Kerala - Thiruvananthapuram   

State preparing action plan to fight Japanese encephalitis

THIRUVANANTHAPURAM: The Health Department is in the process of drawing up a State-level action plan for improved surveillance and diagnosis of Japanese Encephalitis (JE), a vector-borne zoonotic disease with high case fatality, which has been occurring in a cyclical pattern in the State since 1995.

The focus of the action plan would be on improving the surveillance and reporting of all cases of Acute Encephalitis Syndrome (AES) as well as confirmed cases of JE; strengthening case detection and diagnostic facilities and integrated vector control measures. Another important aspect of the action plan would be the intensified focus on IEC (information, education and communication) campaigns so that all information regarding the prevention, control and management aspects of JE is disseminated to the health workers working at the grassroots level.

The first major JE outbreak was reported in Alapuzha in 1995, when a large number of deaths were reported. Since then, cases are being reported sporadically from all districts. The disease has major epidemic potential and is of public health importance as a vector — mosquitoes belonging to the Culex species — is involved.

The lack of a proper reporting system has been one of the major drawbacks for forming a proper surveillance system and drawing up efficient public health strategies for controlling the disease. Reporting system has been poor because it is very difficult to differentiate JE from other encephalitis (inflammation of brain) diseases which may be caused by bacteria or other viruses. Proper confirmation of JE also requires extensive laboratory support for testing blood as well as cerebrospinal fluid.

Hence for surveillance purposes, all States are following the guidelines brought out by the National Vector Borne Disease Control Programme in 2001, which insists on the reportage of all AES cases as well as separate reportage of lab-confirmed cases of JE.

At a recently concluded workshop here on JE for doctors, experts from the National Institute of Virology and the Centre for Research on Medical Entomology, Madurai, stressed the importance of adopting integrated vector control measures, setting up a reliable and quality-assured laboratory network and the need for disseminating information of the management of the disease among primary care physicians.

JE is a viral disease transmitted through the bite of infected Culex mosquitoes. The main reservoirs of the virus are water birds as well as pigs and the outbreaks can occur wherever there is close interaction between human and animal population. The vector mosquito, Culex species, is also quite common in the State. An outdoor-breeding species, Culex mosquitoes breed in paddy fields and any stagnant water bodies and hence the strategies that need to be adopted in vector control are slightly different from what is advocated for controlling the vectors (Aedes species) that spread dengue and chikungunya.

Even though vaccine against JE has been found to be effective, vaccination is successful only in communities where it is total and sustained because the stress is on herd immunity rather than individual immunity. It requires at least a month before the vaccine takes effect and hence, once there is an outbreak, vaccination has no role in prevention, say experts .

There is no specific treatment for JE; the stress is on early symptomatic management with proper ICU support to reduce case mortality. The majority of JE cases occur in children and hence it is important to disseminate information on early management and support to all paediatricians in the field.

It was pointed out at the workshop that with the State Virology Institute being strengthened, it can serve as the apex lab for all virological investigations while the laboratories in Medical Colleges can serve as the sentinel labs as most of the cases would be reported in hospitals.

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