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HEALTH STATUS OF CHILDREN DUE TO JAPANESE ENCEPHALITIS IN GORAKHPUR
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HEALTH STATUS OF CHILDREN DUE TO
JAPANESE ENCEPHALITIS IN GORAKHPUR
Authored By - MISS MONIKA SINGH
& DR. ARVIND KUMAR SINGH
Student of Research, Professor
Amity Law School, Amity University,
Lucknow Campus, Uttar Pradesh
ABSTRACT
Japanese Encephalitis (JE) is a
vector-borne viral disease that affects the brain directly leading to coma and
finally death. It is a major health challenge in Asia and Pacific regions due
to its high epidemic potential, high case-fatality and neuropsychiatric
sequelae among survivors. It finally leads to Acute Encephalitis Syndrome (AES)
that creates devastation in eastern Uttar Pradesh for more than three decades.
The epicentre of Encephalitis in Uttar Pradesh is Gorakhpur, mostly affects its
rural areas. Other regions of Uttar Pradesh that are the most affected by JE
are Sant Kabir Nagar, Basti, Kushinagar, Maharajganj, Siddharth Nagar, Deoria
and Mau. In rainy season, this disease is commonly prevalent in Uttar Pradesh
and make the condition of children worse. It is generally spread by mosquitoes,
especially those of the genus Culex. Pigs and wild birds are also known for
serving as reservoir for Japanese Encephalitis Virus (JEV). Initial symptoms of
JE are cold, fever and headache. When it crosses the blood and brain barriers
then it becomes threat for life. It is not fully curable disease but its
vaccine can prevent this to some extent. there are three types of Japanese
Encephalitis vaccinations that are used in India at large scale. In 2006, the
Japanese Encephalitis vaccine was launched in our country. A massive
encephalitis vaccination program has been launched by Shri Yogi Aditya Nath
(Chief Minister of Uttar Pradesh) Government during 2017-18 which is a positive
step towards saving the lifes of many people of our country.
KEY WORDS
Japanese Encephalitis, Epidemiology,
Vector borne diseases, Gorakhpur, Uttar Pradesh
OBJECTIVES OF THE STUDY
·
To examine the causes of Japanese Encephalitis in the region
of Gorakhpur, Uttar Pradesh.
·
To
test the impact of JE/AES on children between age group 0-10.
·
To
study the steps taken by Government to reduce the disease in the area.
·
To
discover the reasons responsible for reduction in the JE cases.
HISTORY AND DEVELOPMENT OF JAPANESE ENCEPHALITIS
The virus of Japanese
Encephalitis was first described in Japan in 1870s and then on a continuous
basis had rapidly spread throughout large parts of Asia and now more than half
of the world population of 24 countries treat it as an epidemic. In recent
years, due to globalisation and industrialisation, expansion of a geographic
JEV to new geographic area can be seen mostly in peri-urban area causing an
increasing risk for the transmission of Japanese Encephalitis in many areas,
not necessarily only in rural regions.
In 1924, the outbreak of JE was the
largest with more than 6000 cases on which 60% were fatal. In 1934, the virus
was found in Monkeys in Hayashi region. While in 1935, neutralizing antibody in
recovered patients that succeed in protecting mice from JE was discovered which
helped further in demonstrating the geographical distribution of JE, including
cluster of cases occurred in Beijing in 1934 and 1935.
In 1938, Hammon et al. provided
collaborative evidence of mosquitoe-borne mode of JE transmission by isolating
JE virus from Culex tritaeniorhynchus mosquitoes. Viruses which were being
isolated from human cases in Japan in 1935 and in Beijing in 1949 provided the
prototype Nakayama, Beijing and P3 strain, respectively, that are now used in
the production of vaccine. During the first half of the 20th
century, temperate region of Japan, Korea and China were being recognised for
Japanese Encephalitis virus expansion. Later on the augmentation of the
epidemic activity has been reported from much off the Southwest Asia, India and
Sri Lanka.
INTRODUCTION OF JAPANESE ENCEPHALITIS AND ACUTE ENCEPHALITIS SYNDROME IN
UTTAR PRADESH
Japanese Encephalitis Virus infection
mostly occurs in temperate and tropical regions of Asia. The countries such as
China, Japan, Korea and India as well as other countries of Asia are severely
affected by this virus but most of the countries controlled the spread of
disease by vaccination. In India, it has become a major issue of health
department of pediatric and the epidemics are reported frequently in many areas
of the country. Based on the serelogical surveys, the first case of JE in India
was reported from Tamil Nadu in 1955. In between 1955-1966, a total number of
approximate 65 cases were reported from Southern India. In 1973, in Bankura
district of West Bengal, a major outbreak of the virus of 42.6% fatality rate
was reported. While in Uttar Pradesh, the first outbreak of JE virus was
occurred in 1973 in Gorakhpur with 1005 cases and 298 deaths. However, in
August 2017, due to the negligence in Encephalitis treatment ward and lack of
oxygen supply at Baba Raghav Das (BRD) medical college, the deaths of 30
children in just 48 hours were reported. This incident put the Government
behind the bar and a series of political war got accelerated between Government
and oppositions. But incident like this is not new to Gorakhpur, as this
district is the epicentre of Encephalitis which affect mostly its rural areas.
The cultivation of paddy is common in Gorakhpur that requires heavy amount of
water which bolsters the breeding of the mosquitoes.
According to the season and location
of the weather condition of Uttar Pradesh is dynamic, i.e. changes frequently.
In east Uttar Pradesh (Sant Kabir Nagar, Basti, Kushinagar, Maharajganj,
Siddharth Nagar and Gorakhpur) are flood-prone areas and people also depend on
domestic animals like cows, goats, pigs, horses, baffaloes and dogs. Pigs are
the great amplifier of the JEV but the population is not aware of this fact.
According to the figures, in recent years around 50,000 children died without
reaching to hospital. JE can be air borne, water borne, the result of the bite
of mosquitoes or spread by ticks. The present study will show thw status and
trends of the JE and AES cases in Gorakhpur, Uttar Pradesh through the data
obtained from the health authorities of the district. This also draws out the
seasonal variations in the occurrence of the cases and mortality due to the JE
along with other details associated with it.
METHODOLOGY
Study Area
The Gorakhpur district covers an area
of ??3,483.8 square kilometers (1,345.1 sq mi). The district is located in the
Purvanchal district of Uttar Pradesh. The district is about 270 kilometers east of Lucknow and about
102 kilometers from the Nepal border. It is located on the banks of the Rapti
River.
According to the 2011 census,
Gorakhpur district has a population of 4,440,895. This gives it the 40th
position (out of 640) in India. The
population density of the region is 1337 inhabitants per square kilometer
(3460 inhabitants per square kilometer). Its population growth in the decade
2001-2011 was 17.81%. Gorakhpur has a sex ratio of 944 females per 1,000 males
and a literacy rate of 70.83%. Scheduled Castes constituted 21.08% of the population and Scheduled Castes 0.41%.
Medical Facility of Gorakhpur
One of the nation’s most backward
regions continues to be Gorakhpur’s location in eastern Uttar Pradesh. Poverty
and inadequate health care are closely linked in the region. The public or
charity hospitals are overburdened.
BRD Medical College Hospital is the
only facility capable of treating encephalitis and other infectious diseases in
a 300-kilometer-wide region.
This hospital receives patients from
the eastern districts of Bihar, Basti, the terai regions of Nepal, and Gonda.
In these districts, sanitation and cleanliness have been a major problem. In
fact, India’s dirtiest district was named Gonda in the 2017 Swachh Bharat
Survey.
In these areas, encephalitis is
highly common, especially in children under the age of 10 years. Culex vishnui
and Culex tritaeniorhynchus mosquito bites cause Japanese encephalitis and
Acute Encephalitis Syndrome. These mosquito species reside in filth. The
monsoon season is consistently the worst for kids in Gorakhpur.
Data Collection
The survey method has been done on 50
families of various regions of the Gorakhpur district. A study on the basis of
age distribution and sex distribution has been conducted. An analysis of the
secondary data has been performed in order to get the better result or
conclusion of the research.
The study shows that the children are
more susceptible to get this disease than adults. If we see the average age of
the children who get affected in eastern Uttar Pradesh is 6.8%. It has also
been reported that maximum cases were found from the age group of 4 to 6 years.
With the help of vaccination campaign and spreading awareness among the locals,
the cases has been prevented a bit.
|
Age Group (years)
|
0-5 years
|
5-10 years
|
More than 10 years
|
|
Total =50
|
27
|
16
|
7
|
Table 1: JE Cases on Age
Distribution
|
Sex
|
Males
|
Females
|
|
In percentage (%)
|
60%
|
40%
|
Table 2: JE Cases on Sex Distribution
From table 1, it is clear that the
age group from 0-5 are more susceptible followed by 5-10 age group and more
than 10 are less likely get infected
from this JE virus. The rate of infection in 0-5 age group is much higher, i.e.
27 cases from total 50 cases. Table 2 shows the susceptibility of males to get
affected by the disease over females. Females are 20% less percentage (60%-40%)
of getting infection over the males.
TRANSMISSION OF JAPANESE
ENCEPHALITIS VIRUS
Most
of the time, JEV is spread in rural agricultural areas through rice cultivation
and flooded irrigation. In some parts of Asia, these conditions might be close
to major cities. In the temperate regions of Asia, the JE virus only spreads
during specific seasons. Human illness typically rises during the hot and wet
seasons. A zoonotic infection known as JE is spread by a vector. Humans are
infected with the disease when Culex mosquitoes bite them. The JE virus is
primarily zoonotic in its natural cycle, with man acting as an unintentional
host. The neurotropic and arbovirus JE viral’s primary target is the central
nervous system. After the initiation of rainstorm, it will require 3 months for
JE cases to surface.
During
the monsoon, vector mosquitoes proliferate in large numbers, which raises the
risk of JEV and mosquito-human interaction. In the end, the JEV transmission
raises the JE instances. The JE is a JEV-caused brain illness that is
perpetuated in a cycle involving mosquitoes and vertebrate hosts (primarily
pigs and birds). The JE virus naturally infects water birds of the Ardeidae
family, primarily cattle egrets and pond herons. Pigs play a significant part
in this natural cycle and act as an amplifier host. They support protracted
viraemia and allow for the proliferation of many viruses without causing
illness. As a result, mosquitoes have a greater probability of contracting an
infection from pigs. Humans are accidental or dead-end hosts because they typically
do not produce the necessary amounts of
DIAGNOSIS OF JAPANESE ENCEPHALITIS
Commercially
available confirmatory tests that look for JEV-specific antigens and antibodies
serve as the foundation for diagnosis. Complement fixation testing (CF),
hemagglutination inhibition testing (HI), and enzyme-linked immunosorbent
assays (ELISA) for IgG (pair) and IgM (MAC) antibodies are all used to test for
antibodies. In order to detect antigens, one should perform an
immunofluorescence assay (IFA), an immunoperoxidase test, and a rapid,
sensitive, and specific reverse passive hemagglutination (RPHA) test. The IgM
ELISA test is the most common, but this is because of the drawbacks most of the
aforementioned tests have. The test is IgM antibodies in the cerebrospinal
fluid/serum of patients within 3-5 days after infection. However, no detectable
IgM was found in the serum after 8 days. In the United States, only the
Centers for Disease Control and Prevention (CDC) and a few specialized
reference laboratories offer confirmatory tests. Indirect fluorescent antibody
staining is used to demonstrate viral antigens in tissues.
CLINICAL FEATURES OF JAPANESE ENCEPHALITIS
Japanese Encephalitis cases show
signs and symptoms similar those of viral origin encephalitis. As JE does not
show any specific manifestations, it misleads the symptoms of many other causes
that may be viral, fungal, bacterial and protozoan. For making diagnosis and
facilitation of observation easy, the NVBDCP in 2006 altered the definition of
JE case as those AES case which is identified in a person of any age and facing
a change in mental status with the high degree of fever and symptoms of
confusion, disorientation leading to coma and talking inability. The incubation
period of JEV varies from 2 to 15 days, however many of the infection show no
symptoms. This virus greatly affects children with variation in mortality rate.
The major symptoms are fever, headache and laziness while signs that developed
during ARS includes neck rigidity, hemiparesis, cachexia and fever between
100.5 -105.9 degree F (38-48 degree C). At later stage, mental retardation can
be the result of JE followed by long-lasting neurological defect such as
emotional liability, deafness, etc. due to the impairment of central nervous
system.
TREATMENT OF JAPANESE ENCEPHALITIS
The
JE virus cannot be completely treated because there is no specific antiviral
medication available. The only effective treatment for it, though, is
vaccination. By fogging with extremely low levels of insecticides and immunizing
children, JEV can be prevented as well as its vector mosquitoes. Inactivated
vaccines derived from cell culture, live attenuated vaccines derived from mouse
brains, and cell culture vaccines are the three types of vaccines that have
been widely used. There are currently three vaccines on the market: SA-I4-I4-2,
ICS1, and JESPECT (marketed as IMOJEV in other countries and as JESPECT in New
Zealand and Australia). Currently, genotype-III virus is the basis for all
vaccines. India started immunizing 1 million people against JE in 2006.
Children aged 1 to 15 in India began receiving the JE vaccine in 2006. After
that, only one dose of the JE vaccine (SA-I4-I4-2) was administered as part of
the national immunization program. It is necessary to raise community awareness
in order to protect people from mosquito bites and to identify JE cases
early.
PREVENTION AND CONTROL OF JAPANESE ENCEPHALITIS
Japanese Encephalitis can be
prevented largely based on two interventions:
Ø Mosquito/vector control
Ø by an immunization system
Vector Control
It is an important way to control and
prevent the Japanese Encephalitis. For controlling the vector population, the
methods that are adopted in endemic area since long are insecticides and bed
nets. For preventing local transmission especially in peri-urban, thermal
fogging with ultra-low volume insecticides such as malathion and pyrethrum has
been recommended. Some other ways to prevent larval development are water
management and irrigation practices such as intermittent irrigation, constant
flow system periodic lowering of water level. But this is not possible in rural
areas to prevent mosquito breeding, therefore there vector control alone cannot
prevent JE.
Immunization
For the prevention of any disease,
immunization through effective vaccine is necessary, so is the case in JE. It
is necessary for the Government to launch a large-scale immunization program
for the susceptible human population. Vaccination directly provides antibody to
fight against the JEV. There are many vaccines which are being used currently
for JE; like purified, formalin-inactivated mouse-brain derived, cell-culture
derived, live attenuated and cell-culture derived inactivated. The most
produced and internationally distributed among these vaccines is mouse-brain
derived inactivated vaccine.
RECOMMENDATIONS AGAINST JAPANESE ENCEPHALITIS
According to current epidemiological
studies, the risk of Japanese encephalitis is changing and increasing
worldwide. Japanese encephalitis is a volatile and unpredictable danger to
travelers; However, there are safe and effective methods of vaccination.
Vaccination is recommended for children in all regions and adults in areas
endemic for Japanese encephalitis. Vaccination is recommended for all
immigrants residing in endemic countries and traveling to rural or peri-urban
areas of endemic countries, regardless of length or purpose of stay. Travelers
with unknown or appropriately altered plans should also be vaccinated [66]. The
decision to vaccinate should be based on factors such as (a) the risks
associated with a particular route; (b) the incidence and mortality rates of
Japanese encephalitis in the region; (c) the availability of effective
vaccination; d) A high risk after vaccination. Adverse reactions, although
possible; (e) Possibility of future travel to JE endemic countries, etc. The
following are the vaccination schedules recommended by the World Health Organization.
a. Live attenuated vaccine: one dose
given before or at the eighth month
B. Live chimeric vaccine:
administered in a single dose before or at the ninth month
c) Inactivated vaccine: 2 doses, the
first dose is administered before or at 6 months of age, and the second dose is
usually administered 4 weeks apart.
Depending on the type of vaccine
received, booster doses are also recommended to further enhance immunity
against JE. Vaccination against Japanese encephalitis is generally not
recommended during pregnancy because of the risk to the fetus; However, if
traveling to JE-endemic areas, vaccination is recommended because the benefits
to the mother and developing fetus outweigh the risks.
JAPANESE ENCEPHALITIS VACCINATION IN UTTAR PRADESH, INDIA
During 2006, JE vaccination campaign
was launched in the most sensitive districts of Assam, Karnataka and Uttar
Pradesh. Other 86 JE endemic districts in the States of Andhra Pradesh, Assam,
Goa, Haryana, Bihar, Tamil Nadu, Kerala, Maharashtra, West Bengal and Uttar
Pradesh had been covered. ASE/JE case management reorientation training course
has been initiated and carried out in Andhra Pradesh, Assam, Haryana, Tamil
Nadu, Karnataka, West Bengal and Uttar Pradesh during 2008-2009.
Bharat Biotech manufactured JENVAC
got licensed as a 2-dose vaccine in 2014 in India. During 2017-18 which is a
positive step towards saving the lifes of many people of our country, a massive
encephalitis vaccination program has been launched by Shri Yogi Aditya Nath
(Chief Minister of Uttar Pradesh) Government.
Dastak Abhiyan, an initiative launched by Uttar Pradesh government in association with
UNICEF on April 15, 2022, has many health workers going door-to-door to all the
homes in the encephalitis-affected villages to spread information about it.
They urge people not to visit ‘quacks’ and to adopt preventive measures like
drinking clean water and getting an encephalitis vaccine.
CONCLUSION
Japanese Encephalitis is a major
public health issue for the entire world. However, a rise trend of JE can be
noticed clearly in Asia. Certain ecological and environmental factors are
responsible for the expansion of the JEV. Only prevention can control this
disease because it has no specific treatment. With a high-quality immunization
program, we need a powerful system of surveillance for controlling JE. Other
ways can also be adopted for preventing it along with vaccination program, such
as modified agriculture practices, pig vaccination, vector control, rigorous
monitoring and improved living standards.
The most commonly affected age group
is 1-5 years with peak occurrence in the month of September. Safe and effective
JE vaccines are available in all JE endemic states in India to prevent the
disease and additionally to reduce the risk for JE and AES; all travellers to
JE-endemic areas should take precautions to avoid mosquito bites especially in
high peak season. Though the downward trend in CFR has been started and several
encephalitis treatment centres have been established at block level in
JE-endemic districts of eastern Uttar Pradesh, but still government needs to be
strengthened awareness activities like “Dastak” campaign and intersectoral
preventive activities.
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Article Information
HEALTH STATUS OF CHILDREN DUE TO JAPANESE ENCEPHALITIS IN GORAKHPUR
Authors: MISS MONIKA SINGH, DR. ARVIND KUMAR SINGH
- Journal IJLRA
- ISSN 2582-6433
- Published 2023/04/13
- Volume 2
- Issue 7
About Journal
International Journal for Legal Research and Analysis
- Abbreviation IJLRA
- ISSN 2582-6433
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