Getting a grip on encephalitis

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Getting a grip on encephalitis

Japanese Encephalitis has been a major killer in easter Uttar Pradesh for years together. Yogi Adityanath Government’s vaccination drive is a great step, but more is needed

In 2016, when eastern Uttar Pradesh was in the grip of encephalitis, Yogi Adityanath,  Member of Parliament from Gorakhpur, had said children were dying because the State Government does not have the political will to control this disease. As MP, he had raised the issue almost 10 times in the Lok Sabha and demanded a complete cure for this disease. A year later, when Yogi took charge of Uttar Pradesh as Chief Minister on March 19, within three months, he ordered the vaccination of children in the age group of one to 15 years. “I have seen children dying of this disease. The time has come to give this dreaded disease a silent burial”, Yogi said, while kicking off the massive vaccination campaign from Kushinagar, nestled in eastern Uttar Pradesh and one of the most backward regions of the State. Over 88 lakh children were identified across endemic regions and were vaccinated in one of the biggest vaccination drive carried out in Uttar Pradesh in the recent past.

Encephalitis is generally called a ‘poor man’s disease’ and is more or less a rural phenomenon. But, of late some incidents of Japanese Encephalitis have been reported from urban areas too. Encephalitis is the inflammation of brain tissues and the most common cause is viral infection. In rare cases, it can be caused by bacteria. This disease attacks malnourished children up to 15 years of age. The parents of these children are poor and live in villages. They have to travel hundreds of kilometres before they can get quality treatment — which is available only in Baba Raghav Das (BRD) Medical College and Hospital in Gorakhpur. But by that time it is often too late. The BRD Hospital is the nerve centre for treatment in encephalitis, where sick children from not only Uttar Pradesh but also from Bihar and neighbouring Nepal come for treatment.

The disease has been a serial killer for the last 36 years. The death rate, two to three years ago, used to range between 16 per cent and 20 per cent. But in last couple of years it has taken a dangerous turn. The mortality rate rose to 29 per cent in 2013 and has been above 30 per cent since 2014. The disease has  killed several thousand children in the last three decades, with 2005 being the worst, in which over 1,500 children had died. It had drawn global attention.

In 2006, the Lucknow Bench of the Allahabad High Court termed this catastrophe as a national medical emergency and called for a national policy to eradicate encephalitis. The same year, a 100-page report was submitted to then Prime Minister Manmohan Singh and a Group of Ministers (GoM) was set up to formulate a national policy to eradicate this disease. It was decided that a vaccination campaign should be launched in a systematic way, but eventually nothing happened. Various reasons were cited, and one of them was the paucity of Indian vaccines. The then UPA Government did not show a political will to purchase Chinese vaccines.

The disease’s fatality rate is almost 30 per cent. As encephalitis virus affects brain almost 40 per cent of the children who survive are left mentally retarded. Their rehabilitation programme very lengthy and needs money. The BRD College of Gorakhpur is full of heart-wrenching stories of how poor parents had to sell off their land, cattle or mortgage jewellery to private money lenders so that they could get the best possible treatment in the hospital.

Doctors say that because of the expensive rehabilitation programme, the dropout rate is very high; a majority of the parents prefer to stay back at their homes after initial visits to the rehabilitation centre in Gorakhpur. Some parents recount as how they had been asked by the villagers to discard their mentally retarded child because the child depends on them (parents) for all its daily basic needs even.

Yogi, who belongs to Gorakhpur, had his tryst with this dreaded disease. He has seen how children, who were malnourished but active, suddenly fell ill. One or two convulsions and their parents rush them to Gorakhpur’s BRD Hospital, where they are diagnosed as suffering from encephalitis. A good number of children who survive turn physically challenged. As Member of Parliament, Yogi had organised several camps where medical contraptions like crutches were distributed among these children, from the Sansad Nidhi.

This gesture may have a humanitarian touch, but it cannot guarantee eradication of the disease. Vaccination is considered to be the best protection from Japanese Encephalitis. In 2006, a vaccination drive was launched but that had failed to give desired result. One dose of vaccination was to follow with another. As the children did not get the second dose because of paucity of vaccines, the death rate continued to rise. Activists working for eradication of encephalitis raised the demand to make encephalitis eradication programmes a national programme. They argued that if diseases like small pox and polio could be eradicated, why could not encephalitis. Some decades ago, countries such as China, Japan and Korea were ravaged by encephalitis. Now these countries are encephalitis-free. If they could do why cannot India do it, was their forceful argument.

Their contention is valid because the disease is both predictable and preventable. The annual monsoon fills parched paddy fields, which bear the mosquitoes that spread Japanese Encephalitis from pigs to humans, devastating malnourished children with low immunity systems. The diseases cause headache and vomiting and can lead to coma, brain dysfunctions, seizures and inflammations of the heart and the kidney. Another strain of the disease — acute encephalitis syndrome — spreads through contaminated water. Residents defecate in the fields, contaminating the ground water. Experts say that maintaining cleanliness could halve the deaths in acute encephalitis syndrome cases.

But for Japanese Encephalitis, vaccination is the best cure. The health department has identified 38 districts where this campaign is launched. But almost the whole of eastern Uttar Pradesh is in the grip of Japanese Encephalitis — with districts such as Gorakhpur, Deoria, Gonda, Basti, Sidharthnagar, Sant Kabirnagar, Kushinagar, Maharajganj, Balrampur, Ghazipur and Azamgarh, being declared encephalitis-affected. The Union Government has chipped in and provided one crore doses of vaccines. This special vaccination campaign was launched on May 25 and was to end on June 11, but got extended by a week.

The State Government has made a good beginning by launching the massive vaccination drive, but this remains a short-term step. If the Government wants a permanent solution, it should appoint doctors at the Primary Health Centres (PHCs) to ensure that children get quality treatment at their door-steps. Once the virus strikes, the parents have a window period of less than an hour to provide treatment. The encephalitis rate is high because parents are not able to utilise that window period effectively. If trained and qualified doctors are posted in PHCs this fatality rate could be brought down.

 (The writer is Chief of Bureau, The Pioneer, Lucknow)

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