[Public Health] Japanese Encephalitis Menace in India: Reasons, Prevention and control

1. What is Japanese Encephalitis (JE)?
2. What are the symptoms?
3. Geographical Spread
4. Solution for Japanese Encephalitis (JE)?
5. What is Acute encephalitis syndrome  (AES)?
6. Why is Japanese Encephalitis in News?
7. JEEV (2 marker)
8. National Vector Borne Disease Control Programme (5 marker)
9. Mock Questions

What is Japanese Encephalitis (JE)?

• The suffix -itis means “inflammation”.
• Encephalitis means inflammation of the brain
• Meningitis inflammation of the meninges (the tissues that surround the brain or spinal cord)

What are the symptoms?

• headache and stiff neck
• Convulsions
• Weakness of the arms, legs
• Pain behind the eyes
• Raised body temperature between 38 and 41 degrees Celsius.
• If untreated, it can result in to Coma, paralysis Mental retardation or death. fatality rate can be as high as 60%

Geographical Spread

• Flavivirus reproduces in pigs but doesn’t infect them. So, Pigs are amplifying hosts. (also water birds)
• Mosquitoes belonging to the Culex tritaeniorhynchus and Culex vishnui groups – they usually breed in flooded rice fields.
• These Culex mosquitoes are normally zoophilic, i.e. they prefer to take blood meals from animals rather than from humans.
• These Mosquitoes usually prefer to drink the blood of such pigs. But when the population of such mosquitoes increases exponentially (during rainy season, around August), human biting rate increases.
• And thus Flavivirus gets transferred from pigs to humans and damages our brain= inflation of brain = Japanese Encephilitis.
• Man is the dead end host, i.e. JE is not transmitted from one infected person to other.

In short, Japanese Encephalitis requires four things

1. Pigs with flavivirus (Amplifying host).
2. Rice fields (Mosquito breeding ground)
3. Culex mosquitos (carrier)
4. Human (The innocent victim)

Therefore, JE is found throughout south east Asia, because Rice cultivation and pig rearing is common.
But because of the critical role of pigs, its presence in Muslim countries is negligible.

Solution for Japanese Encephalitis (JE)?

1. Vaccination
2. Chemical vector control (e.g. spraying chemicals to kill mosquitos)= not good solution, because the breeding sites (irrigated rice fields) are huge.
3. Keep larvae eating fish, such as guppies, in ponds.
4. Personal protection (using repellents and/or mosquito nets) = good idea.
5. There is no transmission from person to person and therefore patients do not need to be isolated.
6. If there is large scale outbreak of JE, Government would need to eliminate pig population = problem of livelihood.
7. Rice growing farmers should never be encouraged to do pig rearing as a secondary source of income.
8. Firstly, there is no curative treatment for J.E. (i.e. No magic pill, injection etc. that will cure it). J.E. is treated symptomatically by reducing the fever, analgesics for headache, sedatives for seizures and specialized intravenous therapy to reduce cerebral swelling.

Apart from Japanese, there is another type of Encephalitis, known as Acute encephalitis syndrome  (AES)

What is Acute encephalitis syndrome  (AES)?

• This is also inflammation of brain.
• But it is caused by entero virus.
• The virus comes in the air or water through open defecation and circulates mainly through shallow hand pumps in the area.

Why is Japanese Encephalitis in News?

In India alone, the of Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES), which have claimed nearly 1,000 lives so far in 2012.
In Oct 2012, Government of India launched a Rs.4000 crore plan to tackle JE problem.
Main Target States : Uttar Pradesh, West Bengal, Tamil Nadu, Bihar and Assam. This plan will jointly implemented by following Ministries of

1. Health and Family Welfare,
2. Drinking Water and Sanitation,
3. Social Justice and Empowerment,
4. Housing and Urban Poverty Alleviation
5. Women and Child Development.

Plan has following components:

1. Vaccination of Children (1.5 to 15 years age group)
2. provide safe drinking water to the affected persons by replacing shallow tubewells with deep tubewells  (To prevent Acute Encephalitis Syndrome (AES))
3. Provide proper sanitation facilities. (Perhaps allotting more money under Total Sanitation Campaign)
4. Provide alternative means of livelihood for pig-rearing farmers.
5. Set up special schools for mentally challenged children.

JEEV (2 marker)

• JEEV is the brandname of India’s first indigenously developed vaccine for Japanese Encephalitis (JE). There is no other vaccine available to private doctors in India currently. But the company has yet to obtain approval of WHO to export this vaccine to other countries. (important because this happened in Sept.2012)

National Vector Borne Disease Control Programme (5 marker)

• It is a comprehensive programme for prevention and control of vector borne diseases namely Malaria,
• Filaria, Kala-azar, Japanese Encephalitis (JE), Dengue and Chikungunya.
• It is covered under the overall umbrella of National Rural Health Mission.

Mock Questions

Please note: you can find truckload of potential MCQs Statements and 2 markers from India Yearbook’s chapter on Health and Family Welfare.
Multi Choice Question (MCQ)
Which of the following statements are correct?

1. Swine is the amplifying host of the virus responsible for Japanese Encephalitis.
2. Aedes aegypti mosquito is the main carrier of Japanese Encephalitis.
3. Poultry culling is essential during the outbreak of Japanese Encephalitis.
4. Japanese Encephalitis is widely prevalent in Arid and Desert areas of Africa.
5. Japanese Encephalitis can spread by talking or touching a patient.
6. The vectors of Japanese Encephalitis breed in large water bodies such as paddy fields.

Mains

1. To what extend the geography and climate of India are responsible for the menace of Malaria, Dengue, Chikungunya  and Jap.Encephalities. Suggest long term mitigation efforts required to uproot these diseases. (25 marks).
2. Suggest measures for prevention and control of “Japanese Encephalitis” in India (12 marks)
3. The JEEV vaccine has been making the headlines in the recent months. Who make the ideal candidates for receiving this vaccine and what are its benefits? (2 marks)

Interview: As a district collector what steps would you take in case of an outbreak of Japanese Encephalitis / Dengue / SARS?
Ref:

1. http://www.indianexpress.com/news/govt-nod-for-rs-4000cr-plan-to-fight-japanese-encephalitis/1018801/
2. http://www.who.int/water_sanitation_health/diseases/encephalitis/en/
3. http://www.baliadvertiser.biz/articles/paradise/2012/japanese.html
4. http://newindianexpress.com/business/news/article606368.ece