On one hand, the Indian Medical Association announced that the doctors would go on strike nationwide in solidarity with their counterparts in West Bengal, all non-essential services will be withdrawn and only emergency and casualty services will be offered. This is an irony of our nation; the doctors too are making it a politicised publicity. On the other hand, around 100 children have died of Japanese Encephalitis in Muzaffarpur district of Bihar. These all are reported deaths while the locals claim that the actual toll could be higher as many from the remote villages fail to make it to the hospitals in the district headquarters.
The Nitish Kumar government looks clueless in checking the death toll and the spread of Japanese Encephalitis in this North Bihar district and its neighbourhood.
Currently, Muzaffarpur is at the epicentre of Japanese Encephalitis but only a couple of years ago, Gorakhpur in Uttar Pradesh was in the grip of Japanese Encephalitis, which killed thousands of children over four decades. When Yogi Adityanath government took over from Akhilesh Yadav, Japanese Encephalitis was the biggest health challenge in eastern Uttar Pradesh in 2017.
Japanese Encephalitis (JE) is an infection of the brain caused by the Japanese Encephalitis Virus (JEV) while most infections result in little or no symptoms, occasional inflammation of the brain occurs. In these cases, symptoms may include headache, vomiting, fever, confusion, and seizures. This occurs about five to 15 days after infection and by then, the chances of survival are very rare.
JEV is generally spread by mosquitoes, specifically those of the Culex type. Pigs and wild birds serve as a reservoir for the virus. The disease mostly occurs outside of cities. Diagnosis is based on blood or cerebrospinal fluid testing.
Prevention is generally with the Japanese Encephalitis vaccine, which is both safe and effective. Other measures include avoiding mosquito bites. Once infected, there is no specific treatment, with care being supportive. This is generally carried out in the hospital. Permanent problems occur in up to half of the people who recover from JE. The disease occurs in Southeast Asia and the Western Pacific. About 3 billion people live in areas where the disease occurs. About 68,000 symptomatic cases occur a year with about 17,000 deaths. Often cases occur in outbreaks. The disease was first described in 1871.
More than 500 children had died of Japanese Encephalitis that year in Gorakhpur and its neighbourhood. Altogether 14 districts of the region were in the grip of Japanese Encephalitis. In August 2017, many children admitted for treatment of Japanese Encephalitis and Acute Encephalitis Syndrome (AES), died at the BRD Hospital of Gorakhpur leading to the huge political furore.
Pushed against the wall, Yogi Adityanath government opted for desperate measures and launched Action Plan 2018 in collaboration of the World Health Organisation (WHO) and UNICEF for containing AES and Japanese Encephalitis.
A massive vaccination drive was launched for Japanese Encephalitis. A robust health and sanitation campaign was launched.
Early vaccination was pushed. Drive to segregate pigs from affected habitation was launched. Immediate response teams were put to work for fogging. The information campaign was launched to convince parents not to let their kids sleep on mud floors, to use India Mark-2 water pipes or hand pump for drinking water and to immediately reach out to ambulance helpline 108 in case of any early symptoms. These measures seem to have worked for Uttar Pradesh. The cases of Japanese encephalitis and AES dropped by about two-thirds in 2018 compared to a year ago. 187 deaths occurred due to Japanese encephalitis and AES in 2018 against 557 in 2017. The total number of cases of Japanese encephalitis and AES dropped from 3,817 in 2018 to 2,043 in 2017 in the affected 14 districts. Fewer numbers of patients of Japanese encephalitis and AES reaching hospitals meant that the doctors could take better care of those admitted resulting in a drop in mortality rate. While one in every seven patients of JE and AES died in 2017, this came down to one in 11 last year. Till February this year, no deaths due to JE and AES were reported despite 35 cases in the region.
Since both the eastern UP and north Bihar share almost same geographical hot and humid climate, a favourable ground for the spread of JE and AES, the measures adopted by the Yogi Adityanath government might help the Nitish Kumar government not only in checking deaths due to the outbreak of this endemic but will also help defusing growing tension among aam aadmi against the ruling dispensation in Bihar. However, the Nitish Kumar government of Bihar, too, has a standard operating procedure (SOP) in place which was laid in 2015 in the view of rising cases of JE and AES. In 2012, 120 children had died of the disease while the death toll was 90 in 2014.
The 2015 SOP was laid by the health department of Bihar in consultation with UNICEF to meet the encephalitis challenge. The SOP mandates that grass-root health workers including auxiliary nurse-midwife (ANM), accredited social health activists (ASHA) and Anganwadi employees have to conduct a household-level survey to check if any child has symptoms of Japanese Encephalitis and AES.
The efforts brought down the encephalitis death toll to four in 2016 and 2017, and 11 last year. But it has seen a spike this year clearly showing that the SOP was not followed. Encephalitis situation is desperate in Bihar for the Nitish Kumar government.
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