The encephalitis crisis: 2017 saw most cases since 2010; Uttar Pradesh continues to fare terribly in public health

After  over 1,300 deaths  were reported in Uttar Pradesh’s  BRD Medical College and Hospital in 2017 alone — most of them due to encephalitis — government records accessed by Firstpost reveal that this year has recorded the most number of encephalitis cases across the country since 2010. In response to an RTI query, the National Vector Borne Disease Control Programme (NVBDCP) said that a total of 12,578 people have been affected by the Acute Encephalitis Syndrome (AES) in 2017, a rise of over 243 percent since 2010. [caption id=“attachment_4292887” align=“alignnone” width=“825”] Acute Encephalitis Syndrome cases have more than doubled since 2010[/caption] S Vijaya in the Department of Microbiology and Cell Biology at the Indian Institute of Science in Bengaluru said that the pattern is obvious. “The numbers clearly show a steady, increasing trend, and the small drops in the middle years might just be lapses in the health department’s record keeping. However, I wouldn’t consider the numbers sacrosanct — the important point here is that the trend is upwards,” she said.

Vijaya attributes the rising number of AES in the country to the following reasons: Uncontrolled growth in the population, sudden growth of crowded cities and poorly developed towns that are not supplied with water and sanitation infrastructure. “These are infections of poverty and poor hygiene,” she said.

The report also said that a total of 74, 535 cases of AES have been recorded in India since 2010. As a  _Firstpost_ report pointed out last year, over 26,000 of these cases were observed in Uttar Pradesh alone. NVBDCP, which is an agency under the Ministry of Health and Family Welfare, added in its reply to an RTI that this year too, Uttar Pradesh carried the largest AES burden in India at 4,515 cases, followed by Assam and West Bengal. “Uttar Pradesh has been leading on this list for a long time. These diseases take hold because of local socio-political conditions, civic facilities, overcrowding, poverty, corrupt government health systems etc. Uttar Pradesh doesn’t fare well in any those sectors,” Vijaya said. Here is a map showing the state-wise distribution of the disease’s spread (information was provided on only 22 states): [caption id=“attachment_4296019” align=“alignnone” width=“825”] Acute Encephaitis Syndrome cases in India in 2017[/caption] The data, however, is accurate only until 12 December, 2017. About the states recording “zero” cases of AES, Vijaya says, “I do not believe any of that. It’s just that there is no data available.” However, Manoj Murhekar, a senior official at the Indian Council of Medical Research (ICMR), told Firstpost that one reason behind the increasing AES cases in India could be improving data-keeping practices. “More number of surveillance sites, better record keeping the result in more cases getting reported, which may explain the statistics you have received.” A  2016 study on the disease in Uttar Pradesh’s Gorakhpur, where Murhekar was one of the co-authors, concluded that large proportion of AES cases are caused by a bacterium called scrub typhus , a form of typhus. This, in turn, was linked to the environment and living conditions around people who tested positive with AES. “I have read medical reports from both Uttar Pradesh and Assam — most of these cases are due to scrub typhus. There hasn’t been a major change in the environmental factors in these regions, so it is unlikely the number of cases will increase drastically,” he said. Murhekar says one way to bring down the number of AES cases is by initiating more research projects to investigate why children develop the disease. “We are planning to undertake such projects this year.” Based on studies, ICMR recommended to the Uttar Pradesh government several steps for early detection and diagnosis of encephalitis, so that persons with high fever suspected of carrying the scrub typhus bacterium do not progress to AES.AES is an umbrella term for all symptoms which lead to inflammatory brain diseases. The syndrome can be caused by bacteria, fungi or virus of different strains which are difficult to identify individually. The term AES was coined by the World Health Organisation in 2006 to refer to a group of diseases which seem similar to one another but are difficult to differentiate during an outbreak. Vijaya said, “There is a dynamic change in the proportion of encephalitis caused by various etiological agents. Some 10 or 15 years ago, it was predominantly Japanese Encephalitis Virus, even in Gorakhpur. But over the last 10 years, the scene has changed — recently, scrub typhus has been behind most cases. From the symptoms, you cannot tell what is causing it, unless you perform diagnostic molecular tests. The pattern keeps shifting, it is a moving target.”