Re: Uttar Pradesh: 2010 Encephalitis cases - Toll reaches 541
Re: Uttar Pradesh: 2010 Encephalitis cases - Toll reaches 541
Archive Number 20101231.4604
Published Date 31-DEC-2010
Subject PRO/AH/EDR> Japanese encephalitis & other - India (28): (UP)
JAPANESE ENCEPHALITIS AND OTHER - INDIA (28): (UTTAR PRADESH)
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Thu 30 Dec 2010
From: TJ John <tjacobjohn@yahoo.co.in> [edited]
The Gorakhpur region in eastern Uttar Pradesh (UP) is a paddy (rice)
cultivating area. That means the combination of Culicine mosquitoes
that breed in rice fields and water birds that develop Japanese
encephalitis (JE) viremia. Thus, it is a JE affected eco-type area; in
2006 and since then some JE vaccination (Chinese live SA14-14-2) has
been going on. In 2006, when a mass campaign was conducted, the
prevalence plummeted. Since then the EPI [Expanded Program on
Immunization] mode of vaccine delivery is beset with many problems, so
JE continues relentlessly. The National Institute of Virology [NIV]
(of Pune, Maharashtra, an ICMR [Indian Council of Medical Research]
Centre) has established a field station in Gorakhpur for
investigations. That is how we know that there are JE cases and non-JE
cases.
The non-JE "acute encephalitis syndrome" could be one or more
conditions. Enterovirus(es) have been proposed since both the field
station and the Lucknow Medical College virologist have isolated many
enteroviruses including a rare isolate from CSF. The NIV people
discount the enterovirus theory but the Lucknow people insist it is an
enterovirus disease.
It cannot be an enterovirus syndrome since it is annually recurrent
and geographically confined. Enteroviruses spread widely. My guess is
that it may not even be a viral syndrome -- virologists look only for
viruses. It could even be a non-infectious problem (such as the
'hepatomyoencephalopathy' we have described in western UP -- it was
called Saharanpur encephalitis for over 2 decades and investigated by
NIV repeatedly. Our systematic studies showed it to be _Cassia
occidentalis_ poisoning of children who ate lots of the beans. A
Google search on Saharanpur encephalitis is a way to search or look
for hepatomyoencephalopathy, or else I can send a series of
publications.
--
Dr T Jacob John
Department of Clinical Virology
Christian Medical College
Vellore, Tamil Nadu
India
<tjacobjohn@yahoo.co.in>
[ProMED-mail is grateful to Dr John for his comments.
As Dr John indicated, clearly a health landscape view ("healthscape")
is essential to determine the etiology and epidemiology of the cases
of encephalitis that have been going on in this area of Gorakhpur.
Until that information is in hand, prevention and control will not be
possible. Vaccination to prevent Japanese encephalitis virus
infections will be helpful, but for less than half the reported cases.
Another (other) etiological agents that are endemic in the area must
be involved in the cases termed acute encephalitis syndrome. Dr John
mentions possible involvement of the plant _Cassia occidentalis_ (or
_Senna occidentalis_) with the common name of coffee senna or
coffeeweed. It contains toxins in all parts (seeds, roots, leaves,
fruits). The symptoms of intoxication include diarrhea, tremors and
dark brown urine if plant parts are consumed in large quantities. The
toxic compounds in it include anthraquinones, emodin glycosides,
toxalbumins, and alkaloids.
A map showing the location of Uttar Pradesh state can be accessed at
<http://www.indianorphanages.net/images/india-political-map.gif>.
A HealthMap/ProMED-mail interactive map of India is available at
<http://healthmap.org/r/02lp>. - Mod.TY]
[see also:
Japanese encephalitis and other - India (27): (UP) 20101228.4576
Japanese encephalitis and other - India (26): (UP) 20101204.4351
Japanese encephalitis and other - India (25): (UP) 20101105.4006
Japanese encephalitis and other - India (24): (UP) 20101014.3727
Japanese encephalitis and other - India (23): (UP) 20101013.3711
Japanese encephalitis & other - India (22): (UP) 20101001.3568
Japanese encephalitis & other - India (21): (UP) 20100929.3525
Japanese encephalitis & other - India (20): (UP) 20100921.3402
Japanese encephalitis & other - India (18): (UP, BH) Nepal 20100915.3340
Japanese encephalitis & other - India (10): (AS) 20100805.2646
Japanese encephalitis & other - India (09): (UP) 20100728.2535
Japanese encephalitis & other - India (08): (ML) 20100723.2473
Japanese encephalitis & other - India (07): (MN) conf. 20100716.2380
Japanese encephalitis & other - India (02): (AP) 20100422.1309
Japanese encephalitis & other - India: (UP) 20100416.1236]
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