Vaccination of up to 25 lakh children slated to occur after outbreak ends.
After at least 31 of over 93 children that had contracted Encephalitis or brain fever in Odisha were confirmed to have died of Japanese Encephalitis (JE) virus, the Union Health Ministry has decided to roll out vaccination in four districts of the state.
The vaccination drive for JE for children uptil fifteen years of age in Malkangiri, Kokrajhar, Jajpur and Mayurbhanj will occur after the state declares that the outbreak has ended.
A team of officials from the Immunization department at the centre visited Orissa last month to assess the readiness of the state to conduct a vaccination drive. A population of up to 25 lakh children under the age of 15 years are slated to be immunized within two weeks, later this year, but only after Odisha declares that the outbreak has ended.
India imports JE vaccine from National Biotech Group's Chengdu Institute in China since 2006 after first cases surfaced in Gorakhpur district of Uttar Pradesh. One vial of injectible JE vaccine costs upto Rs 150 and contains five doses. “This vaccine contains live virus. It cannot be administered during an outbreak as we do not know it’s mode of interaction with the wild virus that is dominant in the region currently. Only after the outbreak has subsided that we can inject the vaccine into the community,” said Dr Pradeep Haldar, Deputy Commissioner, Immunization at the Health Ministry.
Once a person is vaccinated it takes up to 4 to 6 weeks for the immunity against JE to set in. “If a person contracts the virus during the month of being vaccinated, community will blame it on vaccination, saying the infection occured due to immunization. This has happened in the past,” Dr Haldar said.
A person at any age can be vaccinated against JE, however the disease burden is high in children uptil 15 years, with 90% of cases being reported in children uptil five years.
Children are being immunized against JE in 199 districts of 18 states currently. After the recent spate of deaths, Odisha is the 19th state to be added to the list of high-burded JE states, this year. In 2015, India saw 1609 cases of JE of which 279 (17.34%) patients died.
According to National Health Profile between January to December in 2014, Odisha had recorded 990 cases and 116 deaths due to Encephalitis. In 2015, Odisha recorded the highest cases of Encephalitis at 1451 and up to 118 deaths. However, no cases were recorded under the category of JE. “Not all cases of Encephalitis necessarily turn out to be cases of JE. In Malkangiri, we are seeing an atypical presentation of cases post-monsoon, this year. This has never been seen before,” Dr Haldar said.
“Given poor testing facilities for samples and limited period of survival it has been tough to confirm cases of Encephalitis as JE, but there was no harm in immunizing children in the past,” argued a state health official at Orissa. “We have been asking for vaccines since 2012, it is only now that we will recieve them. This is a huge medical debate. We cannot consider vaccination until state confirms cases of JE and reports to the centre,” said Haldar.
An expert panel of doctors constituted by the state are probing other causes of death and said that five patients may have developed brain fever after consuming a plant - 'bana chakunda,' which is deemed to be toxic.
Japanese Encephalitis in India:
In 2015
Cases - 1609
Deaths - 279
Case Fatality Ratio - 17.34%
High burden states in 2015
Cases Deaths
Assam 614 135
West Bengal 342 75
Uttar Pradesh 351 42
(Source - National Health Profile, 2016)
Pigs and wild birds are hosts of the virus. Japanese Encephalitis Virus is spread by infected mosquitoes of Culex species. It infects humans when an infected mosquito bites the human
Symptoms include rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and ultimately death. Of those who survive, 20%–30% suffer permanent intellectual, behavioural or neurological problems such as paralysis, recurrent seizures or the inability to speak.
JE has no treatment, preventive vaccination can help
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