In the wake of the deaths of 60 children in a government hospital in Gorakhpur recently, all eyes now are on a disease for which some of the children were believed to have been admitted: Japanese Encephalitis (JE).
Tamil Nadu has a long history with the disease — it was first recognised in India in 1955, with cases reported in the then North Arcot district of the State and from neighbouring Andhra Pradesh.
JE is a viral disease transmitted by the bite of the Culex mosquito. Acute Encephalitis Syndrome is a group of neurological conditions caused by a number of pathogens, including bacteria and viruses. Blood tests can establish if a case of AES is specifically JE.
Data from the National Vector Borne Disease Surveillance Programme for Tamil Nadu since 2010 show that the number of cases went up for a few years, but dropped last year. From 11 cases in 2010, the number went up to 53 cases in 2015, but dropped to 51 cases last year. As of August 6 this year, 22 cases were reported. Hundreds of cases of Acute Encephalitis Syndrome (AES), however, continue to be reported year on year — this year there have been 659 cases in the State, while in 2016 there were 859.
“Though JE is a disease that has high morbidity and mortality, T.N. has had no deaths due to it for three years now,” said Director of Public Health K. Kolandaisamy.
He explained that the State had adopted a multi-faceted approach to the disease. Surveillance for AES has been ongoing for around 30 years now. “Even before the vaccine came in, if there was a report of any child with AES, an epidemic-control response was immediately launched in the area,” he said.
The second approach involved surveillance of the virus through collection of mosquitoes to check for positivity, even if cases had not been reported in the area.
The vaccine is now administered along with the Measles Rubella vaccine to all children in these districts in two doses. Coverage, he said, was around 85%.
“The vaccine is not generally available in the private sector, which is why it is not 100%,” he said. The cases reported, he said, were of people who had not been vaccinated, and sporadically, cases from other districts and States.
The JE vaccine is administered in 13 endemic districts in the State — it was initially piloted in three districts and later extended to cover the others.
No anti-viral treatment
“There is no anti-viral treatment for JE,” explains Dr. Bala Ramachandran, chief of paediatric intensive care, Kanchi Kamakoti CHILDS Trust Hospital. The disease causes an inflammation of the brain and can be accompanied by fever, seizures and diminished consciousness.
“Though some patients go on to recover, many continue to have neurological issues even after they are cured. These include seizures, developmental delays and learning disabilities among others,” he said.
Management of the disease includes administration of anti-edema medicines, said T. Ravichandran, director, Institute of Child Health, Egmore.