An outbreak of Japanese Encephalitis in Uttar Pradesh has recently claimed the lives of nearly 700 children, according to official figures whereas other agencies claim that the real toll could be closer to 1,500.

Uttar Pradesh is the most populous state in the country, with a population of 180 million. The worst hit area is Gorakhpur district, which is about 250 Km Southeast of the state capital Lucknow. Japanese encephalitis outbreak in Uttar Pradesh was first noticed in 1978, since then around 8,000 people have died due to this disease and also in the neighboring state of Bihar.

Japanese Encephalitis (JE) incidence in Gorakhpur district of Uttar Pradesh from 1982-1988 showed an increasing trend in the incidence of JE. In 1982 , the total number of annual cases and case fatality rate (CFR) were 118 and 23.7% respectively whereas in 1988, the number of cases have gone up to 772 with a case fatality rate of 32.2%.

1145 cases of Japanese encephalitis have been reported from 14 districts of Uttar Pradesh state, India during 29th July to 30th August 2005. About one-fourth of the cases (n=296) have died due to JE. 90 cases from the adjoining districts of Bihar have also been admitted to the hospitals in Uttar Pradesh. Entomological surveys of these affected villages reveal high density of Culex tritaeniorhynchus and Culex vishnui group, which are reported to be the major vectors of JE.

Almost all cases reported in these areas are from below 15 years of age group. The usual symptoms like high fever with encephalitis followed by delirium were observed which finally lead to death within a short period. Cases who have survived show evidence of mental retardation and/or neurological deficit. Out of 168 serum/CSF samples examined, 92 (55%) were found to be positive for IgM antibodies against JE virus.

According to the United Nations annual development report, for every 1,000 Indian children born, 63 will die before the age of five due to diseases. In addition, Uttar Pradesh is one of four Indian states with high mortality rate in young age children. This year (2005) around 200,000 children have been immunized with Japanese encephalitis vaccine in Uttar Pradesh.

About 300,000 doses of JE vaccine manufactured at Central Research Institute, Kasauli, Himachal Pradesh, India have been sent to the State Government of UP. Public health experts and senior pediatricians are already in the affected areas to assist the local health authorities to check the outbreak of JE.

img1: http://news.bbc.co.uk/2/hi/south_asia/4230562.stm
img2:“A scene at the Baba Raghav Das Medical College in Gorakhpur, where children affected with Japanese Encephalitis were admitted ”. Source: www.frontlineonnet.com
img3: Child with acute infection of JE. Source : http://in.rediff.com/news/2005/aug/24look.htm

References:

• Kar NJ, Bora D, Sharma RC, Bhattacharjee J, Datta KK, Sharma RS:Epidemiological profile of Japanese encephalitis in Gorakhpur district, Uttar Pradesh, 1982-1988. J Commun Dis. 1992 Sep; 24(3):145-9