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UP declares year-long war on encephalitis

Author: Aman Sharma
Publication: The Economic Times
Date: January 5, 2018
URL:   https://m.economictimes.com/news/politics-and-nation/up-declares-year-long-war-on-encephalitis/amp_articleshow/62386146.cms?__twitter_impression=true

The UP government is gearing up to wage a war against the biggest child killers in the state - Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES).

It has prepared a one-year plan for 2018 beginning January 1 which envisages early vaccination, segregating pigs from affected habitation, rushing immediate response teams for fogging to stop outbreak, encouraging consumption of water only from an 'India Mark-2' tap or hand pump, and convincing parents not to let their kids sleep on the mud floor and call the 108 ambulance helpline immediately if they find any symptoms.

This is the first such detailed oneyear-plan with monthly targets to fight the two deadly diseases, the state health minister Sidharth Nath Singh told ET.

The exercise comes in the wake of mounting criticism over the new BJP government's perceived failure to stop children dying of these diseases.

File picture of children in the state-run Baba Raghav Das Medical College.

The one-year document prepared by the state government, along with the World Health Organisation and the United Nations Children's Fund, carries a message from Chief Minister Yogi Adityanath, "Our slogan is Sabka Saath Sabka Vikas (with all, development for all) which is not possible without a healthy body of the citizens of UP. In our sankalp (resolution) document, we promised every family will be healthy. A new thinking is needed."

"JE and AES is not merely a disease but a huge problem for which all departments of government need to work with the community help. We are working seriously with Centre for a permanent solution to JE," the CM says in the document.

The Gorakhpur division, the CM's home base, has been the worst affected by the epidemic that strikes with unfailing regularity every year from July till October.

The government now plans to contain the damage caused by JE and AES by prevention and prompt treatment. While there is a vaccine against JE, there is none against AES yet and the key to saving a life is prompt treatment.

"The main cause of AES is JE. Vaccination is a big weapon against JE. Earlier vaccination percentage was not enough. We vaccinated 92 lakh children in age group 1-15 last year and the result showed," Singh said.

As for AES, in earlier years only 17% AES patients were admitted to primary and secondary health centres, and 83% were admitted straight to medical colleges such as BRD by when their situation had become serious and became a major reason for death, Singh said. In 2017, 56% AES patients were treated at primary and secondary health centres after the government improved facilities there. "The AES death rate there was just 3%," he said.

According to government data, deaths due to AES dropped from 641 in 2016 to 552 till the end of November 2017. "There was 7% reduction in death rate (proportion of admitted patients who failed to survive) due to JE in 2017, from 19% in 2016 to 12% in 2017.

AES death rate went down from 16% to 13% in 2017. JE incidence went down by 9%," the state health minister said.

At Gorakhpur BRD Medical College, where child deaths made headlines, Singh said deaths in the paediatric wing due to all kinds of ailments in 2017 fell to about 1,700 from around 6,000 in 2016.

The number of AES patients in the state went up, though, from 2,900 in 2015 to 3,911 in 2016 and to more than 4,500 last year.

Under the one-year plan for 2018, five beds each will be added in the 10 paediatric intensive care units (PICU) set up in smaller hospitals in the nine worst affected districts in Gorakhpur and Basti divisions that report 85% of all JE and AES patients in UP. Besides, 104 encephalitis treatment centres (ETC) opened at block level in these districts will be strengthened with proper medicines to fight JE and AES. A mini paediatric intensive care unit will be opened in 15 such ETCs with three beds and a ventilator apiece.

The messaging will now be clear - that if parents see any symptom of JE or AES in their child, they should straightaway call the 108 Ambulance Service to take the child to either a PICU or an ETC, rather than waste time believing the fever will subside, or take the child to a quack. The plan hence stresses on ground-level intervention.

A new standard operating procedure has been prepared to specify what medical condition will prompt a PICU or ETC to refer a patient to the medical college. It goes to the extent of specifying in what position a child patient should be laid in the ambulance or the hospital bed to mandating the quantity of drugs whose availability will be ensured in PICUs and ETCs so that effective treatment begins early.

The plan document says that local doctors are now being trained by American experts to treat JE and AES, and that CMC Vellore last year trained 366 doctors and 26,000 frontline workers in districts hit by JE and AES so that medical treatment given to patients at the primary and secondary health facilities for AES is as good as at medical colleges. A detailed death audit will be done to assess what transpired before any patient died due to AES. UP also plans an early vaccination drive for JE this year from March, following feedback that a vaccinated child takes about two months to build immunity.

However, the situations which lead to children contracting JE or AES also require fundamental interventions in the sphere of prevention. Cleanliness, clean drinking water and dealing with mosquitoes are therefore among the top priorities in the state's action plan.

AES is caused mainly by JE and Scub Typhus (a non-viral bacterial infection). The monsoon season makes it worse. These diseases also mainly affect 1-15 year olds in poor families in eastern UP given that children suffering from malnutrition have poor immunity. "If parents can stop letting their children sleep on the mud floor, a major difference will be made in the fight," said health minister Singh.

"We will also convince women not to take children on their back to the fields in the sowing season and motivate NGOs to open small creches."

The plan document says that 617 highly sensitive villages in respect of JE and AES have now been identified for cleanliness drives and going open defecation-free on priority. Besides, 'immediate response teams' will be set up at state, district and block levels to intervene in case of report of outbreak of AES from any area. "This will involve immediate fogging in the village of Melythyne technical spray, telling people to use mosquito repellents, wear full sleeve clothes and keep safe from mosquitos after sunset by using mosquito nets while sleeping," the plan says.

Stopping water accumulation is also among the keys tasks identified - relevant government departments have been assigned tasks.

The biggest task however could be to stop pigs from mingling with the human population. JE is caused due to mosquitoes and pigs, with a pig acting as an amplifying host after a male mosquito bites it. A male mosquito can travel four-five kilometres, as per the plan document. Further, a female mosquito becomes infected too by biting the pig. Both sets of mosquitoes then bite humans during the monsoon season.

The plan says pigs will have to be taken out of human inhabited areas which are affected and shifted to separate enclosures outside the village. The AES is mainly caused by JE and polluted drinking water. The plan hence stresses on having more India Mark -2 hand pumps in villages and encouraging people to use only those for water consumption.

With the elaborate plan, the state has made a beginning in combating the killer diseases. Its efficacy will, however, depend on implementation.
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