NEW DELHI: Japanese Encephalitis (JE) has become a serious problem in the country. A review by Union health minister Ghulam Nabi Azad on July 19 showed that the nation has already recorded 749 cases of Acute Encephalitis Syndrome (AES)/JE and 115 deaths.
The worst-affected states have been Uttar Pradesh, which has recorded 425 AES/JE cases and 74 deaths, and Assam with 146 AES/JE cases and 29 deaths, even though the JE season is yet to arrive.
Vaccination claims made by the most-affected states like UP, Assam and West Bengal have now been questioned by Unicef.
While JE vaccination coverage in Gorakhpur and Bahraich has been shown by the UP government to be 97% and 100.2%, Unicef's own assessment says it won't even have crossed 52.3% and 50.5%, respectively.
Following the disparity in figures, Dr V M Katoch, director-general of Indian Council of Medical Research, will lead a team of experts to Gorakhpur on Friday to ascertain the ground reality.
Sources told TOI that Azad asked Dr Katoch on July 19 to visit UP and create a verifiable directory of vaccinated children for JE, which should include address and contact details of all vaccinated children.
The Union health ministry has also called for a revaccination JE campaign in the seven most sensitive districts in eastern UP. The ministry had estimated that 66 lakh doses would be required for this special round, and an indent to this effect was issued on January 19. In June, the ministry sent 16 lakh usable doses to UP but the state supposedly accepted only 7.44 lakh doses, based on the assumption that the rest had already expired.
The special round was planned for May 31, which was then postponed to June 14. However, it has still not taken off and is now expected to be held sometime in September.
To make matters worse, the infighting between the UP health department and the Centre has led to the expiry of 15 lakh doses of JE vaccine.
Meanwhile, the ministry is faced with another challenge. Scientists don't have a clue what virus is actually causing AES -- a severe neurological condition associated with significant morbidity and mortality.
ICMR estimates show that only about 15% of all cases and deaths are being caused by the JE virus.
The presentation given to the minister showed that the JE sero-positivity in UP has been 35.88% in 2005, 14.2% in 2006, 10% in 2007, 8% in 2008, 10% in 2009 and 2% till date this year.
According to the National Institute of Virology, Pune, in 2006 Enerovirus 76 was isolated in 20% of samples and throat swabs. Thereafter, the detection has reduced to 4%. In 2009, various entrero viruses belonging to groups A and B were detected in 34% of the samples of rectal swabs.
The mystery virus has been causing brain fever and claiming lives in UP over the past few years. But no breakthrough has been made regarding the virus identity and nature.
Experts from Centre for Disease Control and Prevention (CDC), Atlanta, had collected 150 samples from UP to help identify the virus. But, CDC, too, failed to make any headway. AES is characterised by inflammation of the brain, seizures and convulsions among children.
International NGO PATH's senior programme officer for JE Dr Pritu Dhalaria told TOI, "Usually around four to five enteroviruses work in tandem, in clusters in particular areas. Therefore, it is difficult to identify exactly which virus is the deadly one. Non-polio enteroviruses are very common across the globe. They are second only to the common cold viruses the rhinoviruses, as the most common viral infectious agents in humans."
Transmission of enterovirus infections is increased by poor hygiene and overcrowded living conditions. Measures that can be taken to avoid getting infected with enteroviruses include frequent hand washing.
Enteroviruses can be found in the respiratory secretions and stool of an infected person. Other persons may become infected by direct contact with secretions from an infected person or by contact with contaminated surfaces or objects.
AES/JE cases and deaths in UP since 2005
2005: 6,061 cases and 1,500 deaths
2006: 2,320 cases and 528 deaths
2007: 3,024 cases and 645 deaths
2008: 3,012 cases and 537 deaths
2009: 3,073 cases and 556 deaths
2010: 425 cases till date and 74 deaths
AES/JE cases across the nation in 2010
Andhra Pradesh: 20 cases, no death
Assam: 146 cases, 29 deaths
Bihar: 23 cases, no death
Manipur: 67 cases, 10 deaths
Tamil Nadu: 68 cases, 2 deaths
Uttar Pradesh: 425 cases, 74 deaths
Total: 749 cases and 115 deaths
The worst-affected states have been Uttar Pradesh, which has recorded 425 AES/JE cases and 74 deaths, and Assam with 146 AES/JE cases and 29 deaths, even though the JE season is yet to arrive.
Vaccination claims made by the most-affected states like UP, Assam and West Bengal have now been questioned by Unicef.
While JE vaccination coverage in Gorakhpur and Bahraich has been shown by the UP government to be 97% and 100.2%, Unicef's own assessment says it won't even have crossed 52.3% and 50.5%, respectively.
Following the disparity in figures, Dr V M Katoch, director-general of Indian Council of Medical Research, will lead a team of experts to Gorakhpur on Friday to ascertain the ground reality.
Sources told TOI that Azad asked Dr Katoch on July 19 to visit UP and create a verifiable directory of vaccinated children for JE, which should include address and contact details of all vaccinated children.
The Union health ministry has also called for a revaccination JE campaign in the seven most sensitive districts in eastern UP. The ministry had estimated that 66 lakh doses would be required for this special round, and an indent to this effect was issued on January 19. In June, the ministry sent 16 lakh usable doses to UP but the state supposedly accepted only 7.44 lakh doses, based on the assumption that the rest had already expired.
The special round was planned for May 31, which was then postponed to June 14. However, it has still not taken off and is now expected to be held sometime in September.
To make matters worse, the infighting between the UP health department and the Centre has led to the expiry of 15 lakh doses of JE vaccine.
Meanwhile, the ministry is faced with another challenge. Scientists don't have a clue what virus is actually causing AES -- a severe neurological condition associated with significant morbidity and mortality.
ICMR estimates show that only about 15% of all cases and deaths are being caused by the JE virus.
The presentation given to the minister showed that the JE sero-positivity in UP has been 35.88% in 2005, 14.2% in 2006, 10% in 2007, 8% in 2008, 10% in 2009 and 2% till date this year.
According to the National Institute of Virology, Pune, in 2006 Enerovirus 76 was isolated in 20% of samples and throat swabs. Thereafter, the detection has reduced to 4%. In 2009, various entrero viruses belonging to groups A and B were detected in 34% of the samples of rectal swabs.
The mystery virus has been causing brain fever and claiming lives in UP over the past few years. But no breakthrough has been made regarding the virus identity and nature.
Experts from Centre for Disease Control and Prevention (CDC), Atlanta, had collected 150 samples from UP to help identify the virus. But, CDC, too, failed to make any headway. AES is characterised by inflammation of the brain, seizures and convulsions among children.
International NGO PATH's senior programme officer for JE Dr Pritu Dhalaria told TOI, "Usually around four to five enteroviruses work in tandem, in clusters in particular areas. Therefore, it is difficult to identify exactly which virus is the deadly one. Non-polio enteroviruses are very common across the globe. They are second only to the common cold viruses the rhinoviruses, as the most common viral infectious agents in humans."
Transmission of enterovirus infections is increased by poor hygiene and overcrowded living conditions. Measures that can be taken to avoid getting infected with enteroviruses include frequent hand washing.
Enteroviruses can be found in the respiratory secretions and stool of an infected person. Other persons may become infected by direct contact with secretions from an infected person or by contact with contaminated surfaces or objects.
AES/JE cases and deaths in UP since 2005
2005: 6,061 cases and 1,500 deaths
2006: 2,320 cases and 528 deaths
2007: 3,024 cases and 645 deaths
2008: 3,012 cases and 537 deaths
2009: 3,073 cases and 556 deaths
2010: 425 cases till date and 74 deaths
AES/JE cases across the nation in 2010
Andhra Pradesh: 20 cases, no death
Assam: 146 cases, 29 deaths
Bihar: 23 cases, no death
Manipur: 67 cases, 10 deaths
Tamil Nadu: 68 cases, 2 deaths
Uttar Pradesh: 425 cases, 74 deaths
Total: 749 cases and 115 deaths