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Japanese Encephalitis-Gorakhpur Tragedy
Aug 16, 2017

[GS Paper II: (Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources)]

Why in News? 

At least 60 children lost their lives recently at the state-run BRD Medical College Hospital in Gorakhpur, Uttar Pradesh due to various reasons including infections caused by Japanese Encephalitis (JE).The deaths are also being blamed on possible disruption of oxygen supply in medical wards. 

What is Japanese Encephalitis (JE)?

  • The JE virus is a flavivirus related to dengue, yellow fever and West Nile viruses.
  • It spreads to humans from pigs and water birds through the bite of infected mosquitoes of the Culex family. JE largely affects children under age of 15 years.
  • In the tropics and subtropics, transmission can occur year-round, but often intensifies during the rainy season (during which mosquito population increases) and pre-harvest period in rice-cultivating regions, where rice fields get filled with standing water.
  • There is no cure for the disease, treatment is only supportive and aims at relieving severe clinical signs and supporting the patient as her body fights to overcome the infection.

Acute Encephalitis Syndrome

  • Acute Encephalitis Syndrome (AES) is an umbrella term for all symptoms which cause inflammatory brain diseases. The World Health Organisation (WHO) in 2006, coined the term AES to signify a group of diseases which seem similar to one another but are difficult to differentiate in the chaotic environment of an outbreak.
  • AES can be caused by a range of factors, including toxins in unripe lychee fruit, viruses, bacteria, fungi, parasites and chemical poisons. It is not vaccine-preventable.
  • In India, AES outbreaks in north and eastern India have been linked to children eating unripe lychee fruit on empty stomachs. Unripe lychees contain the toxins hypoglycin A (naturally occurring amino acid) and methylenecyclopropyl-glycine (MCPG), which cause vomiting if ingested in large quantities.

Encephalitis: A perennial issue

  • Japanese Encephalitis is recognised as the leading cause of the disease in India. According to a report by Indian Council of Medical Research, JE VIRUS was first recognised in 1955 in the country, when cases of encephalitis were reported in Tamil Nadu. 
  • Since 1972, the disease has spread to newer regions including West Bengal, Uttar Pradesh, Assam, Bihar, Manipur, Andhra Pradesh, Goa, Puducherry and Karnataka.
  • Uttar Pradesh carries the largest AES burden in India and has succumbed to repeated outbreaks.

Why Gorakhpur?

  • JE is highly endemic in Eastern Uttar Pradesh.
  • The unique geography of this region also helps in the spread of JE VIRUS which has an abundance of paddy fields and a bowl-shaped landscape that allows water to collect in pools. 
  • Heavy rains saturate the region which causes ideal breeding conditions for mosquitoes that transmit the virus from pigs to humans. 
  • In addition, high temperature and relative humidity provide a favourable environment for JE VIRUS transmission.
  • Eastern Uttar Pradesh is one of the most backward regions of the country. Poverty and poor health services go hand in hand in the region further accentuated by overburdened  government hospitals.
  • BRD Medical College hospital is the only hospital within 300 sq. kms  with decent facilities to treat encephalitis and similar infectious diseases.

Problems in controlling the JE 

  • The main cause of U.P.’s  JE crisis is lack of infrastructure, unclear data on disease burden and lack of access to clean water and toilets.
  • In March 2017, the U.P government launched a JE vaccination drive in 38 districts in U.P. but it was not supplemented with access to clean water and sanitation.

Measures and policies taken by Govt.

  • The Directorate of National Vector Borne Diseases Control Programme (NVBDCP) has been given the responsibility for preventing and controlling Japanese Encephalitis/Acute Encephalitis Syndrome. The Ministry of Health and Family Welfare is the nodal agency for the overseeing the programme. 
  • JE vaccines were introduced under the Universal Immunization Programme. They are to be administered to infants in two doses between 9-12 months and 16-24 months.

Way Forward

  • Environmental and ecological factors are responsible for the spread of JE VIRUS. There is no specific treatment for JE; only prevention can control the disease. 
  • Control may be possible only after developing a strong surveillance system together with a high-quality immunization program. 
  • Implementation of a vaccination program for young children, as well as modified agricultural practices, pig vaccination, rigorous monitoring, vector control, and improved living standards can reduce the number of JE cases.
  • Awareness needs to be developed on personal protection against mosquito bites and the importance of early referral of cases.
  • More healthcare providers need to be brought into the system, including nurses, optometrists, anaesthetists and AYUSH (ayurveda, yoga and naturopathy, unani, siddha and homoeopathy) workers. Nurses should be empowered so that they can take off some of the load from physicians.

PT Facts

  • Universal Immunization Programme (UIP) is a vaccination program launched by the Government of India in 1985. It is one of the key programmes under National Rural Health Mission (NRHM) since 2005. 
  • The program now consists of vaccination for 12 diseases- Tuberculosis, Diphtheria, Pertussis (whooping cough), Tetanus, Poliomyelitis, Measles, Hepatitis B, Diarrhoea, Japanese Encephalitis, Rubella, Pneumonia( Heamophilus Influenza Type B)and Pneumococcal diseases (Pneumococcal Pneumonia and Meningitis). 
  • Hepatitis B and Pneumococcal diseases were added to the UIP in 2007 and 2017 respectively.


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