India Encephalitis 2014 - 1,808 fatalities

[Ronan Kelly]

India released the 2015 National Health Profile http://www.cbhidghs.nic.in/writeread...e/NHP-2015.pdf which included encephalitis numbers from 2014 that have largely been published now for 6 months (see post 448 above), but are being reported as news by the Indian media for example;

India had over 10,000 Acute Encephalitis Syndrome cases

IANS | Sep 23, 2015, 01.17 PM IST

India witnessed 10,834 cases of Acute Encephalitis Syndrome (AES) in 2014, with Uttar Pradesh recording the highest with 3,329 cases, followed by Assam with 2,194, said a new report by the health ministry released on Tuesday.
...
There was no Japanese Encephalitis or AES case in Nagaland, Maharashtra, Manipur and Punjab.

http://timesofindia.indiatimes.com/life-style/health-fitness/health-news/India-had-over-10000-Acute-Encephalitis-Syndrome-cases/articleshow/49072533.cms?from=mdr

The last sentence is odd because the IDSP has in their own report 20 cases (6 positive for JE) and one fatality from Nagaland, Manipur had 16 cases (1 positive for JE) and Punjab reported 2 cases of AES. - Ro

[Ronan Kelly]

J Med Virol. 2016 Apr 20. doi: 10.1002/jmv.24556. [Epub ahead of print]
A large outbreak of Japanese encephalitis predominantly among adults in northern region of West Bengal, India.
Gurav YK1, Bondre VP2, Tandale BV1, Damle RG2, Mallick S3, Ghosh US4, Nag SS5.
Author information
Abstract
Unusual rise of acute encephalitis syndrome cases (AES) were reported in July 2014 in the northern region of West Bengal, India. Investigations were carried out to characterize the outbreak and to identify the associated virus etiology. This observational study is based on 398 line listed AES cases, mostly (70.8%, 282/398) adults, with case fatality ratio of 28.9% (115/398). Japanese encephalitis virus infection was detected in 134 (49.4%) among 271 AES cases tested and most of them (79.1%, 106/134) were adults. The study reports a large outbreak of genotype III Japanese encephalitis among adults in northern region of West Bengal, India. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS:
Acute encephalitis syndrome; Adults; Disease outbreak; Eastern India; Genotype III; Japanese encephalitis virus

http://www.ncbi.nlm.nih.gov/pubmed/27096294

Comment: As expected, cases of Japanese Encephalitis are being under reported by the National Vector Borne Disease Control Programme. The NVBDCP reported 415 cases of JE, 78 fatal, from 2,385 cases of AES, 348 fatal, in Bengal in 2014. This study suggests that the proportion of AES cases caused by JE is in fact much higher. - Ro

[Ronan Kelly]

Odisha added in Japanese Encephalitis high-burden states this year
MAITRI PORECHA | Wed, 23 Nov 2016-03:25pm , New Delhi , DNA
...
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.
...
http://www.dnaindia.com/india/report...medium=twitter

[ATTACH]n764347[/ATTACH]

http://nvbdcp.gov.in/Doc/je-aes-cd-20Nov16.pdf

Comment: These cases & deaths were not included in the NVBDCP annual figures for 2014. - Ro

[Ronan Kelly]

Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study

Aakash Shrivastava, PhD, Anil Kumar, MD, Jerry D Thomas, MD, Kayla F Laserson, ScD, Gyan Bhushan, MD, Melissa D Carter, PhD, Mala Chhabra, MD, Veena Mittal, MD, Shashi Khare, MD, James J Sejvar, MD, Mayank Dwivedi, MD, Samantha L Isenberg, PhD, Rudolph Johnson, PhD, James L Pirkle, MD, Jon D Sharer, PhD, Patricia L Hall, PhD, Rajesh Yadav, MBBS, Anoop Velayudhan, MBBS, Mohan Papanna, MD, Pankaj Singh, D Somashekar, MD, Arghya Pradhan, MBBS, Kapil Goel, MD, Rajesh Pandey, MBBS, Mohan Kumar, MBBS, Satish Kumar, MD, Amit Chakrabarti, MD, P Sivaperumal, PhD, A Ramesh Kumar, PhD, Joshua G Schier, MD, Arthur Chang, MD, Leigh Ann Graham, PhD, Thomas P Mathews, PhD, Darryl Johnson, PhD, Liza Valentin, PhD, Kathleen L Caldwell, PhD, Jeffery M Jarrett, MS, Leslie A Harden, MS, Gary R Takeoka, PhD, Suxiang Tong, PhD, Krista Queen, PhD, Clinton Paden, PhD, Anne Whitney, PhD, Dana L Haberling, MSPH, Ram Singh, PhD, Ravi Shankar Singh, MD, Kenneth C Earhart, MD, A C Dhariwal, MD, L S Chauhan, DPH, S Venkatesh, MD, Dr Padmini Srikantiah, MD'Correspondence information about the author Dr Padmini Srikantiah

Summary
Background
Outbreaks of unexplained illness frequently remain under-investigated. In India, outbreaks of an acute neurological illness with high mortality among children occur annually in Muzaffarpur, the country's largest litchi cultivation region. In 2014, we aimed to investigate the cause and risk factors for this illness.

Methods
In this hospital-based surveillance and nested age-matched case-control study, we did laboratory investigations to assess potential infectious and non-infectious causes of this acute neurological illness. Cases were children aged 15 years or younger who were admitted to two hospitals in Muzaffarpur with new-onset seizures or altered sensorium. Age-matched controls were residents of Muzaffarpur who were admitted to the same two hospitals for a non-neurologic illness within seven days of the date of admission of the case. Clinical specimens (blood, cerebrospinal fluid, and urine) and environmental specimens (litchis) were tested for evidence of infectious pathogens, pesticides, toxic metals, and other non-infectious causes, including presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement. Matched and unmatched (controlling for age) bivariate analyses were done and risk factors for illness were expressed as matched odds ratios and odds ratios (unmatched analyses).

Findings
Between May 26, and July 17, 2014, 390 patients meeting the case definition were admitted to the two referral hospitals in Muzaffarpur, of whom 122 (31%) died. On admission, 204 (62%) of 327 had blood glucose concentration of 70 mg/dL or less. 104 cases were compared with 104 age-matched hospital controls. Litchi consumption (matched odds ratio [mOR] 9?6 [95% CI 3?6 ? 24]) and absence of an evening meal (2?2 [1?2?4?3]) in the 24 h preceding illness onset were associated with illness. The absence of an evening meal significantly modified the effect of eating litchis on illness (odds ratio [OR] 7?8 [95% CI 3?3?18?8], without evening meal; OR 3?6 [1?1?11?1] with an evening meal). Tests for infectious agents and pesticides were negative. Metabolites of hypoglycin A, MCPG, or both were detected in 48 [66%] of 73 urine specimens from case-patients and none from 15 controls; 72 (90%) of 80 case-patient specimens had abnormal plasma acylcarnitine profiles, consistent with severe disruption of fatty acid metabolism. In 36 litchi arils tested from Muzaffarpur, hypoglycin A concentrations ranged from 12?4 μg/g to 152?0 μg/g and MCPG ranged from 44?9 μg/g to 220?0 μg/g.

Interpretation
Our investigation suggests an outbreak of acute encephalopathy in Muzaffarpur associated with both hypoglycin A and MCPG toxicity. To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness. A comprehensive investigative approach in Muzaffarpur led to timely public health recommendations, underscoring the importance of using systematic methods in other unexplained illness outbreaks.

Funding
US Centers for Disease Control and Prevention.

Full paper available at; http://www.thelancet.com/journals/la...035-9/abstract