Japanese Encephalitis Control Program | Medical Science Optional Notes for UPSC PDF Download

Problem Statement

Japanese encephalitis is a disease associated with a high mortality rate, and survivors often experience various degrees of neurological complications. Over the past few years, it has emerged as a significant public health concern. Approximately three billion people reside in countries where the Japanese encephalitis (JE) virus is endemic. Conservatively estimated, there are 50,000 to 175,000 reported cases annually, resulting in 10,000 to 15,000 deaths.

According to data from the Directorate of National Vector-Borne Disease Control Programme (NVBDCP) website, from January 1 to August 13 this year, 1208 cases of Acute Encephalitis Syndrome (AES) have been reported in Uttar Pradesh, with 152 of these cases leading to the death of the patient.

• Currently, 171 districts across 19 states in India are endemic for Japanese encephalitis.
• A significant outbreak of Japanese encephalitis occurred in eastern Uttar Pradesh in 2005, resulting in over 5000 cases and 1000 deaths.
• This prompted the crucial decision to introduce the live attenuated SA 14-14-2 vaccine in highly endemic areas.
• Concurrently, NVBDCP developed surveillance and case management guidelines for reporting Acute Encephalitis Syndrome (AES), including Japanese encephalitis, as the surveillance was primarily outbreak-based before these guidelines were established.

States such as Andhra Pradesh, West Bengal, Assam, Tamil Nadu, Karnataka, Bihar, Maharashtra, Manipur, Haryana, Kerala, and Uttar Pradesh are reporting the highest number of Japanese encephalitis cases.
Strategies for the prevention and control of Japanese encephalitis include:
Strengthening surveillance activities through sentinel sites in tertiary health care institutions.

• The Government of India offers need-based assistance to states, encompassing support for training programs and social mobilization. Epidemiological monitoring of the disease is conducted for the effective implementation of preventive and control measures, and technical support is provided upon request by the state health authorities.

Timely diagnosis and appropriate case management are crucial:

• Given the absence of a specific cure for this ailment, early case management plays a vital role in reducing the likelihood of complications and fatalities.
• To prevent complications, it is imperative to report cases early. Therefore, the community should be thoroughly informed about the disease's signs and symptoms, as well as the healthcare facilities accessible at health centers and hospitals.

Integrated vector control includes:

• Personal protection and the use of larvivorous fishes, capacity building, and behavior change communication.

Behavioral changes: Emphasis should be placed on keeping pigs away from human dwellings, particularly in pigsties, especially during the dusk-to-dawn period when vector mosquitoes are most active. Wearing clothes that fully cover the body to prevent mosquito bites is recommended. The use of bed-nets is also a crucial precaution. Implementing a complete ban on open defecation is essential. Piggeries should be kept away (4-5 km) from human dwellings.

• Since Japanese encephalitis vectors are outdoor resters, indoor residual spray is not effective. States are advised to use malathion for outdoor fogging as an outbreak control measure in affected areas.

Vaccination

• Given the absence of specific therapy, vaccination remains the most crucial control measure and is recommended for all children aged 1-15 years residing in highly endemic areas such as Andhra Pradesh, Uttar Pradesh, and Karnataka.
• Visitors to endemic areas are also advised to receive the vaccine if their expected duration of stay is more than 4 weeks.

Vaccines
Three types of vaccine are available

The program encompasses 60 districts with a high burden of Japanese Encephalitis (JE) and Acute Encephalitis Syndrome, spanning five states.

Multipronged Approach- Intersectoral collaboration to address the complex issue

• The Nodal Body for Health and Family Welfare
• The Ministry responsible for Drinking Water and Sanitation
• The Ministry overseeing Housing and Urban Poverty Alleviation
• The Ministry of Social Justice and Empowerment
• The Ministry focused on Women and Child Development

The objective of the program is to decrease the incidence of Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES) in children, leading to lower rates of morbidity, mortality, and disability.

The major objectives of the programme are as follows:
(i) Enhancing and broadening Japanese Encephalitis (JE) vaccination in affected districts.
(ii) Reinforcing surveillance, vector control, case management, and ensuring the timely referral of severe and complicated cases.
(iii) Increasing accessibility to safe drinking water and proper sanitation facilities for the target population in affected rural and urban areas.
(iv) Assessing the disability burden resulting from JE/AES and providing adequate facilities for physical, medical, neurological, and social rehabilitation.
(v) Improving the nutritional status of children at risk of JE/AES.
(vi) Conducting intensified Information, Education, and Communication/Behavior Change Communication (IEC/BCC) activities related to JE/AES.