What is Japanese
Encephalitis?
Japanese Encephalitis (JE) is a mosquito-borne viral
infection of the brain. There is, however, a debate about the origin of the
disease and whether it is enteroviruses — caused by virus found in pigs and
birds. There is no cure for JE.
Why only Gorakhpur?
While Gorakhpur has a considerable burden of disease, it is
incorrect to assume that JE cases are clustered in Gorakhpur district alone. JE
epidemics are reported from many parts of India however, it is highly endemic
in Eastern Uttar Pradesh. Gorakhpur is a nodal point not because there are more
cases in the district but because the only tertiary care centre with 100 beds
dedicated to JE is in Gorakhpur. So, cases from nearby districts like
Kushinagar and Deoria districts are referred to there for treatment.
Japanese Encephalitis
Why does vaccination
not work?
It is a misconception that the JE vaccine will eradicate the
disease in a short span of time. While vaccination is critical, at the heart of
U.P.’s crisis is lack of infrastructure, unclear data on disease burden and
lack of access to clean water and toilets. In March, the State government
launched a JE vaccination drive in 38 districts in U.P. but it was not
supplemented with access to clean water and sanitation.
The efficacy of the JE vaccine is between 85-90%. The
lessons learnt from polio vaccination drives is that people left out of each
round of vaccination are the most disenfranchised, most likely to take ill and
least likely to seek medical care in time.
The Gorakhpur
mystery...
Over the years, there have been cases in the area which are
clinically different from one another. JE is one kind of encephalitis which
falls under a spectrum of diseases called Acute Encephalitis Syndrome (AES).
Doctors in endemic regions in U.P. have found cases with similar symptoms but
without the virus, leading to some debate over the cause of the disease. While
public health experts have found a difference in case definitions across
Eastern districts of U.P., this is something Indian scientific community is
still trying to understand.
However, specific research on this has not been supported by
the government so far, despite decades of annual outbreaks. Due to lack of
research, U.P. government gets their burden of disease data from hospitals,
essentially leaving out cases that do not come into public health facilities.
This results in wrong forecasts as the government budget for next year’s JE
intervention. Because of the lack of reliable data & research, UP’s policy
intervention to curb JE cases has failed for decades.
Were all those who
died in BRD Hospital suffering from JE?
No. The State government is yet to release data of exactly
how many of them were admitted for JE treatment.
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