Japanese Encephalitis Viral Disease in India

As though the dengue, chikungunya and H1N1 outbreaks weren’t enough, now we have to contend with the resurgence of Japanese encephalitis in India. As it is, a recent study conducted by researchers from John Hopkins Bloomberg School of Public Health has concluded that the cases of dengue and chikungunya have been under-reported in India. Last year alone, 1500 cases of Japanese encephalitis were reported in India, particularly in the northeastern states. The cases and deaths due to this form of encephalitis have more than doubled since 2010.

The number of people with variant forms of viral illnesses, which often go unreported and undetected, is difficult to establish. In Bangalore, there have been recent case reports of a type of viral infection that can cause severe joint and muscle pains, temporarily disabling a person.

In Kolkata this year, as of 12 July, 21 deaths related to encephalitis have been reported. Last year the toll due to various forms of encephalitis was over 200. On 17 July, a state of high alert was issued by the health authorities in Arunachal Pradesh, where a child has succumbed due to Japanese encephalitis. While in Assam experts believe that a change in weather and a warmer climate have resulted in a five-fold increase in Japanese encephalitis cases over the last five years.

While there is still no reason to panic since the incidence of new cases seems to be confined to one area of the country, in these days of immigration and frequent travel by all modes of transportation, it is vital to be aware of the nature of the illness, as well as the treatment and preventive measures of this deadly condition.

Since it first emerged in the 1870s, the Japanese encephalitis virus, which belongs to the family of flavi viruses, has spread across the Southeast Asian region. Studies indicate that it emerged from the Indonesia-Malaysian region, and has evolved into different genotypes since. It is spread by the Culex mosquito, and the transmission intensifies during the monsoon season. It is no coincidence that the countries in the Southeast Asian region are major rice cultivators, and have huge rural agrarian areas – factors that are associated with the spread of the disease.

Symptoms of the Disease

The initial signs and symptoms of the infection that predominantly affects the brain could be fever, myalgia, headache, nausea, vomiting and diarrhoea, which may last for several days. In about 1 in 250 cases the illness takes a severe turn with the development of high fever, neck stiffness, disorientation, seizures, spastic paralysis, coma and death. The case-fatality rate may be as high as 30%, and from among those who survive the severe form of the illness, about a quarter can end up with permanent intellectual, behavioural and neurological problems.

As with most viral infections, there is no effective antiviral antibiotic available to fully treat the infection. Treatment therefore, is confined to supportive measures to reduce the symptoms and to stabilise the patient’s condition. Patients may require assistance with feeding, airway management and seizure control. Rehabilitation of residual deficits is undertaken if required at a later stage.

Fortunately a vaccine is available to prevent the spread of the illness. A live attenuated Chinese vaccine has been predominantly used worldwide. India launched its own indigenous Japanese encephalitis vaccine in 2013 called Jenvac, in a bid to check the import of the vaccine from China.

Preventive Measures

What can you do to check the spread of mosquito-borne illnesses? Maintaining hygienic conditions in the house and work area would help immensely. This means that pollution pertaining to water, environment and air has to be curbed. Waterlogged areas are to be cleared since mosquitoes breed in these areas. During monsoon, extra protection against mosquito bites is necessary. If you happen to live in the endemic areas, get yourself vaccinated. If you happen to know somebody with the signs of the illness, or if you develop them yourselves, make sure early diagnosis is made and treatment initiated at the earliest. Spread the message about the illness and its prevention amongst your family and friends.

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