The Gorakhpur tragedy and its aftermath

Japanese Encephalitis in Gorakhpur: A deadly disease explained

Needing care: Medical staff attend to a child admitted in the Encephalitis ward of BRD Hospital in Gorakhpur .

Needing care: Medical staff attend to a child admitted in the Encephalitis ward of BRD Hospital in Gorakhpur .   | Photo Credit: AFP

Gorakhpur offers the only tertiary care centre for Japanese Encephalitis with 100 dedicated beds.

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 in Gorakhpur: A deadly disease explained
 

 

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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Printable version | May 25, 2020 11:27:04 AM | https://www.thehindu.com/sci-tech/health/japanese-encephalitis-a-deadly-disease-explained/article19486806.ece

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