The scourge of encephalitis has once again struck parts of Uttar Pradesh and killed or crippled a large number of children. This dance of death has become an annual feature. The public health community views it as a crisis that can be controlled, if the political will to engage in reforms exists. For one thing, the pattern of the epidemic, with Gorakhpur as its nucleus, has been studied well, after a major outbreak more than three decades ago. It is clearly linked to the monsoon rain, which inundates the large number of rice fields in this area, leading to a rapid rise in the density of Culex mosquitoes. The period between July and November then becomes transmission season for encephalitis through mosquito bites. The epidemic is amplified by the presence of large numbers of pigs, which act as hosts. What all this underscores is the need for a State-wide massive prevention campaign that should consist of three parts: distributing insecticide-treated bed nets, free or subsidised, to protect against mosquito bites; creating awareness on the need to keep pigs away from habitations; and persuading people to avoid outdoor movement when the mosquito is most active. Gorakhpur, where more than one child is assigned to the same hospital bed during an epidemic, also needs rapid expansion of its infrastructure.
Prevention is likely to be the more effective approach to curb the spread of encephalitis in India. The Indian Council of Medical Research is yet to confirm the different virus strains causing the annual epidemics. Last year, the ICMR said Japanese Encephalitis represents only about 15 per cent of the fatal cases, and it would take more research to isolate the other viruses. Union Health Minister Ghulam Nabi Azad has reiterated this view. If this is correct, vaccination against Japanese Encephalitis can only be of limited value, even if it is scaled up to cover the entire population. Public health policy should therefore focus on removing the factors that aid transmission. This can only be achieved through massive investments in hygienic housing, sanitation, supply of bed nets, vector control, and behaviour modification. Relocating pigs is a sensitive issue in the encephalitis-hit districts, and calls for measures that inspire confidence in the community. Andhra Pradesh has carried out such a programme successfully and may offer important lessons. Moreover, incentives for hygienic practices are bound to persuade those rearing the animals to do the right thing. What is worrying is that the infection is spreading — to more places in Uttar Pradesh and Bihar. The epidemic needs action on a war footing.