Ronan Kelly
Retired 2020
Despite promise to end Encephalitis and other NTDs by 2030, why is action missing?
December 26,2015, 03.34 PM IST | | The Hans India
Indian government along with other governments of UN member countries had adopted the Sustainable Development Goals (SDGs) at the 70th UN General Assembly in New York in September 2015. One of the SDG targets (3.3) promises that "By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases (NTDs) and combat hepatitis, water-borne diseases and other communicable diseases." Encephalitis, one of the NTDs, continues to severely impact under-15 year old people with very little well-coordinated response to contain, and eventually eliminate it. Why?
...
AIIMS Patna, Epidemic Investigation Unit thus initially mounted a time place person distribution investigation of the 2012 epidemic.
The data was collected on tablets or mobiles from the residence of patients of AESJE during 2012 and later during 2013, 14 and 15 on a well-designed pilot tested data collection instrument. The position of mobile in terms of latitude and longitude was transmitted from the residence of patient to the database on the server through the net. Historical Data was obtained by the courtesy of the UP Government of 2009 and 10 and latitude and longitude values were found and fed into the data through addresses using Epi-info map software.
Perusal would reveal that the number of cases remained nearly constant over the years though JE positives decreased from 12 to 6 percent between 2009 and 2011. The proportion affected across districts was also similar suggesting that populations were not developing any immunity against the unknown agent of AES though vaccination against JE were probably causing decrease in JE.
The epidemic is limited in the south by the river Saryu though it crosses the Gandak into Muzzafarpur on 7th May 2012 to get 2 cases, spreads north to it on 27th and gets into a full blown epidemic by 13th June, the daily rate crossing 50 cases per day, starts subsiding by 15th June and by 7th July the original rates of about 5 per day have returned. This is premonsoon. The later post monsoon curve beginning 27th July, peaking around 1st September and subsiding near 19th November, is contributed by Gorakhpur. Not crossing the river Saryu, sparing areas south to it and then river Ganges, after Chapra, sparing Patna suggests that it is limited by the fast flowing midstream of these rivers. It crosses the Gandak because it is weakened pre-monsoon. The post monsoon spurt in Gorakhpur is perhaps because of the contamination of surface water sources due to flooding of rivers or use for toilet, bathing etcetra. The spread lends force to waterborne transmission through feco-oral contamination and thus preventable by a. using the midstream to prevent horizontal transmission.
...
Dr GK Singh and Dr CM Singh, Citizen News Service (CNS) Columnists
http://www.thehansindia.com/posts/i...her-NTDs-by-2030-why-is-action-missing-195646
Comment: Interesting to read of the geographical & temporal spread in Bihar and Uttar Pradesh, but I'm not sure I agree with some of the assumptions made by the authors of this article. It's too early to say whether these outbreaks all share one etiology - I suspect that they do not. Cases in Gaya, Bihar have shown a higher positivity for JE than those in Muzzafarpur. While increased handwashing in Muzaffarpur may have helped reduce any oral-route infections, 2015 was also a poor year for litchi yields. Linking previous year's outbreaks to litchis may also have changed consumption behaviors this year. There are still too many variables in play. One could also argue that the post monsoon outbreaks in Gorakhpur could result from an increase in the mosquito population. The call has to continue for better data and well-planned epidemiological investigations. - Ro
December 26,2015, 03.34 PM IST | | The Hans India
Indian government along with other governments of UN member countries had adopted the Sustainable Development Goals (SDGs) at the 70th UN General Assembly in New York in September 2015. One of the SDG targets (3.3) promises that "By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases (NTDs) and combat hepatitis, water-borne diseases and other communicable diseases." Encephalitis, one of the NTDs, continues to severely impact under-15 year old people with very little well-coordinated response to contain, and eventually eliminate it. Why?
...
AIIMS Patna, Epidemic Investigation Unit thus initially mounted a time place person distribution investigation of the 2012 epidemic.
The data was collected on tablets or mobiles from the residence of patients of AESJE during 2012 and later during 2013, 14 and 15 on a well-designed pilot tested data collection instrument. The position of mobile in terms of latitude and longitude was transmitted from the residence of patient to the database on the server through the net. Historical Data was obtained by the courtesy of the UP Government of 2009 and 10 and latitude and longitude values were found and fed into the data through addresses using Epi-info map software.
Perusal would reveal that the number of cases remained nearly constant over the years though JE positives decreased from 12 to 6 percent between 2009 and 2011. The proportion affected across districts was also similar suggesting that populations were not developing any immunity against the unknown agent of AES though vaccination against JE were probably causing decrease in JE.
The epidemic is limited in the south by the river Saryu though it crosses the Gandak into Muzzafarpur on 7th May 2012 to get 2 cases, spreads north to it on 27th and gets into a full blown epidemic by 13th June, the daily rate crossing 50 cases per day, starts subsiding by 15th June and by 7th July the original rates of about 5 per day have returned. This is premonsoon. The later post monsoon curve beginning 27th July, peaking around 1st September and subsiding near 19th November, is contributed by Gorakhpur. Not crossing the river Saryu, sparing areas south to it and then river Ganges, after Chapra, sparing Patna suggests that it is limited by the fast flowing midstream of these rivers. It crosses the Gandak because it is weakened pre-monsoon. The post monsoon spurt in Gorakhpur is perhaps because of the contamination of surface water sources due to flooding of rivers or use for toilet, bathing etcetra. The spread lends force to waterborne transmission through feco-oral contamination and thus preventable by a. using the midstream to prevent horizontal transmission.
...
Dr GK Singh and Dr CM Singh, Citizen News Service (CNS) Columnists
http://www.thehansindia.com/posts/i...her-NTDs-by-2030-why-is-action-missing-195646
Comment: Interesting to read of the geographical & temporal spread in Bihar and Uttar Pradesh, but I'm not sure I agree with some of the assumptions made by the authors of this article. It's too early to say whether these outbreaks all share one etiology - I suspect that they do not. Cases in Gaya, Bihar have shown a higher positivity for JE than those in Muzzafarpur. While increased handwashing in Muzaffarpur may have helped reduce any oral-route infections, 2015 was also a poor year for litchi yields. Linking previous year's outbreaks to litchis may also have changed consumption behaviors this year. There are still too many variables in play. One could also argue that the post monsoon outbreaks in Gorakhpur could result from an increase in the mosquito population. The call has to continue for better data and well-planned epidemiological investigations. - Ro
