ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Cyclical Season of Death

Hundreds of children die from Japanese encephalitis in Uttar Pradesh as the centre and the state play the blame game.

Since 2005, in an annual macabre ritual acute encephalitis syndrome (AES) claims hundreds of lives in Uttar Pradesh. As the disease – Japanese encephalitis (JE) is the leading viral cause of AES – primarily affects those under 15, a majority of the deaths are of children. This year the number of victims had already touched 465 by mid-October. According to official estimates, the deaths due to je were 645 in 2007, 537 in 2008 and 556 in 2009. A majority of the survivors face long-term neurological disability, a further burden on the poverty-stricken families in eastern UP where JE is endemic in many districts. The disease claims victims in the neighbouring states too, notably Bihar and Assam, but the numbers are nowhere near those in UP. So deep is the frustration of people of eastern UP with both the centre and the state governments that some 500 of them from the seven most severely affected districts wrote letters in blood to national party leaders including the president and the prime minister in mid-September. Perhaps only gestures like these can get the media and the government to look at this cyclical and preventable tragedy. The Allahabad High Court also intervened recently by directing that a meeting of experts be held to provide solutions.

While the centre and the state administrations have been taking steps to deal with the situation, what is missing is a sense of urgency and a well-coordinated multipronged strategy. According to the World Health Organisation, JE is a mosquito-borne viral encephalitis that is maintained in a cycle of virus transmission between vertebrate amplifying hosts (pigs, herons, egrets) and several Culex mosquito species. The greatest transmission to humans occurs in rural settings, particularly those in which agricultural practices increase the potential for breeding of vectors or infection of vertebrate hosts. The Government of India’s “Operational Guide to Japanese Encephalitis” notes that vector control has been the mainstay of JE control, but this has had a limited impact and requires large resources because the vector breeds in paddy fields. The most promising preventive tool is the JE vaccine (for the AES, however, symptomatic treatment is the only option). Vaccination campaigns are being carried out in eastern UP and the neighbouring districts of Bihar since 2006. However, identifying the virus behind AES has proved tricky (the National Institute of Virology has established a field laboratory on the premises of BRD Medical College, Gorakhpur). There is no doubt that poor sanitation and lack of potable water supply are the main causes of the outbreak. Hygiene awareness lessons can have little meaning in areas where families living in grinding poverty depend on contaminated sources of drinking water. While installing handpumps may not be the best solution, even that simple action seems to be mired in difficulties. The state administration says that it is now trying to coordinate with the Jal Nigam to do so in high-risk areas.

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