers proved positive. The staff turnover rate has reduced and the team remain committed and well-motivated. Planned visit to Assam has been cancelled due to political unrest in the area. Team will now visit Siliguri, West Bengal in February 2013.
Meeting with Dr Srivastava principal of BRD Medical College gave an update on current research into AES. AES was principally a rural problem but significant evidence disease afflicting city areas. No finite view as to a specific cause for the ‘non-JE version’ of AES, but a number of possible reasons under research. Dr Srivastava was very supportive of PGSS activities and success of education and awareness building achieved.
Several village visits (1st phase and 2nd phase). After one year, the 2nd phase villages appear more advanced than 1st phase villages after their first year.
Discussion with officials of the other NGO’s. Only met with one NGO but very aware of work of PGSS. Dr Singh (NEEP) unfortunately called away and not able to meet this time. NGO’s do not appear to overlap activities in the same villages.


3. Issues raised
Facilitators can encounter non-co-operation, especially with Moslem communities who are often more superstitious than Hindus and resist vaccination clinics.
Some villagers unhappy re dismantling water pumps to clean. This is more a problem with the older pumps, but not a genuine reason to defer regular chlorine bleaching.
Problem with supply of Gambujia fish. Government sources failed to deliver this year. Alternative sources being investigated.
Some regular village meetings impacted by numerous festivals!
Poorer communities unable to afford mosquito nets resulting in frequent requests for donation of nets.


4. Observations
The transition of leadership from Father Gibi to Father Varghese appears to have gone smoothly. The Father is well briefed and knowledgeable re the villages and the appropriate actions for disease control.
The quality of communications has improved. Puppet shows and street theatre are well managed and the quality of posters and wall writings are first class.
The better villages are clearly those that have an involved and committed village leadership (Pradhan). This indicates that the rights based approach is working.
After just one year the ‘new villages’ appear to be benefiting from PGSS support and sensitisation, indicating the value of expanding the project and capitalising on the knowledge and experience gained in the first phase villages.



5. Next activities
Prepare annual report (due 18/19th December) for translation (French) for the Ministry of Foreign Affairs.
Release second annual payment of funds.
Discuss with TdH and PGSS how cross-fertilisation of ideas and support could possibly assist the challenging work of SKVS, Kushinagar.
Investigate possibilities of increased distribution of mosquito nets for poorer villages.
Follow up actions required to obtain regular resourcing of replacement of Gambujia fish.

[Ronan Kelly]

Underground water polluted in 30 districts
TNN | Mar 15, 2013, 04.47 AM IST


PATNA: Underground water in at least 30 districts of the state is polluted with chemicals which the people of 23,576 habitations are forced to consume. Of them, drinking water of 1,001 habitations has arsenic, 2,691 habitations has fluoride and 10,884 habitations has iron contents.

This was admitted by public health engineering department ( PHED) minister Chandra Mohan Rai in the state assembly on Thursday. He said the government in 2012-13 set a target for providing purified underground water in 6,100 habitations by sinking India Mark II hand pumps. Against this target, 2,040 habitations have been fully covered.

Replying to the debate on the budgetary demand of his department for Rs 939.47 crore, Rai said arsenic is found in 13 districts which are situated along the Ganga, fluoride in 11 southern districts having borders with Jharkhand and iron in some districts in Kosi belt. After complains about meningitis and encephalitis came from 114 blocks in 11 districts, samples of the underground water of these areas have been sent for testing.
...
"Providing safe drinking water to each person is a daunting task in view of the chemical pollutions and floods every year," Rai said and added the target was not only to provide drinking water but quality water. To check the quality of water, laboratories have been opened in all the 38 districts, he added.
...
http://timesofindia.indiatimes.com/c...w/18981005.cms

[Ronan Kelly]

machine translated;

Preparation of Drinking Water Quality Testing
Updated on: Fri, 15 Mar 2013 12:05 AM (IST)

Gorakhpur: Rural Drinking Water Mission under the auspices of clean drinking water quality testing workshop was held on Thursday. Were told that each gram panchayat and twenty samples will be tested.

He was instructed to prepare for it. The workshop also addressed the District Development Officer Dr. Abhay Srivastava. Workshop on Rural Development, Panchayati Raj, child development, education, health, water corporation, underground water department officials were present.

http://www.jagran.com/uttar-pradesh/...-10217629.html