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**Ronan Kelly** · October 8, 2011, 06:08 AM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Political blame game begins over UP encephalitis
CNN-IBN

New Delhi: After CNN-IBN's report which exposed the successive governments in Uttar Pradesh for ignoring deaths due to encephalitis for 33 years, political blame game has started with the Congress blaming Mayawati government while the BJP criticising both the Centre and the state establishments for the medical crisis.

...

The BJP on Saturday slammed both the Centre and the Uttar Pradesh government for the rise in cases of encephalitis.

BJP spokesman Vijay Bahadur Pathak said, "As an opposition party, we can only put pressure. Vaccination is the problem. Government spent Rs 1000 crore on vaccination. But they didn't ensure that the second dose is given."

Beyond the political blame game, Health Minister Ghulam Nabi Azad refused to come on camera but passed the buck to the Mayawati government.

...

Social activists have also reacted to the alarming situation.

Chairperson, National Commission for Protection of Child Rights (NCPCR), Shanta Sinha said, "It is time for the government to take action on this. As a commission, we can take cognizance of this but more has to be done by the state government. There is so much money for health initiatives. What is happening with all that money? The state must ensure that it is used so that children are treated properly."

Centre for Social Research (CSR) chief, Ranjana Kumari said that this was absolutely a criminal neglect by UP government as well as by the central government.
"The government should spend much more money. After the report, UP government has woken up to the call and they have asked for 100 beds. That is nothing, that is too little, too late. They should better invest more money into the area and try to eradicate this disease," she said.

...

Reacting to the situation, Congress General Secretary Digvijaya Singh said that the Uttar Pradesh government needs to do more. "More needs to be done because of the living conditions in that area. We need to be a little more sensitive to this. The Government of India is taking adequate precautions, but at the same time, the state government should also realise the seriousness of the issue," he said.

...

http://ibnlive.in.com/news/political-blame-game-begins-over-up-encephalitis/191217-37-64.html

Ro's comment: Each of these commentators fails to address the main problem with encephalitis control in Uttar Pradesh: No one knows with absolute certainty what is causing 90% of the cases. Increasingly both official and media reports are emphasizing a waterborne route by an as yet unidentified enterovirus. One would hope that some of the money being spent could focus on research determining the cause of this annual tragedy. Once that is achieved, proper control measures could be implemented.

**Ronan Kelly** · October 8, 2011, 07:00 AM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Some recent papers investigating the causes of AES;

Etiology and clinico-epidemiological profile of acute viral encephalitis in children of western Uttar Pradesh, India

...
Results
Eighty-seven patients were enrolled in the study. The most common etiology of VE was enterovirus 71 (42.1%), followed by measles (21.1%), varicella zoster virus (15.8%), herpes simplex virus (10.5%), and mumps (10.5%). Japanese encephalitis virus was not found in any case. Enterovirus 71 infection caused significant morbidity in children; mortality occurred in 50%. A preponderance of cases occurred in December. In our study generalized convulsions along with altered sensorium were the significant findings in patients with VE.

Conclusions
Enterovirus 71, the major etiology of VE in our study, was associated with significant mortality and morbidity. Such studies should be conducted frequently to assess the role of emerging VE in different regions.

ScienceDirect

http://www.sciencedirect.com/science/article/pii/S1201971209001945

An epidemic of encephalitis associated with human enterovirus B in Uttar Pradesh, India, 2008

...
Results
Enterovirus RNA was detected in 37 (41.11%) of 90 CSF samples by real-time polymerase chain reaction (PCR). Seroneutralisation, amplification and sequencing of the 3′-end of the VP1 region of EV isolates revealed coxsackievirus B5 (CBV) and echovirus 19 (ECV) as the main serotypes causing this epidemic. Phylogenetic analysis showed that sequence divergence among the same serotypes was 0?4% at the nucleotide level.

Conclusions
This is the first report suggesting that CBV 5 and ECV 19 may be responsible for an epidemic of encephalitis in India. These serotypes were variant and evolved within the studied area.

ScienceDirect

http://www.sciencedirect.com/science/article/pii/S1386653211000989

Enteroviruses in Patients with Acute Encephalitis, Uttar Pradesh, India
...
ConclusionsThe viral RNA detected in CSF samples from patients hospitalized with encephalitis in Uttar Pradesh showed close identity with the EV-89 and EV-76 that recently were reported as an unusual group classified genetically as group A EV (EV-A) (10). Presence of the virus was also confirmed by its isolation and typing. Human EV-76 was detected in isolates in 1 rectal swab and 2 CSF specimens, and human EV-89 was detected in 2 rectal swabs by using amplification of VP1/2A or VP1 regions. Sequence analysis showed nt homology of 92.7%?97.7% with Bangladesh EV-76 and EV-89 strains recovered from patients with acute flaccid paralysis (AFP). The failure of amplification of typing regions in most specimens may be due to a low viral load.EVs are known to cause severe neurologic diseases ranging from AFP to encephalitis (11). In recent years, Southeast Asian countries have reported outbreaks of encephalitis caused by EV-71 (12,13). During AFP surveillance activities, Bangladesh strains were isolated from stool specimens (14). AFP patients infected with echoviruses and coxsackie B viruses also have been detected in India (15). Isolation of EV from clinical specimens collected from children with encephalitis in the present study indicates viable virus. Detection of EV-89/76 RNA in the CSF of ≈20% of the patients suggests the association of these viruses with encephalitis. Also, in 10 (3.3%) of 306 patients, co-infections of JE virus and EV were detected. Further studies are needed to understand the relative contributions of these viruses in causing sporadic and outbreak infections of encephalitis.
Accumulation of water in a saucer-shaped landscape (terai) and extensive rice cultivation in eastern Uttar Pradesh and adjoining regions favor the growth of vector mosquito populations and waterborne pathogens. Though the source of infection in the present study is unclear, the data warrant active surveillance of encephalitis cases. Inadequate hygiene and the unsanitary conditions that prevail in the study region may encourage the spread of EV infections in the community. Studies conducted on environmental samples may provide clues related to the dynamics of EV infections in humans.
...

403

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657625/

**Ronan Kelly** · October 8, 2011, 04:16 PM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Report on 500 UP kids? deaths sought
TNN | Oct 9, 2011, 01.09AM IST

NEW DELHI: Expressing concern over the death of 500 children allegedly due to encephalitis, the national child rights commission has asked for a report on the matter from the Uttar Pradesh government in 15 days.

In a letter to the state chief secretary, the National Commission for Protection of Child Rights ( NCPCR) said that the issue amounted to violation of 'children's right to life, survival and development'.

The Commission has asked the UP government for the total number of cases of encephalitis reported so far this year, the existing mechanism for review of the health calamities and the action taken by the concerned departments, especially the department of water and sanitation, to prevent encephalitis in Gorakhpur.

...

Report on 500 UP kids’ deaths sought | India News - Times of India

http://timesofindia.indiatimes.com/india/Report-on-500-UP-kids-deaths-sought/articleshow/10283483.cms

India News: Expressing concern over the death of 500 children allegedly due to encephalitis, the national child rights commission has asked for a report on the ma

Ro's note: In total at least 827 people have died from encephalitis across India so far this year with most cases from Uttar Pradesh, Assam and Bihar.

**alert** · October 8, 2011, 06:08 PM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Originally posted by Ronan Kelly View Post

Ro's comment: Each of these commentators fails to address the main problem with encephalitis control in Uttar Pradesh: No one knows with absolute certainty what is causing 90% of the cases. Increasingly both official and media reports are emphasizing a waterborne route by an as yet unidentified enterovirus. One would hope that some of the money being spent could focus on research determining the cause of this annual tragedy. Once that is achieved, proper control measures could be implemented.

I agree. The mention of Enteroviruses 71, 76, and 89 in the post that follows is, to my knowledge, the first specific report of which enteroviruses are suspected. EV71 is a common pathogen throughout much of Asia, more commonly known for its involvement in HFMD, and could easily be a background detection.

The problem with blaming any of the AES on enteroviruses, however, is that they spread widely and easily. I can't find the link now, but there was a ProMED post from an official at the NIV that indicates that he thought enterovirus was unlikely, because if this was due to enteroviruses, it would have spread way beyond Uttar Pradesh.

It is really disappointing that after all this time, no one seems to know what is causing these cases.

**Ronan Kelly** · October 10, 2011, 06:35 PM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Court orders meeting of experts to deal with JE

Express News Service

Posted: Tue Oct 11 2011, 03:39 hrs
Allahabad:

The Allahabad High Court has directed that a meeting of the experts be held, preferably within a fortnight in New Delhi, to deal with the issue of Japanese Encephalitis (JE) that has been affecting several eastern UP districts in the state for the last few years.
Coming down heavily on the officials of the state government, the court said that IAS officials could only file reports and only experts can come up with suggestions that could be implemented to control the situation.

The court also asked the Director, Epidemic/Japanese Encephalitis (JE)/Acute Encephalitis Syndrome (AES), to be present in the court on October 20 with the details of the deliberations of the meeting of the experts. The court passed the order on September 29, before it went on Dussehra vacation.
...

The court directed that the meeting be presided over by the Director, National Vector Borne Disease Control Programme of Government of India, along with Joint Secretary, Ministry of Health and Family Welfare. Director General (Medical Health and Family Welfare), UP, Director General (Medical Education), Director (Epidemics), Principal of BRD Medical College, Gorakhpur, and Head of Department of Micro-biology Department (Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow) would attend the meeting. The experts may suggest measures that may be implemented by the state government in coordination with the Centre.

...

It had earlier been decided to install 2,817 such hand pumps - which were supposed to prevent people from drawing water at shallow levels, where it can get mixed with sewage leading to contamination ? but only 668 have been installed so far.

The court also said that the state government and BRD Medical College, which was entrusted with the task of suggesting and implementing various measures, have not shown any inclination to improve the situation.

Court orders meeting of experts to deal with JE

http://www.indianexpress.com/news/court-orders-meeting-of-experts-to-deal-with-je/858412/0

Allahabad High Court has directed that a meeting of the experts be held,preferably within a fortnight in New Delhi,to deal with the issue of Japanese Encephalitis.

**Ronan Kelly** · October 13, 2011, 05:25 PM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

SHRC issues notice to UP
TNN | Oct 14, 2011, 02.13AM IST

LUCKNOW: Taking suo motu cognizance of the news item published in The Times of India under the headline a?Encephalitis-stung Gorakhpur counts its dead a" Acute Shortage Of Facilities Even As Hospitals Overflow With Patients on October 12, the Uttar Pradesh State Human Rights Commission has issued notices to UP chief secretary, principal secretary (medical and health), director general( medical and health), chief medical officer, Gorakpur, chief medical officer, Maharajganj, chief medical officer, Deoria, and chief medical officer, Kushinagar.

Justice Vishnu Sahai, member, SHRC, asked the above officials to apprise them with the measures taken to contain the spread of encephalitis and deaths taking place on account of it. The commission has also asked them to post more doctors and nurses in various government hospitals in Gorakhpur, Kushinagar, Deoria, and Maharajganj. The order also said that more beds to be provided to the patients suffering from encephalitis in these hospitals and unless inevitable, a single patient should be lodged on one bed.

...

SHRC issues notice to UP | Lucknow News - Times of India

http://timesofindia.indiatimes.com/city/lucknow/SHRC-issues-notice-to-UP/articleshow/10346605.cms

Taking suo motu cognizance of the news item published in The Times of India under the headline aEncephalitis-stung Gorakhpur counts its dead a" Acute

**Ronan Kelly** · October 20, 2011, 05:45 AM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Japanese Encephalitis deaths: Azad to visit Gorakhpur
Submitted by admin4 on 20 October 2011 - 1:43pm
India News
By IANS,

New Delhi : Union Health Minister Ghulam Nabi Azad and Congress general secretary Digvijay Singh will Thursday visit Gorakhpur in Uttar Pradesh to enquire about efforts to control Japanese Encephalitis that has killed at least 450 people in the state.

"He (Azad) will leave for Gorakhpur today (Thursday) with a health ministry team and will be back Friday," a health ministry official told IANS.

...

Japanese Encephalitis deaths: Azad to visit Gorakhpur

http://twocircles.net/2011oct20/japanese_encephalitis_deaths_azad_visit_gorakhpur.html

By IANS,

UP encephalitis toll rises, govt takes stock
Agencies
New Delhi, October 20, 2011First Published: 12:14 IST(20/10/2011)
Last Updated: 12:17 IST(20/10/2011)Share more...1 Comment Email print

With growing concern over spread of encephalitis virus in eastern parts of Uttar Pradesh, AICC general secretary has asked Union health minister Ghulam Nabi Azad and Congress general secretary to take stock of the situation. According to health officials, around 500 patients have succumbed to the viral disease this year.

Azad and his team are expected to visit the Baba Raghav Das medical college in Gorakhpur and hold a meeting with the state health officials during their day-long visit.

...

http://www.hindustantimes.com/UP-encephalitis-toll-rises-govt-takes-stock/Article1-759386.aspx

**Ronan Kelly** · October 21, 2011, 08:00 PM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Azad's visit to encephalitis-hit state ends with blame game
Shailvee Sharda, TNN | Oct 22, 2011, 05.21AM IST

LUCKNOW: Union health minister Ghulam Nabi Azad blamed UP government for not being able to tackle the encephalitis epidemic in the state. The disease has killed 465 children in 2011 alone in Uttar Pradesh.

He said, "Health is a state subject and a more serious effort was needed to manage the situation here." However, he also said he would speak to prime minister Manmohan Singh over the issue.

...
Azad said, "A coordination committee comprising Union ministries of health, water resources and irrigation, social justice and women and child welfare would be formed after a discussion with the prime minister. The committee will make a coordinated effort to tackle the problem." Azad also said, "The UP government must take immediate steps to save lives. It must think about the children who have survived the disease as majority of them have mental and behavioural problems. The Centre had given funds for the department of physical medicine and rehabilitation but the grant is lying unutilised. The department must come up soon in patients' interest."
...
The NICD also blamed 'khichwa' (locally made cast iron hand-pump) as a major factor behind the disease. The hand pump is the main source of drinking water in the region. Stating that prevention is the only way to save lives, Azad said, "Aspect of prevention involves active participation from ministries of water management and rural development. Social welfare department also needs to pitch in for spreading awareness about the issue."

Locals were, however, disappointed over the political nature of the health minister's visit. "We were hoping for some concrete steps but he simply blamed the state government for whatever is happening. The entire exercise was conducted surely with Vidhan Sabha elections 2012 in mind," said a local NGO member.

Azad's visit to encephalitis-hit state ends with blame game | Lucknow News - Times of India

http://timesofindia.indiatimes.com/city/lucknow/Azads-visit-to-encephalitis-hit-state-ends-with-blame-game/articleshow/10448148.cms

Union health minister Ghulam Nabi Azad blamed UP government for not being able to tackle the encephalitis epidemic in the state. The disease has kille

**Ronan Kelly** · October 30, 2011, 02:17 PM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

No central funds to check Encephalitis: UP govt
Last Updated: Sunday, October 30, 2011, 21:02

Lucknow: Uttar Pradesh government on Sunday blamed the Centre for not releasing Rs 300 crore to check the spread of Encephalitis, while rejecting Union Health Minister Ghulam Nabi Azad's claim that lack of sanitation and proper drinking water was hampering the battle against the disease.

"The state has done whatever it can from its limited resources to check spread of Acute Encephalitis Syndrome (AES). The state has sent Rs 300 crore proposal for providing sanitation and proper drinking water in eastern UP but it has not been accepted," a health department spokesman said here.

Reacting to media reports regarding Health Minister's letter to state government, he said till date no such letter was received by the government.
...

We batted at the best time: Nayar

http://zeenews.india.com/news/uttar-pradesh/no-central-funds-to-check-encephalitis-up-govt_738976.html

Mumbai`s Abhishek Nayar on Saturday said his team was expecting a total in the region of 240-250 ahead of the Vijay Hazare Trophy semifinal against Delhi.

**Ronan Kelly** · October 31, 2011, 05:45 AM

Re: Whose failure? Encephalitis kills 50,000 in 30 years; UP-Centre Blame game continues; UNICEF offers assistance

Centre-UP spat over encephalitis continues
TNN | Oct 31, 2011, 07.22AM IST

LUCKNOW: A day after Union health minister Ghulam Nabi Azad said that the Centre has played a proactive role in curbing Japanese encephalitis cases in eastern UP, a state government spokesperson said that the immunisation initiative undertaken by them proved to be useful.

Azad had said that since 2006, Union health ministry officials had visited the place 17 times and insisted that the second shot of JE vaccine be given to children in the affected area.

UP government instead said that Centre has been apathetic to the cause of dying children. "Projects worth Rs 300 crore to ensure safe drinking water and improve sanitation conditions in the area are pending with the Centre," said an official statement.

...

Centre-UP spat overencephalitis continues | Lucknow News - Times of India

http://timesofindia.indiatimes.com/city/lucknow/Centre-UP-spat-overencephalitis-continues/articleshow/10549674.cms

Azad had said that since 2006, Union health ministry officials had visited the place 17 times and insisted that the second shot of JE vaccine be given

UNICEF to help in eradication of encephalitis in UP

Oct 31, 9:45 AM
The United Nations Children's Fund - UNICEF will help in eradication of various forms of encephalitis that claim hundreds of life in eastern Uttar Pradesh every year. A team headed by the UNICEF’s State Coordinator Vakeel Ahmad visited the affected area to take stock of the situation. Union Health Minister Ghulam Nabi Azad also visited the affected areas in Gorakhpur and Basti divisions and announced that the Centre will adopt a multi-pronged strategy to tackle the disease.

The medical experts have identified two types of encephalitis in the region. One is Japanese Encephalitis which is caused by the mosquito bite. Another type is caused by the contaminated water. The experts claim that JE has been tamed to certain extent due to repeated vaccination in the area.

The water-borne encephalitis needs a multi-pronged approach to control it. Sanitation and purification of drinking water sources is core issue that needs to be talked. UNICEF has now taken up the task of educating the people about hygiene and importance of clean drinking water. The death toll due to encephalitis has crossed 500 mark this year and 90% of the cases are caused by the contaminated water. There are several centrally sponsored schemes like Total Sanitation, Swajal Dhara and Rajiv Gandhi Drinking water Mission that are meant for sanitation and safe drinking water. The need of the hour is to pool resources from these schemes and to provide a clean and healthy environment in the encephalitis affected areas of eastern UP.

http://www.newsonair.com/news.asp?cat=state&id=ST7744

**Ronan Kelly** · November 1, 2011, 03:19 PM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Very nice article from Inda's Frontline Magazine. Please follow the link to read in full.

Apathy virus

T.K. RAJALAKSHMI
in Gorakhpur

Absence of preventive measures and affordable and accessible health care leads to nearly 500 encephalitis deaths in Uttar Pradesh.

IT is a strange paradox. In a country that aspires to be a superpower and boasts of rapid economic growth, 488 children died in a State, Uttar Pradesh, from encephalitis alone this year. It is nothing less than a national shame and tragedy. In six districts of Bihar, close to 200 children died this year. These are deaths that occurred in hospitals and hence were reported; the actual toll could be far higher.

Most of the deaths have been due to viral encephalitis caused by an enterovirus, but a few cases have been attributed to Japanese encephalitis (JE), too, which has once again raised the demand for mass JE vaccination. Last year, until December 2010, there were 3,350 encephalitis admissions in hospitals but fewer deaths. The admissions this year until October have been around 2,600, but the mortality rate has been high; the number of admissions may cross 3,000 by 2011-end.

The clamour for the JE vaccine is justifiable, and the fact is that it is much needed despite its high production costs, and the Central government needs to ensure its universal availability. But what has brought matters to such a pass is the abject lack of simple preventive measures, coupled with a total absence of affordable, timely and accessible health care. It is also not a coincidence that most of the children admitted to hospitals were severely malnourished and already in what is called an immune-compromised state. This implies that the enterovirus outbreaks mainly affected the poor.

...

India’s National Fortnightly Magazine

http://www.frontline.in/stories/20111118282303200.htm

Frontline, the fortnightly English magazine from The Hindu, since 1984. Covering politics, social issues, environment, finance, business, economy, science, technology, art, culture, movies, entertainment, and social media.

**Ronan Kelly** · November 7, 2011, 05:50 AM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Encephalitis: Govt forms GoM, but Mayawati demands financial aid
CNN-IBN

New Delhi: The fight against encephalitis has now taken a political turn. The Centre has formed a Group of Ministers (GoM) to tackle the crisis, but the Mayawati government is insisting on a Rs 300 crore aid instead.

Under heavy criticism for first ignoring this medical emergency and then putting the blame on the Uttar Pradesh government, the Centre finally decided to act. The government set up a GoM headed by Health Minister Ghulam Nabi Azad to come up with steps to deal with the crisis. But the question is whether a GoM will actually help.

...

http://ibnlive.in.com/news/encephalitis-govt-forms-gom-but-maya-wants-aid/199885-37-64.html

**alert** · November 7, 2011, 10:49 AM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Way to go, Ronan!

Protecting Global Health, One Alert at a Time | ProMED

http://www.promedmail.org/

ProMED: Your 24/7 early warning system for emerging infectious diseases worldwide. Subscribe now to search alerts.

Published Date: 2011-11-07 09:09:10
Subject: PRO/EDR> Japanese encephalitis & other - India (33): (MA) comment
Archive Number: 20111107.3311

JAPANESE ENCEPHALITIS AND OTHER - INDIA (33): MAHARASHTRA, COMMENT
************************************************** ****************

A ProMED-mail post

Protecting Global Health, One Alert at a Time | ProMED

http://www.promedmail.org

ProMED: Your 24/7 early warning system for emerging infectious diseases worldwide. Subscribe now to search alerts.

ProMED-mail is a program of the
International Society for Infectious Diseases

The International Society for Infectious Diseases (ISID) - ISID

http://www.isid.org

The International Society for Infectious Diseases advances research, education, and global outbreak response worldwide.

Date: Sun 6 Nov 2011From: Prabhjot Singh

[Re: ProMED-mail Japanese encephalitis & other - India (32): (MA)
20111106.3302]
----------------------------------------------------------------------
It's not strange to see these cases of encephalitis appearing in
Mumbai. Mumbai, being a hub, has a high number of people from the
affected states of UP and Bihar that work as temporary workers in the
city. The appearance of disease after Diwali [festival of lights], in
the last week of October, when a large number of these migrant workers
visit their homes in the north of the country, should point towards
imported cases than actual transmission in the city. Also, it might
point towards the higher than estimated transmission of the yet
undiagnosed etiological agent in the Northern states of the country.

--
Communicated by:
Prabhjot Singh

[ProMED-mail thanks Prabhjot Sing for these interesting comments. It
would be of interest to know the recent travel histories of the
patients involved to know, as Dr Singh suggests, if these are all
imported cases or have been locally acquired. Ronan Kelly of
FluTrackers suggested that Chandipura virus infection should be
considered as a possible etiologic agent in some of these recent
(2011) encephalitis cases in India (see ProMED-mail archive no.
20100807.2690). Laboratory tests are needed to confirm or rule out
this possibility.

**Ronan Kelly** · November 19, 2011, 05:57 AM

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Criminal neglect

''Public health should become a priority.''

Encephalitis has emerged as a major killer disease in Uttar Pradesh, Bihar and West Bengal, with hundreds of people, especially children, succumbing to it in recent weeks.
...
Even when it did not kill, it left thousands of people with lasting physical damage. It is a seasonal disease which afflicts people during the monsoon and post-monsoon months and is caused by mosquitoes that proliferate during this period. (Again misinformation proliferates - the majority of cases are not Japanese encephalitis, but are apparantly caused by contaminated water - Ro)

...

The Central government has constituted a GoM to deal with the situation but according to reports no serious action is taken on the ground to contain the epidemic. The human rights commission has issued a notice to the state and both the state and Central government have blamed each other for inaction. It is only through effective steps to check the spread of mosquitoes, limiting the chances of their being hosted by animals like pigs, improving sanitary and hygienic conditions and increasing public awareness about the causes and methods prevention of disease that it can be brought under control.

Vaccination is effective against a particular strain of mosquitoes that causes the disease. But it has not been undertaken in many of the areas which became susceptible to the epidemic.

...

As in the case of most other diseases preventive steps are best in the case of encephalitis. There is the need for a sustained and motivated campaign year after year but the authorities, both at the Centre and in the states, have been found wanting in that.

Criminal neglect

http://www.deccanherald.com/content/205791/criminal-neglect.html

''Public health should become a priority.''

I agree that prevention is better than cure, but if the disease is caused by contaminated water, all the vaccination and mosquito prevention in the world is not going to stop it. Prior to spending scarce health money on remediation efforts, it is essential to identify the pathogen and the means of infection. This is the basis for prevention and continues to be overlooked in this debate - Ro