Re: India Encephalitis 2014 - 1,210 fatalities
Re: India Encephalitis 2014 - 1,210 fatalities
Volume 20, Number 8—August 2014
Letter
Decline in Japanese Encephalitis, Kushinagar District, Uttar Pradesh, India
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To the Editor: Kakkar et al. recently concluded that the low-quality surveillance data on acute encephalitis syndrome (AES)/Japanese encephalitis (JE) in Kushinagar District, India, provide little evidence to support development of prevention and control measures and to estimate the effect of interventions (1). Analysis of the surveillance data, however, does provide evidence supporting the effect of an ongoing intervention (i.e., JE vaccination).
In accordance with the surveillance protocol, cerebrospinal fluid and/or serum samples from AES patients admitted to the Baba Raghav Das Medical College (Gorakhpur, India) are tested for IgM against JE at the field laboratory of National Institute of Virology (NIV) at Gorakhpur (2). The samples are tested by using the ELISA developed by NIV Pune (Pune, India), which has a specificity of 85% (range 77%–95%) and sensitivity of 71% (range 71%–75%) (3). Patients with samples negative for JE are considered to have JE-negative AES.
Thumbnail of Annual incidence of Japanese encephalitis (JE) and JE-negative acute encephalitis syndrome (AES), Kushinagar District, Uttar Pradesh, India, 2008–2012.
Figure. Annual incidence of Japanese encephalitis (JE) and JE-negative acute encephalitis syndrome (AES), Kushinagar District, Uttar Pradesh, India, 2008–2012.
We obtained the line-list of AES patients from the NIV laboratory at Gorakhpur for 2008–2012. Analysis of the surveillance data indicated that 251 (8.2%, range 4%–14.7%) of the 3,047 AES patients from Kushinagar were positive for JE IgM and therefore considered to be JE case-patients. JE incidence per 100,000 persons in the district declined from 2.3 cases in 2010 to 0.81 in 2011 to 0.58 in 2012 (Figure). The decline in JE incidence since 2010 could be a consequence of JE vaccination activities in Kushinagar. In 2010, a mass vaccination campaign with 1 dose of JE vaccine (SA 14–14–2 strain) was conducted among children 1–15 years of age. Subsequently, the vaccine was introduced into the childhood vaccination program as a 1-dose strategy in 2011 and a 2-dose strategy in 2013. Unfortunately, information about evaluated coverage of JE vaccine is not available from the district. On the other hand, the average annual incidence of JE-negative AES during the same period was 16 cases per 100,000 persons (95% CI 14.8–17.2), and this incidence has remained relatively stable since 2008.
With the isolation of enteroviruses from JE-negative AES patients, waterborne transmission has been hypothesized, and the focus of intervention has shifted toward improving sanitation and water quality. However, enteroviruses were detected only in a small proportion of AES patients. Although the quality of AES surveillance needs to be improved, as Kakkar et al. suggested (1), further studies are needed to understand the etiology of JE-negative AES in the district and the risk factors for transmission. These studies might include systematically investigating patients and environmental samples for enteroviral and other etiologic agents.
Prashant Ranjan, Milind Gore, Sriram Selvaraju, K.P. Kushwaha, D.K. Srivastava, and Manoj MurhekarComments to Author
Author affiliations: Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India (P. Ranjan, S. Selvaraju, M. Murhekar); Indian Council of Medical Research, National Institute of Epidemiology, Gorakhpur, India (M. Gore); Baba Raghav Das Medical Collage, Gorakhpur (K.P. Kushwaha, D.K. Srivastava)
References
Kakkar M, Rogawski ET, Abbas SS, Chaturvedi S, Dhole TN, Hossain SS, Acute encephalitis syndrome surveillance, Kushinagar District, Uttar Pradesh, India, 2011–2012. Emerg Infect Dis. 2013;19:1361–7 . DOIPubMed
Directorate of National Vector Borne Diseases Control Programme. Guidelines for surveillance of acute encephalitis syndrome (with special reference to Japanese encephalitis) [cited 2013 Sep 11].
http://www.nvbdcp.gov.in/Doc/AES guidelines.pdf
World Health Organization Regional Office for Southeast Asia. Fourth bi-regional meeting on the control of Japanese encephalitis. Report of the meeting Bangkok, Thailand, 7–8 June 2009 [cited 2013 Aug 15].
http://www.wpro.who.int/immunization/documents/docs/JEBiregionalMeetingJune2009final.pdf
Figure
Figure. Annual incidence of Japanese encephalitis (JE) and JE-negative acute encephalitis syndrome (AES), Kushinagar District, Uttar Pradesh, India, 2008–2012.
Suggested citation for this article: Ranjan P, Gore M, Selvaraju S, Kushwaha KP, Srivastava DK, et al. Decline in Japanese encephalitis, Kushinagar District, Uttar Pradesh, India [letter]. Emerg Infect Dis [Internet]. 2014 Aug [date cited].
http://dx.doi.org/10.3201/eid2008.131403
DOI: 10.3201/eid2008.131403
http://wwwnc.cdc.gov/eid/article/20/8/13-1403_article
Encephalitis virus in Kushinagar looking for a team of American scientists
Dainikbhaskarlcom | Sep 18, 2,014, 7:22 p.m. PM IST
Gorakhpur. Purvanchal Inseflaitis and her continuing to explore deaths occurred due to the CDC (Centers for Disease Control) in Atlanta, the American team of scientists is working on the third day of his campaign. Inseflaitis team BRD Medical College Kushinagar visiting with children suffering from the disease related details collected at ground level.
Kushinagar team of American experts arrived on Thursday. PHCs and CHCs village of Kushinagar affect the team on the field where the most number of patients in the BRD Medical College Inseflaitis come. The team was in some affected villages and interacted with the local people or the victims' families. The team took samples from many places.
National Institute of Virology and investigation team also took stock of the arrangements. Last Wednesday, the team reached the district hospital and encephalitis with Saisi talks on the issue.
...
http://www.bhaskar.com/news/UP-GOR-...irus-kushinagar-latest-news--4749262-PHO.html
Inseflaitis claimed six more lives
Publish Date: Thu, 18 Sep 2014 08:08 PM (IST) | Updated Date: Thu, 18 Sep 2014 08:08 PM (IST)
Jagran correspondent,
Gorakhpur:
Inseflaitis recruitment of patients and deaths continues. BRD Medical College in the last twenty-four hours, while in the nineteen new patients were admitted and six others were killed. Nehru admitted 220 patients are being treated in hospital.
Those who were admitted to five Gorakhpur, Kushinagar six, three in Bihar and Deoria, Maharajganj, Sntkbirnagr, Ballia and Siddharth are in one patient. Medical College from January till the year 1235, of which 351 patients have been admitted have died.
http://www.jagran.com/uttar-pradesh/gorakhpur-city-11639370.html
375 deaths including thos in other hospitals - Ro
