Whose failure? Encephalitis kills 50,000 in 30 years

[Ronan Kelly]

Whose failure? Encephalitis kills 50,000 in 30 years
Shreya Dhoundial, CNN-IBN

<object classid='clsid:d27cdb6e-ae6d-11cf-96b8-444553540000' codebase='http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=8,0,0,0' width='640' height='360' id='IBNLive' align='middle'><param name='allowScriptAccess' value='always' /><param name='allowFullScreen' value='true' /><param name='movie' value='http://features.ibnlive.in.com/videos/embed/190929/C1520A46F5A03B820B85FADC2E7111C8385B6EFE0E8D09D692202B007C9F6465250AF9776187481B42E0EC7A9A0B83F19C6669118A745B72F748D25CA7C37F771F369E6D63330FF86268C052174590FF7F934C87F3C5/10_2011/encephalitis-gorakhpur_271x181.jpg' /><param name='quality' value='high' /><param name='bgcolor' value='#ffffff' /> <embed src='http://features.ibnlive.in.com/videos/embed/190929/C1520A46F5A03B820B85FADC2E7111C8385B6EFE0E8D09D692202B007C9F6465250AF9776187481B42E0EC7A9A0B83F19C6669118A745B72F748D25CA7C37F771F369E6D63330FF86268C052174590FF7F934C87F3C5/10_2011/encephalitis-gorakhpur_271x181.jpg' quality='high' bgcolor='#ffffff' width='640' height='360' name='IBNLive' align='middle' allowScriptAccess='always' allowFullScreen='true' type='application/x-shockwave-flash' pluginspage='http://www.macromedia.com/go/getflashplayer' /></object>

Gorakhpur: The deadly encephalitis, a water or mosquito borne viral disease, has been striking with alarming regularity in the eastern parts of Uttar Pradesh and 500 children have died due to it in the last two months. More than 50,000 lives have been lost in the last three decades as the public health system has collapsed in the region, which is one of the poorest in India.

Public health experts and activists say that the epidemic has been badly mismanaged for the last 33 years and the story should make 21st century India hang its head in shame. They say that there is no national programme to contain the epidemic in one of India's poorest regions and point out that the response to the crisis by the government and the media has been both shocking and lethargic.

...
http://ibnlive.in.com/news/whose-failure-encephalitis-kills-50000-in-30-yrs/190929-3.html

UP health mininster calls meet on encephalitis issue
CNN-IBN


New Delhi: Acting on the CNN-IBN's report on rising cases of encephalitis, Uttar Pradesh health minister has called a meeting of all concerned departments of health, water and rural development to a review of the prevailing situation.

Meanwhile, the state government has released Rs 18 crore for a 100-bed ward for Gorakhpur patients. It has also sanctioned 300 deep borewells in the area.

The deadly encephalitis, a water or mosquito borne viral disease, has been striking with alarming regularity in the eastern parts of Uttar Pradesh and 500 children have died due to it in the last two months. More than 50,000 lives have been lost in the last three decades as the public health system has collapsed in the region, which is one of the poorest in India.

...

http://ibnlive.in.com/news/up-health-mininster-calls-meet-on-encephalitis/190958-3.html

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Political blame game begins over UP encephalitis
CNN-IBN

New Delhi: After CNN-IBN's report which exposed the successive governments in Uttar Pradesh for ignoring deaths due to encephalitis for 33 years, political blame game has started with the Congress blaming Mayawati government while the BJP criticising both the Centre and the state establishments for the medical crisis.

...

The BJP on Saturday slammed both the Centre and the Uttar Pradesh government for the rise in cases of encephalitis.

BJP spokesman Vijay Bahadur Pathak said, "As an opposition party, we can only put pressure. Vaccination is the problem. Government spent Rs 1000 crore on vaccination. But they didn't ensure that the second dose is given."

Beyond the political blame game, Health Minister Ghulam Nabi Azad refused to come on camera but passed the buck to the Mayawati government.

...

Social activists have also reacted to the alarming situation.

Chairperson, National Commission for Protection of Child Rights (NCPCR), Shanta Sinha said, "It is time for the government to take action on this. As a commission, we can take cognizance of this but more has to be done by the state government. There is so much money for health initiatives. What is happening with all that money? The state must ensure that it is used so that children are treated properly."

Centre for Social Research (CSR) chief, Ranjana Kumari said that this was absolutely a criminal neglect by UP government as well as by the central government.
"The government should spend much more money. After the report, UP government has woken up to the call and they have asked for 100 beds. That is nothing, that is too little, too late. They should better invest more money into the area and try to eradicate this disease," she said.

...

Reacting to the situation, Congress General Secretary Digvijaya Singh said that the Uttar Pradesh government needs to do more. "More needs to be done because of the living conditions in that area. We need to be a little more sensitive to this. The Government of India is taking adequate precautions, but at the same time, the state government should also realise the seriousness of the issue," he said.


...
http://ibnlive.in.com/news/political-blame-game-begins-over-up-encephalitis/191217-37-64.html

Ro's comment: Each of these commentators fails to address the main problem with encephalitis control in Uttar Pradesh: No one knows with absolute certainty what is causing 90% of the cases. Increasingly both official and media reports are emphasizing a waterborne route by an as yet unidentified enterovirus. One would hope that some of the money being spent could focus on research determining the cause of this annual tragedy. Once that is achieved, proper control measures could be implemented.

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Some recent papers investigating the causes of AES;

Etiology and clinico-epidemiological profile of acute viral encephalitis in children of western Uttar Pradesh, India

...
Results
Eighty-seven patients were enrolled in the study. The most common etiology of VE was enterovirus 71 (42.1%), followed by measles (21.1%), varicella zoster virus (15.8%), herpes simplex virus (10.5%), and mumps (10.5%). Japanese encephalitis virus was not found in any case. Enterovirus 71 infection caused significant morbidity in children; mortality occurred in 50%. A preponderance of cases occurred in December. In our study generalized convulsions along with altered sensorium were the significant findings in patients with VE.

Conclusions
Enterovirus 71, the major etiology of VE in our study, was associated with significant mortality and morbidity. Such studies should be conducted frequently to assess the role of emerging VE in different regions.

http://www.sciencedirect.com/science/article/pii/S1201971209001945

An epidemic of encephalitis associated with human enterovirus B in Uttar Pradesh, India, 2008

...
Results
Enterovirus RNA was detected in 37 (41.11%) of 90 CSF samples by real-time polymerase chain reaction (PCR). Seroneutralisation, amplification and sequencing of the 3′-end of the VP1 region of EV isolates revealed coxsackievirus B5 (CBV) and echovirus 19 (ECV) as the main serotypes causing this epidemic. Phylogenetic analysis showed that sequence divergence among the same serotypes was 0?4% at the nucleotide level.

Conclusions
This is the first report suggesting that CBV 5 and ECV 19 may be responsible for an epidemic of encephalitis in India. These serotypes were variant and evolved within the studied area.

http://www.sciencedirect.com/science/article/pii/S1386653211000989

Enteroviruses in Patients with Acute Encephalitis, Uttar Pradesh, India
...
ConclusionsThe viral RNA detected in CSF samples from patients hospitalized with encephalitis in Uttar Pradesh showed close identity with the EV-89 and EV-76 that recently were reported as an unusual group classified genetically as group A EV (EV-A) (10). Presence of the virus was also confirmed by its isolation and typing. Human EV-76 was detected in isolates in 1 rectal swab and 2 CSF specimens, and human EV-89 was detected in 2 rectal swabs by using amplification of VP1/2A or VP1 regions. Sequence analysis showed nt homology of 92.7%?97.7% with Bangladesh EV-76 and EV-89 strains recovered from patients with acute flaccid paralysis (AFP). The failure of amplification of typing regions in most specimens may be due to a low viral load.EVs are known to cause severe neurologic diseases ranging from AFP to encephalitis (11). In recent years, Southeast Asian countries have reported outbreaks of encephalitis caused by EV-71 (12,13). During AFP surveillance activities, Bangladesh strains were isolated from stool specimens (14). AFP patients infected with echoviruses and coxsackie B viruses also have been detected in India (15). Isolation of EV from clinical specimens collected from children with encephalitis in the present study indicates viable virus. Detection of EV-89/76 RNA in the CSF of ≈20% of the patients suggests the association of these viruses with encephalitis. Also, in 10 (3.3%) of 306 patients, co-infections of JE virus and EV were detected. Further studies are needed to understand the relative contributions of these viruses in causing sporadic and outbreak infections of encephalitis.
Accumulation of water in a saucer-shaped landscape (terai) and extensive rice cultivation in eastern Uttar Pradesh and adjoining regions favor the growth of vector mosquito populations and waterborne pathogens. Though the source of infection in the present study is unclear, the data warrant active surveillance of encephalitis cases. Inadequate hygiene and the unsanitary conditions that prevail in the study region may encourage the spread of EV infections in the community. Studies conducted on environmental samples may provide clues related to the dynamics of EV infections in humans.
...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657625/

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Report on 500 UP kids? deaths sought
TNN | Oct 9, 2011, 01.09AM IST

NEW DELHI: Expressing concern over the death of 500 children allegedly due to encephalitis, the national child rights commission has asked for a report on the matter from the Uttar Pradesh government in 15 days.

In a letter to the state chief secretary, the National Commission for Protection of Child Rights ( NCPCR) said that the issue amounted to violation of 'children's right to life, survival and development'.

The Commission has asked the UP government for the total number of cases of encephalitis reported so far this year, the existing mechanism for review of the health calamities and the action taken by the concerned departments, especially the department of water and sanitation, to prevent encephalitis in Gorakhpur.

...
http://timesofindia.indiatimes.com/...P-kids-deaths-sought/articleshow/10283483.cms

Ro's note: In total at least 827 people have died from encephalitis across India so far this year with most cases from Uttar Pradesh, Assam and Bihar.

 

[alert]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Ro's comment: Each of these commentators fails to address the main problem with encephalitis control in Uttar Pradesh: No one knows with absolute certainty what is causing 90% of the cases. Increasingly both official and media reports are emphasizing a waterborne route by an as yet unidentified enterovirus. One would hope that some of the money being spent could focus on research determining the cause of this annual tragedy. Once that is achieved, proper control measures could be implemented.

I agree. The mention of Enteroviruses 71, 76, and 89 in the post that follows is, to my knowledge, the first specific report of which enteroviruses are suspected. EV71 is a common pathogen throughout much of Asia, more commonly known for its involvement in HFMD, and could easily be a background detection.

The problem with blaming any of the AES on enteroviruses, however, is that they spread widely and easily. I can't find the link now, but there was a ProMED post from an official at the NIV that indicates that he thought enterovirus was unlikely, because if this was due to enteroviruses, it would have spread way beyond Uttar Pradesh.

It is really disappointing that after all this time, no one seems to know what is causing these cases.

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Court orders meeting of experts to deal with JE

Express News Service

Posted: Tue Oct 11 2011, 03:39 hrs
Allahabad:

The Allahabad High Court has directed that a meeting of the experts be held, preferably within a fortnight in New Delhi, to deal with the issue of Japanese Encephalitis (JE) that has been affecting several eastern UP districts in the state for the last few years.
Coming down heavily on the officials of the state government, the court said that IAS officials could only file reports and only experts can come up with suggestions that could be implemented to control the situation.

The court also asked the Director, Epidemic/Japanese Encephalitis (JE)/Acute Encephalitis Syndrome (AES), to be present in the court on October 20 with the details of the deliberations of the meeting of the experts. The court passed the order on September 29, before it went on Dussehra vacation.
...

The court directed that the meeting be presided over by the Director, National Vector Borne Disease Control Programme of Government of India, along with Joint Secretary, Ministry of Health and Family Welfare. Director General (Medical Health and Family Welfare), UP, Director General (Medical Education), Director (Epidemics), Principal of BRD Medical College, Gorakhpur, and Head of Department of Micro-biology Department (Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow) would attend the meeting. The experts may suggest measures that may be implemented by the state government in coordination with the Centre.

...

It had earlier been decided to install 2,817 such hand pumps - which were supposed to prevent people from drawing water at shallow levels, where it can get mixed with sewage leading to contamination ? but only 668 have been installed so far.

The court also said that the state government and BRD Medical College, which was entrusted with the task of suggesting and implementing various measures, have not shown any inclination to improve the situation.
http://www.indianexpress.com/news/court-orders-meeting-of-experts-to-deal-with-je/858412/0

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

SHRC issues notice to UP
TNN | Oct 14, 2011, 02.13AM IST

LUCKNOW: Taking suo motu cognizance of the news item published in The Times of India under the headline a?Encephalitis-stung Gorakhpur counts its dead a" Acute Shortage Of Facilities Even As Hospitals Overflow With Patients on October 12, the Uttar Pradesh State Human Rights Commission has issued notices to UP chief secretary, principal secretary (medical and health), director general( medical and health), chief medical officer, Gorakpur, chief medical officer, Maharajganj, chief medical officer, Deoria, and chief medical officer, Kushinagar.

Justice Vishnu Sahai, member, SHRC, asked the above officials to apprise them with the measures taken to contain the spread of encephalitis and deaths taking place on account of it. The commission has also asked them to post more doctors and nurses in various government hospitals in Gorakhpur, Kushinagar, Deoria, and Maharajganj. The order also said that more beds to be provided to the patients suffering from encephalitis in these hospitals and unless inevitable, a single patient should be lodged on one bed.

...
http://timesofindia.indiatimes.com/city/lucknow/SHRC-issues-notice-to-UP/articleshow/10346605.cms

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Japanese Encephalitis deaths: Azad to visit Gorakhpur
Submitted by admin4 on 20 October 2011 - 1:43pm
India News
By IANS,

New Delhi : Union Health Minister Ghulam Nabi Azad and Congress general secretary Digvijay Singh will Thursday visit Gorakhpur in Uttar Pradesh to enquire about efforts to control Japanese Encephalitis that has killed at least 450 people in the state.

"He (Azad) will leave for Gorakhpur today (Thursday) with a health ministry team and will be back Friday," a health ministry official told IANS.

...
http://twocircles.net/2011oct20/japanese_encephalitis_deaths_azad_visit_gorakhpur.html

UP encephalitis toll rises, govt takes stock
Agencies
New Delhi, October 20, 2011First Published: 12:14 IST(20/10/2011)
Last Updated: 12:17 IST(20/10/2011)Share more...1 Comment Email print

With growing concern over spread of encephalitis virus in eastern parts of Uttar Pradesh, AICC general secretary has asked Union health minister Ghulam Nabi Azad and Congress general secretary to take stock of the situation. According to health officials, around 500 patients have succumbed to the viral disease this year.

Azad and his team are expected to visit the Baba Raghav Das medical college in Gorakhpur and hold a meeting with the state health officials during their day-long visit.

...
http://www.hindustantimes.com/UP-encephalitis-toll-rises-govt-takes-stock/Article1-759386.aspx

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Azad's visit to encephalitis-hit state ends with blame game
Shailvee Sharda, TNN | Oct 22, 2011, 05.21AM IST


LUCKNOW: Union health minister Ghulam Nabi Azad blamed UP government for not being able to tackle the encephalitis epidemic in the state. The disease has killed 465 children in 2011 alone in Uttar Pradesh.

He said, "Health is a state subject and a more serious effort was needed to manage the situation here." However, he also said he would speak to prime minister Manmohan Singh over the issue.

...
Azad said, "A coordination committee comprising Union ministries of health, water resources and irrigation, social justice and women and child welfare would be formed after a discussion with the prime minister. The committee will make a coordinated effort to tackle the problem." Azad also said, "The UP government must take immediate steps to save lives. It must think about the children who have survived the disease as majority of them have mental and behavioural problems. The Centre had given funds for the department of physical medicine and rehabilitation but the grant is lying unutilised. The department must come up soon in patients' interest."
...
The NICD also blamed 'khichwa' (locally made cast iron hand-pump) as a major factor behind the disease. The hand pump is the main source of drinking water in the region. Stating that prevention is the only way to save lives, Azad said, "Aspect of prevention involves active participation from ministries of water management and rural development. Social welfare department also needs to pitch in for spreading awareness about the issue."

Locals were, however, disappointed over the political nature of the health minister's visit. "We were hoping for some concrete steps but he simply blamed the state government for whatever is happening. The entire exercise was conducted surely with Vidhan Sabha elections 2012 in mind," said a local NGO member.
http://timesofindia.indiatimes.com/...ends-with-blame-game/articleshow/10448148.cms

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

No central funds to check Encephalitis: UP govt
Last Updated: Sunday, October 30, 2011, 21:02

Lucknow: Uttar Pradesh government on Sunday blamed the Centre for not releasing Rs 300 crore to check the spread of Encephalitis, while rejecting Union Health Minister Ghulam Nabi Azad's claim that lack of sanitation and proper drinking water was hampering the battle against the disease.

"The state has done whatever it can from its limited resources to check spread of Acute Encephalitis Syndrome (AES). The state has sent Rs 300 crore proposal for providing sanitation and proper drinking water in eastern UP but it has not been accepted," a health department spokesman said here.


Reacting to media reports regarding Health Minister's letter to state government, he said till date no such letter was received by the government.
...
http://zeenews.india.com/news/uttar...nds-to-check-encephalitis-up-govt_738976.html

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years; UP-Centre Blame game continues; UNICEF offers assistance

Re: Whose failure? Encephalitis kills 50,000 in 30 years; UP-Centre Blame game continues; UNICEF offers assistance

Centre-UP spat over encephalitis continues
TNN | Oct 31, 2011, 07.22AM IST

LUCKNOW: A day after Union health minister Ghulam Nabi Azad said that the Centre has played a proactive role in curbing Japanese encephalitis cases in eastern UP, a state government spokesperson said that the immunisation initiative undertaken by them proved to be useful.

Azad had said that since 2006, Union health ministry officials had visited the place 17 times and insisted that the second shot of JE vaccine be given to children in the affected area.

UP government instead said that Centre has been apathetic to the cause of dying children. "Projects worth Rs 300 crore to ensure safe drinking water and improve sanitation conditions in the area are pending with the Centre," said an official statement.

...
http://timesofindia.indiatimes.com/...cephalitis-continues/articleshow/10549674.cms

UNICEF to help in eradication of encephalitis in UP


Oct 31, 9:45 AM
The United Nations Children's Fund - UNICEF will help in eradication of various forms of encephalitis that claim hundreds of life in eastern Uttar Pradesh every year. A team headed by the UNICEF’s State Coordinator Vakeel Ahmad visited the affected area to take stock of the situation. Union Health Minister Ghulam Nabi Azad also visited the affected areas in Gorakhpur and Basti divisions and announced that the Centre will adopt a multi-pronged strategy to tackle the disease.

The medical experts have identified two types of encephalitis in the region. One is Japanese Encephalitis which is caused by the mosquito bite. Another type is caused by the contaminated water. The experts claim that JE has been tamed to certain extent due to repeated vaccination in the area.

The water-borne encephalitis needs a multi-pronged approach to control it. Sanitation and purification of drinking water sources is core issue that needs to be talked. UNICEF has now taken up the task of educating the people about hygiene and importance of clean drinking water. The death toll due to encephalitis has crossed 500 mark this year and 90% of the cases are caused by the contaminated water. There are several centrally sponsored schemes like Total Sanitation, Swajal Dhara and Rajiv Gandhi Drinking water Mission that are meant for sanitation and safe drinking water. The need of the hour is to pool resources from these schemes and to provide a clean and healthy environment in the encephalitis affected areas of eastern UP.

http://www.newsonair.com/news.asp?cat=state&id=ST7744

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Very nice article from Inda's Frontline Magazine. Please follow the link to read in full.

Apathy virus


T.K. RAJALAKSHMI
in Gorakhpur


Absence of preventive measures and affordable and accessible health care leads to nearly 500 encephalitis deaths in Uttar Pradesh.


IT is a strange paradox. In a country that aspires to be a superpower and boasts of rapid economic growth, 488 children died in a State, Uttar Pradesh, from encephalitis alone this year. It is nothing less than a national shame and tragedy. In six districts of Bihar, close to 200 children died this year. These are deaths that occurred in hospitals and hence were reported; the actual toll could be far higher.

Most of the deaths have been due to viral encephalitis caused by an enterovirus, but a few cases have been attributed to Japanese encephalitis (JE), too, which has once again raised the demand for mass JE vaccination. Last year, until December 2010, there were 3,350 encephalitis admissions in hospitals but fewer deaths. The admissions this year until October have been around 2,600, but the mortality rate has been high; the number of admissions may cross 3,000 by 2011-end.

The clamour for the JE vaccine is justifiable, and the fact is that it is much needed despite its high production costs, and the Central government needs to ensure its universal availability. But what has brought matters to such a pass is the abject lack of simple preventive measures, coupled with a total absence of affordable, timely and accessible health care. It is also not a coincidence that most of the children admitted to hospitals were severely malnourished and already in what is called an immune-compromised state. This implies that the enterovirus outbreaks mainly affected the poor.

...
http://www.frontline.in/stories/20111118282303200.htm

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Encephalitis: Govt forms GoM, but Mayawati demands financial aid
CNN-IBN

New Delhi: The fight against encephalitis has now taken a political turn. The Centre has formed a Group of Ministers (GoM) to tackle the crisis, but the Mayawati government is insisting on a Rs 300 crore aid instead.

Under heavy criticism for first ignoring this medical emergency and then putting the blame on the Uttar Pradesh government, the Centre finally decided to act. The government set up a GoM headed by Health Minister Ghulam Nabi Azad to come up with steps to deal with the crisis. But the question is whether a GoM will actually help.

...
http://ibnlive.in.com/news/encephalitis-govt-forms-gom-but-maya-wants-aid/199885-37-64.html

 

[alert]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Way to go, Ronan!

http://www.promedmail.org/

Published Date: 2011-11-07 09:09:10
Subject: PRO/EDR> Japanese encephalitis & other - India (33): (MA) comment
Archive Number: 20111107.3311

JAPANESE ENCEPHALITIS AND OTHER - INDIA (33): MAHARASHTRA, COMMENT
******************************************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Sun 6 Nov 2011From: Prabhjot Singh


[Re: ProMED-mail Japanese encephalitis & other - India (32): (MA)
20111106.3302]
----------------------------------------------------------------------
It's not strange to see these cases of encephalitis appearing in
Mumbai. Mumbai, being a hub, has a high number of people from the
affected states of UP and Bihar that work as temporary workers in the
city. The appearance of disease after Diwali [festival of lights], in
the last week of October, when a large number of these migrant workers
visit their homes in the north of the country, should point towards
imported cases than actual transmission in the city. Also, it might
point towards the higher than estimated transmission of the yet
undiagnosed etiological agent in the Northern states of the country.

--
Communicated by:
Prabhjot Singh


[ProMED-mail thanks Prabhjot Sing for these interesting comments. It
would be of interest to know the recent travel histories of the
patients involved to know, as Dr Singh suggests, if these are all
imported cases or have been locally acquired. Ronan Kelly of
FluTrackers suggested that Chandipura virus infection should be
considered as a possible etiologic agent in some of these recent
(2011) encephalitis cases in India (see ProMED-mail archive no.
20100807.2690). Laboratory tests are needed to confirm or rule out
this possibility.

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Criminal neglect

''Public health should become a priority.''


Encephalitis has emerged as a major killer disease in Uttar Pradesh, Bihar and West Bengal, with hundreds of people, especially children, succumbing to it in recent weeks.
...
Even when it did not kill, it left thousands of people with lasting physical damage. It is a seasonal disease which afflicts people during the monsoon and post-monsoon months and is caused by mosquitoes that proliferate during this period. (Again misinformation proliferates - the majority of cases are not Japanese encephalitis, but are apparantly caused by contaminated water - Ro)

...

The Central government has constituted a GoM to deal with the situation but according to reports no serious action is taken on the ground to contain the epidemic. The human rights commission has issued a notice to the state and both the state and Central government have blamed each other for inaction. It is only through effective steps to check the spread of mosquitoes, limiting the chances of their being hosted by animals like pigs, improving sanitary and hygienic conditions and increasing public awareness about the causes and methods prevention of disease that it can be brought under control.

Vaccination is effective against a particular strain of mosquitoes that causes the disease. But it has not been undertaken in many of the areas which became susceptible to the epidemic.

...

As in the case of most other diseases preventive steps are best in the case of encephalitis. There is the need for a sustained and motivated campaign year after year but the authorities, both at the Centre and in the states, have been found wanting in that.
http://www.deccanherald.com/content/205791/criminal-neglect.html

I agree that prevention is better than cure, but if the disease is caused by contaminated water, all the vaccination and mosquito prevention in the world is not going to stop it. Prior to spending scarce health money on remediation efforts, it is essential to identify the pathogen and the means of infection. This is the basis for prevention and continues to be overlooked in this debate - Ro

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

GoM on encephalitis focuses on sanitation, safe drinking water
Express news service

Posted: Tue Nov 22 2011, 03:08 hrs
New Delhi:

...

Faced with these compelling statistics, the first meeting of the GoM on JE focused on the lack of basic amenities such as sanitation and safe drinking water as the reason for the yearly outbreaks of the viral infection, asking the concerned ministries to fix these problems.

The GoM comprises, apart from Health Minister Ghulam Nabi Azad, Urban Development Minister Kamal Math, Minister for Social Justice and Empowerment Mukul Wasnik and Minister of Rural Development, Drinking Water and Sanitation Jairam Ramesh.

...
http://www.indianexpress.com/news/G...es-on-sanitation--safe-drinking-water/878963/

GoM meets to deal with water-borne disease AES
TUESDAY, 22 NOVEMBER 2011 00:40 PNS | NEW DELHI HITS: 49
User Rating: / 0
PoorBest
The Group of Ministers (GoM), set up to work out an action plan to deal with the deadly Japanese Encephalitis and Acute Encephalitis Syndrome (AES) that have claimed over 850 lives so far this year across the country, met for the first time on Monday but could not reach any decision on the way forward.

The GoM will now again meet on Friday even as the water-borne disease has spread its tentacles in 135 districts in 16 States.

“Only the broad contours of the action plan were discussed but a decision on the logistics to tackle the disease at the ground-level remains to be taken,” sources said.

...

http://dailypioneer.com/nation/22252-gom-meets-to-deal-with-water-borne-disease-aes.html

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Homoeopathy clinical trials on JE patients soon .
Saturday, 03 December 2011 00:22 Archana Jyoti | New Delhi

Can homoeopathy help curb killer disease Japanese Encephalitis (JE) which has claimed over 1,000 lives across the country this year? To ascertain this, the Central Council for Research in Homoeopathy (CCRH) of the Health Ministry will soon start clinical trial of homoeopathy on the JE patients in disease endemic zone, Gorakhpur in Uttar Pradesh, to test its efficacy.

Over 450 people have died in Gorakhpur so far due to JE. The first-of its kind, trial would be undertaken at BRD Medical College in Gorakhpur on 100 patients, mostly children, affected with the disease. As per treatment protocol, two groups of 50 patients each would be formed. One group would be subjected to allopathy medicine while the other would be administered allopathy as well as homoeopathy medicines, Professor C Nayak, former director of the CCRH told The Pioneer.

He said treatment protocol for the two-and-a-half year study has already been approved by Scientific Advisory Committee of CCRH and a positive result from the study on humans will not only silence the sceptics of homoeopathy but would also help in curbing the fatal disease.

The need for trial to test homoeopathy came as it was found that JE vaccination among children has failed to deliver results with the menace continuing to spread its tentacles. A total over 7,137 cases have been reported till November this year. (JE vaccination cannot stop the 80+% of encephalitis cases that are not caused by JE! This is not a failure of the vaccine - this is a failure by state and national governments to find the cause of the illness -Ro)

Under the study, the health status and rehabilitation speed of the two groups of patients will be compared to gauge the effectiveness of homoeopathy medicine. "For instance, if the results show that the patients getting allopathy with the addition of homoeopathy have better survival rate or show speedy recovery, then it means alternative Indian Medicine System has efficacy in treating the disease," Nayak said.

The homoeopathy experts are hopeful of positive results. A study by researchers at Kolkata's School of Tropical Medicine and the CCRH showed that the homeopathic medicine Belladonna prevented infection in chick embryos infected with the JE virus.

Moreover, second phase trials for the same study have also shown encouraging results, Prof Nayak said and informed that mice which were given the medicine were able to fight better. "The observations have been published in an American journal of infectious diseases."

http://www.dailypioneer.com/nation/25029-homoeopathy-clinical-trials-on-je-patients-soon.html



American Journal of Infectious Diseases 6 (2): 24-28, 2010
ISSN 1553-6203
© 2010 Science Publications
Corresponding Author: Bhaswati Bandyopadhyay, Department of Microbiology, Virology Unit, School of Tropical Medicine,
Kolkata-700073, India
24
Decreased Intensity of Japanese Encephalitis Virus Infection in Chick
Chorioallantoic Membrane Under Influence of Ultradiluted Belladonna Extract
1Bhaswati Bandyopadhyay, 2Satadal Das, 1Milan Sengupta, 3Chandan Saha,
4Kartick Chandra Das, 4Debabrata Sarkar and 5Chaturbhuj Nayak
1Department of Microbiology, Virology Unit, School of Tropical Medicine, Kolkata-700073, India
2Department of Pathology and Microbiology, D.N. De H. Medical College,
West Bengal University of Health Sciences, Kolkata-700046, India
3Department of Clinical and Experimental Pharmacology,
School of Tropical Medicine, Kolkata-700073, India
4Drug Proving Research Centre, CCRH, Government of India,
Kolkata-700 046, India
5Department of AYUSH, Ministry of Health, CCRH, Government of India, JLN Anudandhan Bhawan,
61-65 Intitutional Area, Janakpuri, New Delhi 110058

Abstract: Problem statement: No specific antiviral therapy is currently available despite an
emergence and resurgence of Japanese encephalitis in South-East Asian Countries. There are only few
recent studies, which were aimed to treat Japanese encephalitis with newer drugs. There is thus a real
need for study on antiviral agents that can reduce the toll of death and neurological sequelae resulting
from infection with this virus. Approach: Optimum dilution of the JE virus was determined which
could produce significant number of pocks on Chorioallantoic Membrane (CAM). Then ultradiluted
belladonna preparations were used to see their inhibitory action on JE virus infection in CAM.
Results: Ultradiluted belladonna showed significantly decreased pock count in CAM in comparison to
JE virus control. Conclusion: Ultradiluted belladonna could inhibit JE virus infection in CAM, which
may be mediated through glycosidase inhibitory role of calystegines present in belladonna.

...
full paper at; http://homeopathyplus.com.au/belladonnastudy.pdf

VERTICAL PREVENTIVE ROLE OF BELLADONNA 200 ON JAPANESE ENCEPHALITIS VIRUS INFECTION IN SUCKLING MICESession ID: M23
Author Name(s): Bhaswati Bandyopadhyay, Milan Sengupta, C.Saha, K. C. Das, Satadal Das, and Chaturbhuj Nayak
Organization: Dept. of Virology, School of Tropical Medicine, Kolkata & CCRH
Conference Session: Session II

Background:Approximately two billion people live in countries where JE presents a significant risk to humans and animals, particularly in China and India, with at least 700 million potentially susceptible children. Although most human infections are mild or asymptomatic, about 50% of patients who develop encephalitis suffer permanent neurological defects, and 30% of them die due to the disease. There is thus a real need for antiviral agents that can reduce the toll of death resulting from infection with JE virus. Therefore, this study was aimed to see whether Belladonna 200 has a preventive role in this infection.
Materials and Methods: For this study we selected Belladonna 200. The aqueous solution of above-mentioned alternative homeopathic medicine was procured from a local reputed homeopathic drug company, HAPCO, Kolkata. For control study, the Potentized distilled water 200 was also procured from HAPCO, Kolkata. JE virus stock ( Nakayama strain) which was maintained in School of Tropical Medicine, Kolkata was used in this study. In experimental group mothers were treated with Belladonna 200 in two groups - in one group (group I) mothers were treated for 7 days and in the other group (group II) mothers were treated for 14 days. There was a control group in which mothers were not treated with belladonna 200. The suckling mice in each group were challenged with JE virus following standard protocol.
Results: Mean ± Standard deviation± Standard error of mean survival rate(%) in control group (N=44), group I (N=40) and group II (N=32) were respectively 49.32±27.15±4.52, 86.63±7.02±1.17 and 85.58±10.22±1.70. The differences between control group and experimental groups were highly significant (p value <0.01), however, there was no significant difference between the two experimental groups.
Conclusion: In conclusion, we may claim that Belladonna 200 has got a preventive role on JE virus infection in suckling mice when mothers were treated with this alternative medicine.

http://pascv2010.ivdnews.net/public/show_abstract/649.html


You should follow the link to read this full blog entry below - Ro;

Homeopathic Belladonna in Japanese Encephalitis? Naah!

Posted by Kausik Datta on Apr 26, 2011

Heh! Right now I have this stupid grin on my face, because I caught this glaring error in a published paper. Okay, it is a paper on homeopathy referenced in a godawful homeopathy website (that I mentioned in my yesterday's write-up), but nevertheless.

....

Let me be very clear: Atropa belladonna and its derived alkaloids ≠ ultradiluted homeopathic belladonna used in this study. Ain't quite the same.

I should also clarify that the doses used (3, 6, 30 and 200 - the authors don't mention the designation) possibly refer to 3, 6, 30 and 200X (the 'X'-designation is prevalent in India, the source of the preparations), which mean, respectively, the dilutions of a thousandth (10-3), a millionth (10-6) - both being fairly plausible dilutions, with reasonable amounts of the original alkaloid left - to be followed by 10-30 and 10-200 - both of which are ridiculous dilutions in which no remnant or trace of the original alkaloid can possibly remain. At these dilutions, only the solvent and dissolved impurities are around.

...

As you can see, they claim significance of the homeopathic dilutions, because the number of pock marks is significantly less with their administration, than with the virus alone. It is indeed significant (but not in the way the authors intended) that they chose not to show any data from the controls, just restricting the observation to 'no significant finding' for the control.

The authors also chose to ignore a very vital comparison: Even in absence of the homeopathic therapy (i.e. in the virus control), the virus-induced pock marks vary significantly (p<0.001, I plugged the numbers to check) from experiment to experiment - say, between the controls for the belladonna 3 and 30 test groups, which should have been nearly identical, because conditions are the same. This inherent/experimental variability in their control groups immediately invalidates their conclusion of difference between control and test groups, because one cannot satisfactorily estimate if the observed effect is due to the treatment or simply random chance events.

The authors also fail to mention why a higher dilution (therefore, more potent according to homeopathic principles) of 6X ends up with more pock marks than a lower dilution (3X). They plot the average counts in the paper, but the graph contains no error bars, leaving no visual means to ascertain the dispersal of their test data vis-à-vis the control.

So, in conclusion, for a study that is hailed by the homeopathy website(s) as the evidence that a homeopathic nostrum works against the JE virus, the study is inadequate (only ex vivo), as well as plain darn wrong because it draws wrong conclusions stemming from a major logical flaw: confirmation bias. The authors saw in the observations only what they wanted to see, and didn't analyze the data critically. This study is sloppy, and I honestly wonder how it even passed peer review to be published in the American Journal of Infectious Disease (admittedly not a journal with whose academic standards I am familiar).

...

http://blogs.nature.com/kausikdatta/2011/04/26/homeopathic-belladonna-in-japanese-encephalitis

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Report on Death of Children in Uttar Pradesh
The National Commission for Protection of Child Rights (NCPCR) had called for a report from the Government of Uttar Pradesh regarding deaths of children in the State, the Minister of Women & Child Development Smt. Krishna Tirath revealed this in Rajya Sabha today in written reply to a question.

The Minister further stated that the Commission has received the report. As per report, 462 children died from Acute Encephalitis Syndrome (AES) and 27 children died from Japanese Encephalitis (JE) in 2011 (as on 31st October, 2011). The State has further informed that a special immunization drive was carried out in 2006 and again in 2010 for Japanese Encephalitis (JE) in Gorakhpur district. Thereafter a regular immunization programme has covered 32,421 children till September, 2011.

She also said that as per the report, reason of AES in more than 50% of the cases is not known. (looking at the numbers above, I would say the cause of death is unknown in 94% of cases -Ro)Investigation for the reasons is going on in Gorakhpur Unit of National Institute of Virology, Pune. Once the reason is known, effective initiative can be planned.

******


DK/BS
(Release ID :78300)
http://pib.nic.in/newsite/erelease.aspx?relid=78300

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

NCPCR Recommends to UP Govt. For Stern Measures to Deal With Japanese Encephalitis




National Commission for Protection of Child Rights (NCPCR) team led by Dr. Yogesh Dube (Member), visited Japanese Encephalitis affected areas of Gorakhpur division, i.e., Gorakhpur, Kushinagar and Deoria districts of Uttar Pradesh during 5th ? 8th December, 2011. Following are the recommendations to the Uttar Pradesh government:-



? All the PHC and CHCs must be strengthened to provide immediate medical assistance to the patients. The district hospitals must be developed as the super specialized hospitals to treat the cases of J.E and A.E.S and special high tech virology laboratory must be set up;

? Every P.H.C, C.H.C and district hospitals shall have Citizen Charter or list of facilities available for public information;

? Ensure approval of the proposals sent by the districts to curb Japanese Encephalitis and Acute Encephalitis Syndrome on priority basis;

? Arrange a team of expert doctors from AIIMS, Dr. Ram Manohar Lohia Hospital and other national level institutions and sent them for the screening of patients so that clear identification of the cases could be done as soon as possible;

? Visit of team of doctors on rotation basis from other medical colleges to work in the affected areas for short period of time so that they can provide their services as well as train the doctors working in the affected areas under their guidance;

? All the vacant post of doctors and paramedical staff must be filled as soon as possible:

? A survey must be conducted to find the number of persons who became disabled due to J.E and A.E.S and a proper rehabilitation plan must be prepared;

? Special attention must be given to the children who are suffering from malnutrition and a survey must be conducted to know the exact details of Gorakhpur and Basti Division and district administration must ensure that no case of malnutrition exists;

? The administration must fix the accountability of every death that took place so that quick and stern action is taken against erring officials;

? Administration can send a proposal to Central Government to add the immunization of J.E and A.E.S in the National Eradication/Immunization Programme;

? Pediatric Ventilators and other machines must be made available to all the district hospital. Every district hospital in affected areas must have a dedicated well equipped 25 beds ward for the J.E and A.E.S patients;

? Ensure formation of a district level committee under the District Magistrate in all the affected districts with appropriate support from the State task force, which will review the situation in every 15 days and will report to the Principal Secretary, Health and also send a copy of the report to the Commission;



? Ensure a Joint Committee at Divisional level under the Divisional Commissioner with representation from Panchayati Raj institutions, Social Welfare Department, Women and Child Development Department, Health Department, Public Health and Engineering Department and Rural Development and Education department. There shall be representation from the civil society as well;

? Every affected district should make an Action Plan and Citizen Charter for long term intervention and immediate intervention to check the epidemic at the earliest in line with the Project Implementation Plan (PIP) developed for Kushinagar district. In the action plan special emphasis must be given to the best interest of the children;

? All the shallow hand pumps must be identified, sealed and replaced with India Mark II hand pumps and these must reach the depth as prescribed by the government norms. Alternative water sources must be developed like water supply through the taps or Rain water Harvesting system in the schools at least on a priority basis;

? Projects of IEC and BCC activities must be approved on a priority basis and a campaign must be carried out in every affected village to sensitize the people about J.E and A.E.S. with active support and co-operation of local NGOs;

? Overall infrastructure of all the laboratories testing the AES and JE samples at district level must be reviewed at the earliest and a report must be sent to the Commission within a month?s time. Increase the number of labs in the affected districts before the next monsoon;

? Water contamination in all the affected areas should be checked on a regular basis. All the sources which are found contaminated should be marked. All the laboratories which are testing water must check the samples of affected areas on priority basis;

? Proper surveillance system must be developed in all the affected areas and a report on this must be shared with the Commission;

? Ensure filling of the pits causing water-logging and breeding of mosquitoes and sprinkling of bleaching powder regularly;

? Vector transmission should be interrupted at the earliest. Vaccination/ Immunization drive must be carried out on a campaign mode to reach every section of the society;

? Every district must have adequate number of fogging machines to carry out fogging in a campaign mode in all the affected areas and the responsibility of monitoring shall be with the gram panchayats;

? Special sanitation and cleanliness drive should be carried out in the affected areas and a report must be sent to the Commission within 2 months; and

? All the committees at village and Panchayat level like Village Water and Sanitation Committee, Village Health Committee etc. must be activated and sensitized about the J.E and A.E.S. Total Sanitation Campaign and School Sanitation and Health Education programmes must be started in all the affected villages/panchayats;

? Training programme for all the doctors working in the area for proper sensitization about the issue and skill development to handle the cases; and

? Ensure profiling and auditing of patients to develop case studies of each patient and also study the recurrence of the disease in the patients.

KKP/bs


(Release ID :78732)

http://pib.nic.in/newsite/erelease.aspx?relid=78732

 

[Ronan Kelly]

Re: Whose failure? Encephalitis kills 50,000 in 30 years

Drive to combat Japanese Encephalitis soon
Kounteya Sinha, TNN | Dec 17, 2011, 05.40AM IST


NEW DELHI: India will soon roll out a national programme to combat Japanese Encephalitis (JE).

Union health minister Ghulam Nabi Azad, who heads a group of ministers (GoM) against JE and Acute Encephalitis Syndrome (AES), will soon send the detailed plan to ministers Jairam Ramesh, Krishna Tirath, Mukul Vasnik and the Prime Minister's Office for final approval.

Once vetted, the programme will be placed before the Cabinet. Sources told TOI the programme, which includes replacement of shallow hand pumps by deep bore hand pumps in acute encephalitis syndrome-affected districts, setting up of ICU wards, especially for JE patients in all district hospitals and identifying the most undernourished children and providing them higher nutrition to fight the virus will first be rolled out in 60 districts in West Bengal, Bihar, Uttar Pradesh, Tamil Nadu and Assam.

Around 10 medical colleges in these states are being identified that will house physical and medical rehabilitation units for JE/AES patients. A ministry official told TOI that "The GOM has met thrice till now, and finalized the provisions of this national programme. We expect it to roll out early next year. Among the 171 districts affected with JE/AES, we will first take up 60," he said.

...
http://timesofindia.indiatimes.com/...se-Encephalitis-soon/articleshow/11140076.cms