India Encephalitis 2016, 1,376 fatalities

Ronan Kelly · Nov 19, 2016

Odisha
Bada Chakunda seeds behind most child deaths, not JE: Experts
By Express News Service | Published: 19th November 2016 02:14 AM |
Last Updated: 19th November 2016 02:40 AM | A+A A- |

BHUBANESWAR: Incredulous as it may sound, an expert committee constituted by the State Government on Friday said consumption of Bada Chakunda (Cassia occidentalis) seeds led to death of most children in Malkangiri district, not the Japanese Encephalitis (JE) outbreak.
...

?We have evidence to suggest that the disease develops due to anthraquinones, a group of toxins usually found in the plant locally known as Bada Chakunda. The anthraquinones toxins are very harmful,? John, Emeritus Professor of Christian Medical College at Vellore, said. In some cases, children with acute encephalopathy in Malkangiri have close similarity with encephalopathy described in western UP districts, he said.
...
Dr John said finding of the deadly toxin in urine was very crucial to confirm and though no medicine is available to treat the encephalopathy, it can be easily prevented. ?Children and their parents have to be advised not to consume raw Chakunda beans,? he said.
...
http://www.newindianexpress.com/sta...al&utm_source=twitter.com&utm_campaign=buffer

Experts attribute Odisha JE deaths to hepatomyoencephalopathy
November 18, 2016
Odisha Sun Times Bureau
Bhubaneswar, Nov 18:
...
There is a popular belief among the tribal populace that Chakunda seeds cure stomach ailments, helps in deworming and its roots helps one recover from anaemia.

Notably, urine samples of five children were sent for test at Lucknow-based Indian Institute of Toxicology Research (IITR) which confirmed positive for the outbreak of the disease.

On the other hand, one more child today succumbed to suspected Japanese encephalitis while undergoing treatment at District Headquarters Hospital. The three-year-old deceased boy from Kataguda village under Kalimela block in Malkangiri district has been identified as Siddhant Betty. With this, the unofficial toll has increased to 116.
...
http://odishasuntimes.com/2016/11/18/experts-attribute-odisha-je-deaths-hepatomyoencephalopathy/

Ronan Kelly · Nov 19, 2016

Odisha
Experts? report on Malkangiri kids death evokes mixed reaction
Odishatv Bureau - November 19, 2016
...
On the other hand, Adivasi Mahasangha, a tribals outfit, did not buy the argument that deaths are due to the consumptions of seeds of ?Bana Chakunda?. The tribal body claimed the reason of the mass death is something else and demanded an inquiry.

?I don?t believe that a child of six-month to 2-year old is known to ?Bana Chakunda? as a food or medicine?, tribal activist Ghanasyam Madkami said.

Meanwhile, Malkangiri district administration vowed to take massive steps for awareness. ?We will take measures to aware people that they would not consume the seeds of this plant for any treatment purpose?, Malkangiri ADM Kalyan Sarkar said.
...
http://odishatv.in/odisha/body-slid...giri-kids-death-evokes-mixed-reaction-177142/

Ronan Kelly · Nov 19, 2016

Odisha
Dalit Camera: Through Un-Touchable Eyes
Yesterday at 6:36am ?
https://youtu.be/zr7HucfbfbQ
In the village of Doriguda, there have been five deaths due to Japanese Encephalitis. Three of them are reported namely Amir Madkami (5), Ramesh Podiami (5) and Surendra Madhi (3). Two of them were unreported namely Debendra Kawasi (3) and Irami Kawasi (4). Here we talk to Debendra Kawasi's mother who explains how during one episode of fever, she received medications from the medic but due to recurrence, she instead took the child to a village elder who uses traditional medicine. The child lost his life. Since all children who went to the hospital were dying, there is a serious deficit of trust in the village towards children being taken to the hospital. But this establishes that in Doriguda, out of 5 deaths, only three are reported. This can give us a sense of how correct or incorrect the official number of 121 is.
https://www.facebook.com/DalitCameraDC/posts/1267402386652013

Ronan Kelly · Nov 20, 2016

Odisha
Three-day survey for JE vaccination begins in Odisha?s Malkangiri
November 20, 2016
Odisha Sun Times Bureau
Malkangiri, Nov 20:

A three-day door-to-door survey for vaccination drive against Japanese Encephalitis (JE) started in Odisha?s Malkangiri district today.

As many as 890 teams have been engaged to undertake the survey on November 20, 21, & 22 for identifying children in the 1-15 age group who will be vaccinated, sources said.

The vaccination programme will start from the first week of December.
...
http://odishasuntimes.com/2016/11/20/three-day-survey-je-vaccination-begins-odishas-malkangiri/

Another child dies of JE; toll jumps to 117 in Malkangiri

Published on 20 November 2016 By Prameya News7 (author)

Bhubaneswar: Even though the State Government claims that the deadly Japanese Encephalitis has come under control, the vector-borne disease continued to take lives in Malkangiri district.

Another shocking report came to the fore as a child died of the dieses on Sunday morning.

With this, the death toll rose to 117 in 74 days in the tribal-dominated district.

The deceased kid was identified as Suresh Madkami of Kamalapada village under Korkanda block of the district. Suresh succumbed to the vector-borne disease while undergoing treatment at the Malkangiri District Headquarters Hospital (DHH), according to reports.
...

- See more at: http://www.prameyanews7.com/en/nov2...iri-JE-menanceOdisha.htm#sthash.Od9V2dd2.dpuf

Memorandum submitted to Governor, Odisha on JE of Malkangiri district, Odisha
To
Dr. S.C. Jamir Date- 19.11.16
Hon?ble Governor, Odisha
Raj Bhawan
Bhubaneswar

Sub- Memorandum on ?Child Death in Malkangiri?

Respected Sir

In the backdrop of death of more than one hundred children in Malakangiri district due to outbreak of Japanese Encephalitis (?), a state-level consultation of Civil Society Groups was organised at Red Cross Bhawan, Bhubaneswar on 17.11.16 to debate and discourse about issues relating to incidence of child death and explore the opportunity of intervention of Civil Society to find out permanent solution to it in terms of checking child death in the district.

The meeting started with welcome address by Sri Manoj Jena, Human Rights Activist and Core-Committee Member of NGO Cell of NHRC followed by presentation of two Fact-finding Reports presented by Sri Pradip Pradhan, State Convener, Right to Food Campaign, Odisha and Member of Advisory Group of NHRC, and Sri Gouranga Mohapatra, Convener, Jana Swasthya Abhijan, Odisha Chapter who depicted child death due to malnutrition and hunger among the tribal children. after presentation, the house engulfed in debating the incidence of child death from various perspectives and citing various reasons such age-old negligence and callousness of the administration, huge corruption and irregularities in implementation of Govt. programme, absence of effective grievance redressal mechanism and monitoring mechanism at district level, deliberate attempt to suppress information about magnitude of child malnutrition, inaccesability to food security programme and denial of entitlement, bad-implementation of food security programme, huge food insecurity among the tribals, disastrous health situation, mal-administration, vacancy in the posts in different offices including District Hospital, PHC and CHC etc.

The prominent members who participated in the consultation were Sri Panchanan Kanungo, former Minister, Govt. of Odisha, Sri Rabi Das, Senior Journalist, Sri Pratap Sahu, Dalit Rights Activists Sri Ashok Mallik, Kalandi Mallik, Prof. Jantrana Parikhit, Madhumita Rath, Suresh Panigrahi, CPI(M), Social Activists like Ashok Das, Mrs. Usharani Behera, Ranjit Swain, Meghna Kinnar, Sri Sudhir Sabat and Sri Ranjit Patnaik from CACL, Sri Akhand, Human Rights Activist, Chandranath Dani, Prakash Nayak, Health expert and many others.

After deliberation, the house felt that it is state-sponsored murder of children in the district and unanimously passed the resolution expressing deep concern over child death and condemned negligence, lackadaisical attitude and failure of the State Govt. to check child death in the district. The house also agreed that the reason of the child death as cited by Govt. does not attribute only health hazard rather food insecurity and malnutrition among the children for years together. The house also resolved to appraise His Excellency to exercise his power as custodian of the tribals of Malkangiri coming under fifth schedule of the Constitution and take the following steps including direction to the State Govt. to check the innocent lives from grave disaster.

A. Constitute Commission of Enquiry to find out the reason of child death in face of diversed views on it and fix responsibility for such holocaust.

B. Appoint High-level expert Team to review the relevance of numerous development programme, manner of implementation of food security programme, whether the programme itself is defective or it is badly implemented with time-bound manner. The recommendation of the team should be properly implemented.

C. Multi-stakeholder Grievance Redressal mechanism to be developed to hear the grievance of the people and address it within time limits and fixing responsibility on the erring officials.

D. As reported, thousands of the tribal children are still suffering from malnutrition in the district who are in red zone. Massive drive needs to be undertaken to identify these children and special nutrition programme to be launched to improve their health condition.

E. Transparency and accountability to be enforced in the implementation of development project and all food security programme.

F. The huge vacancy in different category of Govt. posts should be filled up on war-footing way to revamp administrative mechanism to render service effectively and making it reach out at door step of the people.

Thanking you

Yours sincerely
Pradip Pradhan
Manoj Jena
Madhumita Rath
Dr. Rina Roy
Sanjay Sahu
Bijalalaxmi Routray
http://odishasoochana.blogspot.com/2016/11/memorandum-submitted-to-governor-odisha.html

Ronan Kelly · Nov 20, 2016

[TABLE="class: display dataTable, border: 0, cellpadding: 0, cellspacing: 0, width: 852"]
[TR="class: gradeX even, bgcolor: #FFEEEE"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFD5D5"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFE2E2"]
[/TD]
[TD="width: 5%"]84[/TD]
[TD="width: 7%"]Female[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]November 8, 2016
Time : 12:24 pm[/TD]
[TD="width: 6%"]City : Jodhpur
Distt. : JODHPUR
State : RAJASTHAN[/TD]
[/TR]
[TR="class: gradeX odd, bgcolor: #FFDDDD"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFC4C4"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFD1D1"]
[/TD]
[TD="width: 5%"]84[/TD]
[TD="width: 7%"]Female[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]November 8, 2016
Time : 12:24 pm[/TD]
[TD="width: 6%"]City : Jodhpur
Distt. : JODHPUR
State : RAJASTHAN[/TD]
[/TR]
[TR="class: gradeX even, bgcolor: #FFEEEE"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFD5D5"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFE2E2"]
[/TD]
[TD="width: 5%"]84[/TD]
[TD="width: 7%"]Male[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]November 5, 2016
Time : 6:29 pm[/TD]
[TD="width: 6%"]City : BIJNOR
Distt. : BIJNOUR
State : UTTAR PRADESH[/TD]
[/TR]
[TR="class: gradeX odd, bgcolor: #FFDDDD"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFC4C4"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFD1D1"]
[/TD]
[TD="width: 5%"]9[/TD]
[TD="width: 7%"]Male[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]November 5, 2016
Time : 6:23 pm[/TD]
[TD="width: 6%"]City : BIJNOR
Distt. : BIJNOUR
State : UTTAR PRADESH[/TD]
[/TR]
[TR="class: gradeX even, bgcolor: #FFEEEE"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFD5D5"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFE2E2"]
[/TD]
[TD="width: 5%"]60[/TD]
[TD="width: 7%"]Female[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]November 5, 2016
Time : 6:07 pm[/TD]
[TD="width: 6%"]City : BIJNOR
Distt. : BIJNOUR
State : UTTAR PRADESH[/TD]
[/TR]
[TR="class: gradeX odd, bgcolor: #FFDDDD"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFC4C4"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFD1D1"]
[/TD]
[TD="width: 5%"]30[/TD]
[TD="width: 7%"]Male[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]November 5, 2016
Time : 6:01 pm[/TD]
[TD="width: 6%"]City : BIJNOR
Distt. : BIJNOUR
State : UTTAR PRADESH[/TD]
[/TR]
[TR="class: gradeX even, bgcolor: #FFEEEE"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFD5D5"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFE2E2"]
[/TD]
[TD="width: 5%"]4[/TD]
[TD="width: 7%"]Female[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]November 5, 2016
Time : 6:00 pm[/TD]
[TD="width: 6%"]City : BIJNOR
Distt. : BIJNOUR
State : UTTAR PRADESH[/TD]
[/TR]
[TR="class: gradeX odd, bgcolor: #FFDDDD"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFC4C4"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFD1D1"]
[/TD]
[TD="width: 5%"]132[/TD]
[TD="width: 7%"]Female[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Dead[/TD]
[TD="width: 6%"]November 5, 2016
Time : 5:58 pm[/TD]
[TD="width: 6%"]City : BIJNOR
Distt. : BIJNOUR
State : UTTAR PRADESH[/TD]
[/TR]
[/TABLE]
All ages in months.
http://idsurv.org/display-data.php

Ronan Kelly · Nov 20, 2016

Odisha
Arunkumar G
‏@arunviro Arunkumar G Retweeted Ronan Kelly
We @MCVRMU had a significant role in this investigation @arunviro was member of the team headed by Prof Jacob John
...
7:07 PM - 20 Nov 2016
https://twitter.com/arunviro/status/800475789498011648

Arunkumar G
‏@arunviro Arunkumar G Retweeted Ronan Kelly
@RonanKelly13 Faulty JE lab testing. Only @MCVRMU refuted and showed it is an Encephalopathy. Lab QC is critical
...
7:04 PM - 20 Nov 2016
https://twitter.com/arunviro/status/800475010011803648

I wont go to Medical : yet another death in Malkangiri

Death Certificate of Suresh Madkami (aged 3)
Turn on the television in Malkangiri and almost all local channels are showing the same video. A child sits on a verandah and munches on a few seeds. The anchor in the backdrop says Expert team blames adivasis and their habit of eating seeds of Bana Chakundi for raise in deaths in Malkangiri. (Refer to Exposing glaring flaws in Expert Committee Report on the medical emergency at Malkangiri for more on this). The anchor forgets to mention that the only basis for the Expert team to say this is a trace of a toxin found in a couple of urine samples in a district where 7493 children have died since 2012 and 128 children have died in the past two months, many cases having tested positive for Japanese Encephalitis but he is doing his job. Covering up for his governments crimes which is what the media seems to be doing in Orissa at the moment.
We get a call about the death of another Koya child.
...
http://www.dalitcamera.com/wont-go-m...th-malkangiri/

Comment: I think that it is going to be so difficult to convince the locals that the JE tests were wrong. Many already believe that it is a government cover up. From my interactions over the past few years with Drs. John & Arunkumar, I believe that they are serious scientists who are advocates for a strong epidemiological approach to solving these outbreaks. I hope that they can provide enough evidence to convince parents and save lives. - Ro

Ronan Kelly · Nov 21, 2016

Odisha
Malkangiri deaths: Experts pick holes in Bana Chakunda theory
By Express News Service | Published: 21st November 2016 03:11 AM |
Last Updated: 21st November 2016 05:12 AM
...
Experts argue that such evidence is baseless because no direct link of the toxicity to brain damage has been established. ?Just its presence in urine cannot be the sole evidence to conclude that it caused death among the children,? said official sources.

The report is fraught with glaring loopholes. How could the expert committee conclude that anthraquinones is available only in ?Bana Chakunda? seeds and not in other sources, including plants, in the district? Did the team carry out an extensive survey to ascertain it? It has not been addressed in the report. Similarly, there has to be a safe limit (quantitative) for any toxin in the human or animal body to take hazardous effect.

Did the team investigate and standardise the limit to know that a certain quantity of the toxicity has caused the death, experts wondered. Besides, food-based toxicity remains confined to an area where it is sourced. In Malkangiri, the deaths have been reported from all the blocks and even from Malkangiri town.

It is also questionable why children in the headquarters town also ate the seeds. The report appears to have ignored the dietary habits of tribals which would have provided a reason for the toxicity. The big question is did the children start eating the ?Bana Chakunda? seeds in September this year? The deaths started in September-end and saw a spurt in October before showing a decline.

Was the flowering pattern of the plant taken into account? Besides, is the plant endemic to Malkangiri only where the kids eat its seeds? Interestingly, JE deaths were first reported in 2012 and an RMRC report had confirmed that it was JE and National Institute of Virology, Pune had investigated the samples back then. For next two years, there was no death reported while a smaller number of death was reported in 2015 but the State Government had been denying JE all along.
...
http://www.newindianexpress.com/sta...ck-holes-in-bana-chakunda-theory-1540881.html

Ronan Kelly · Nov 21, 2016

Odisha
JE claims one more life in Malkangiri

Published on 21 November 2016 By Prameya News7 (author)

Bhubaneswar: Another one child has died in Japanese Encephalitis in Malkangiri district on Monday.

The deceased child was identified as Naresh Kabasi of Kiteluguda village under Korukonda Block of the district.

With the death of Kabasi the toll rose to 118 in the last 75 days in the tribal-dominated district.
...
http://www.prameyanews7.com/en/nov2...Malkangiri-JE-claims--in-MalkangiriOdisha.htm

Ronan Kelly · Nov 22, 2016

[h=4]Volume 23, Number 1?January 2017[/h] [h=4]Letter[/h] [h=1]Scrub Typhus Leading to Acute Encephalitis Syndrome, Assam, India[/h] [h=4]On This Page[/h]

[h=4]Figures[/h]

Figure

[h=4]Downloads[/h]

RIS[TXT - 2 KB]

Suggested citation for this article
[h=3]Abstract[/h] To determine the contribution of Orientia tsutsugamushi, the agent of scrub typhus, as a cause of acute encephalitis syndrome (AES) in Assam, India, we conducted a retrospective study of hospital patients with symptoms of AES during 2013?2015. Our findings suggest that O. tsutsugamushi infection leads to AES and the resulting illness and death.

Scrub typhus is a miteborne bacterial disease caused by Orientia tsutsugamushi. Clinical features generally include fever, headache, and myalgia, with or without eschar/rash (1). In India context, scrub typhus was first reported in Assam during World War II (1944?1945) across the India?Myanmar border (2). The northeastern region of India then experienced decades without the disease until it reemerged in 2010 (3). Assam, a northeastern state in India, is recognized as an endemic zone for acute encephalitis syndrome (AES), especially that caused by Japanese encephalitis virus (JEV). However, the etiology of >50% of the AES cases in Assam remains unrecognized (4). In this study, we aimed to determine the contribution of scrub typhus to AES in this region.
We conducted a retrospective study of patients exhibiting symptoms of AES who were admitted during 2013?2015 to Assam Medical College and Hospital, Dibrugarh (a government-funded tertiary care hospital that provides health care for 8 adjoining districts). Serum samples underwent serologic testing with InBios ST Detect IgM ELISA kit (InBios International, Seattle, WA, USA). An optical density of >0.5 was considered positive (5). We extracted DNA from the blood samples by using the QIAamp DNA blood mini kit (QIAGEN, Hilden, Germany) and performed nested PCR for amplification of a 56-kDa gene of Orientia, targeting a 483-bp fragment (6). We compared the sequences obtained with reference strains of Orientia.

Figure. Dendrogram representing Orientia tsutsugamushi sequences (black triangles) from patients with acute encephalitis syndrome, Assam, India, 2013?2015. The phylogenetic tree was constructed on a 56-kDa outer membrane protein gene of O. tsutsugamushi....

We enrolled 511 AES case-patients after disease onset (mean 6.23 days; range 1?14 days); 104 (20.3%) had IgM against O. tsutsugamushi (suggestive of recent infection) (7). Of these 104 patients, 58 (55.7%) were male and 46 (44.2%) were female. Ages ranged from 3 to 80 years (median 25 years). The main clinical features of the 104 IgM-positive case-patients were fever (100%), altered sensorium (100%), headache (67.3%), unconsciousness (55.7%), nausea (40.3%), and neck rigidity (0.9%). None had any record of eschar. Leptospirosis, dengue, and malaria were ruled out for all 104 case-patients. Only 13 (12.5%) of the IgM-positive case-patients were positive for JEV IgM. Orientia DNA was detected in 9 (8.6%) of the samples that had IgM against O. tsutsugamushi. Percentage similarity of the nucleotide sequences (GenBank accession nos. KU163359, KU163361, KU163362, KU163366, KU163369, KU163370, KU163372, KU163373, and KP067915) demonstrated resemblances with the Karp strain of Orientia ranging from 91.9% to 93.7% (Figure). We were able to follow-up 53 of the 104 IgM-positive case-patients and discovered that 26 (49%) died after discharge. These included 4 of the 9 PCR positive case-patients.
The high prevalence of illness and death resulting from scrub typhus in this study can be attributed to various reasons. First, because JEV is the predominant etiologic agent of AES in the northeastern region, especially in Assam, health providers generally do not suspect other etiologic factors, including scrub typhus. Moreover, the nonspecific clinical features of scrub typhus in these patients (i.e., absence of eschar/rash) led to diagnostic dilemmas. In addition, JEV infection, West Nile virus infection, and leptospirosis have been identified as key contributors to AES in the northeastern region (8,9). Treatable bacterial diseases such as leptospirosis and scrub typhus are grossly underestimated because of the low index of suspicion and limited diagnostic facilities, especially in developing countries such as India. Proportion of deaths due to untreated scrub typhus varies across different regions from 0% to 70% (10). Our study found a high case-fatality rate of 49%. The absence of distinguishable clinical features among AES-identifying etiologic factors makes differential diagnosis difficult, and thus the condition remains untreated. That clinicians are unaware of the presence of the disease remains a major hindrance to its recognition and successful treatment.
In our study, the highest numbers of scrub typhus cases were recorded during July?September, the peak season for JEV transmission. The northeastern region has a subtropical climatic pattern, and the season (May?August) is also an appropriate period for sowing and harvesting crops. Agricultural lands cover 22% of the northeastern region, with ≈70% of the total population dependent on agriculture for their livelihood. Because our study was retrospective, the occupations of the patients with positive cases were unknown. However, the areas where the followed-up case-patients lived were primarily agrarian.
Our findings suggest that the bacterium that causes scrub typhus, O. tsutsugamushi, is a notable etiologic agent that contributes to the occurrence of AES and resulting illness and death. We believe that it is urgent that this neglected, treatable disease be considered when diagnosing those with AES, especially during July?September in AES-endemic regions. Recording of occupation details and ecologic background of the attending patients, especially from those in rural areas, could be a vital source for identifying those with suspected scrub typhus. Increasing awareness among clinicians could lead to prompt diagnosis and effective treatment of this almost-forgotten potential source of AES.

Siraj A. Khan

, Trishna Bora, Basanta Laskar, Abdul M. Khan, and Prafulla Dutta

Author affiliations: Regional Medical Research Centre, NE Region, Indian Council of Medical Research, Dibrugarh, Assam, India (S.A. Khan, T. Bora, A.M. Khan, P. Dutta); Assam Medical College and Hospital, Dibrugarh, Assam, India (B. Laskar)
[h=3]Acknowledgments[/h] We thank Hirok Jyoti Borchetia, Sazzad Bin Aminur Rahman, and Bulen Das for their excellent technical assistance in the laboratory.
This work was supported by the Indian Council of Medical Research, India (grant no. NER/19/2012-ECD-I). This study was approved by the institutional ethics committee of the Regional Medical Research Centre, Dibrugarh.
Dr.. Khan is a scientist at the Regional Medical Research Centre, Northeast Region, Dibrugarh, Assam. His research interests include surveillance and molecular epidemiological studies of insect vector-borne diseases, in particular,. identifying disease hotspots and Georgraphic Information Systems mapping.

[h=3]References[/h]

Rathi N, Rathi A. Rickettsial infections: Indian perspective. Indian Pediatr. 2010;47:157?64. DOI PubMed
Davis GE, Austrian RC, Bell EJ. Observations on tsutsugamushi disease (scrub typhus) in Assam and Burma: the recovery of strains of Rickettsia orientalis. Am J Hyg. 1947;46:268?86.PubMed
Khan SA, Dutta P, Khan AM, Topno R, Borah J, Chowdhury P, et al. Re-emergence of scrub typhus in northeast India. Int J Infect Dis. 2012;16:e889?90. DOI PubMed
Rathore SK, Dwibedi B, Kar SK, Dixit S, Sabat J, Panda M. Viral aetiology and clinico-epidemiological features of acute encephalitis syndrome in eastern India. Epidemiol Infect. 2014;142:2514?21. DOI PubMed
Rahi M, Gupte MD, Bhargava A, Varghese GM, Arora R. DHR-ICMR Guidelines for diagnosis & management of Rickettsial diseases in India. Indian J Med Res. 2015;141:417?22. DOI PubMed
Yang HH, Huang IT, Lin CH, Chen TY, Chen LK. New genotypes of Orientia tsutsugamushi isolated from humans in Eastern Taiwan. PLoS One. 2012;7:e46997. DOI PubMed
Blacksell SD, Tanganuchitcharnchai A, Nawtaisong P, Kantipong P, Laongnualpanich A, Day NPJ, et al. Diagnostic accuracy of the InBios Scrub Typhus Detect enzyme-linked immunoassay for the detection of IgM antibodies in Northern Thailand. Clin Vaccine Immunol. 2015;23:148?54. DOI PubMed
Chowdhury P, Khan SA, Dutta P, Topno R, Mahanta J. Characterization of West Nile virus (WNV) isolates from Assam, India: insights into the circulating WNV in northeastern India. Comp Immunol Microbiol Infect Dis. 2014;37:39?47. DOI PubMed
Khan SA, Dutta P, Borah J, Chowdhury P, Topno R, Baishya M, et al. Leptospirosis presenting as acute encephalitis syndrome (AES) in Assam, India. Asian Pac J Trop Dis.2012;2:151?3. DOI
Taylor AJ, Paris DH, Newton PN. A systematic review of mortality from untreated scrub typhus (Orientia tsutsugamushi). PLoS Negl Trop Dis. 2015;9:e0003971. DOI PubMed

[h=3]Figure[/h]

Figure. Dendrogram representing Orientia tsutsugamushi sequences (black triangles) from patients with acute encephalitis syndrome, Assam, India, 2013?2015. The phylogenetic tree was constructed on a 56-kDa outer membrane protein gene of O....

Suggested citation for this article: Khan SA, Bora T, Laskar B, Khan AM, Dutta P. Scrub typhus leading to acute encephalitis syndrome, Assam, India. Emerg Infect Dis. 2017 Jan [date cited]. http://dx.doi.org/10.3201/eid2301.161038
DOI: 10.3201/eid2301.161038
http://wwwnc.cdc.gov/eid/article/23/1/16-1038_article

Ronan Kelly · Nov 23, 2016

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

Ro' Comments: We have reports in this thread of 118 confirmed encephalitis deaths in Odisha to November 21st. Two fatalities were reported in Karnataka to July 10. Delhi reported a death on July 22. Manipur reported 4 deaths to August 10. Madhya Pradesh reported 37 cases with 14 fatalities to August 11. Telangana reported a fatality on Aug 14. Uttar Pradesh reported 463 deaths at BRD, Gorakhpur to Nov 19th implying that at least 75 deaths occurred at other facilities. Maharashtra reported 3 cases of AES, 1 fatal in the Week 28 IDSP report. Chhattisgarh has reported 14 deaths to Nov 1st.

Putting all of this together, confirmed fatalities now total to 1,208 an increase of 135 since Oct 30th.

Comparison of NVBDCP numbers to similar period in previous years:
Year // AES Cases/ Deaths/ JE Cases/ Deaths
2015// 9,854 / 1,210 / 1,730 / 291 for full year
2014// 9,358 / 1,467 / 1,484 / 275 to December 1st
2013// 7,825 / 1,273 / 1,086 / 202 for full year
2012//7,685 / 1,143 / 704 / 136 to November 19th
2011// 7,137 / 1,064 / NA / NA to December 1st

Ronan Kelly · Nov 24, 2016

Odisha
JE claims one more life in Malkangiri, death toll rises to 120

Published on 23 November 2016 By Prameya News7 (author)

Bhubaneswar: Japanese Encephalitis has rendered the Odisha Government and Health department totally helpless as it took life of one more child in Malkangiri district on Wednesday.
The deceased child was identified as Daniel Padiami, a resident of Katanpali village under Podia block of the district.

Japanese Encephalitis has wreaked havoc in the area since the last 76 days and including the death of Daniel, 120 children have lost their lives to the vector borne disease.
...
- See more at: http://www.prameyanews7.com/en/nov2...o-120-JE-ScareOdisha.htm#sthash.A4FhZQrz.dpuf

Thursday, November 24, 2016
300 children die of Japanese encephalitis in Odisha's Malkangiri, govt "undermining" depth of disease: Top doctor

Dr Sylvia Karpagam
By Our Representative
...
Dr Karpagam also wonders why the expert committee is blaming JE on the consumption of seeds of Bana Chakundi plant. He asks, ?This plant is being eaten throughout the year and probably by all families; why are the deaths happening now??
Insisting that five urine samples out of 121 children who died is ?hardly evidence?, Dr Karpagam says, the committee, under Dr Jacob John, is ?twisting facts? and ?misrepresenting?, adding, ?Without having the baseline data, this expert committee cannot make an absolute statement that some cases were due to diet induced encephalopathy and not as a result of JE.?
Referring to the suggestion of the expert team that that ?children and their parents have to be advised not to consume raw Chakundi beans?, Dr Karpagam says, ?Where is his evidence? To expect a community to break a long tradition, without adequate evidence and basis, amounts to abuse of expert position.?
Dr Karpagam queries, ?Why has this expert group not made any comment on the state of disarray and dysfunction of the anganwadis in the area? Have they made any attempts to find out if these children have been receiving adequate foods??
Meanwhile, an NAPM statement on JE deaths says, ?We are indeed shocked that the ?Team of Experts? sent by the Centre has tried to absolve the Government of all responsibility by attributing the deaths to consumption of some local seeds (Bana Chakundi) and not to JE and governmental delay, thereby blaming the adivasis themselves for the deaths!?
http://www.counterview.net/2016/11/...se.html?utm_source=dlvr.it&utm_medium=twitter

Comment: The report below is pretty comprehensive and addressess both sides of the argument - go read it in full for the complete story. - Ro

Did wild seeds lead to child deaths in Malkangiri? A new report provokes debate

11-24 00:00
Ninety seven children have died in the district hospital of Malkangiri in southern Odisha since September. Based on the clinical symptoms of high fever and seizures, doctors suspected the children had died of Acute Encephalitis Syndrome, or brain inflammation, caused by the Japanese Encephalitis virus.

Acute Encephalitis Syndrome is a group of conditions that affect the brain and can be triggered by a range of agents including bacterial and viral infections.

Of the 97 children, the blood samples of 77 were tested in a laboratory in the state capital Bhubaneswar. Antibodies to the Japanese Encephalitis virus were found in the blood samples of 33 children.
...
The team observed that some of the children who had survived the bout of brain inflammation did not show signs of neurological impairment, which is common among those infected with the Japanese Encephalitis virus.

John also noticed the presence of the bada chakunda plant in the area. In 2005, while investigating an outbreak of Acute Encephalitis Syndrome that killed 175 children in Saharanpur district of Uttar Pradesh, John had isolated the toxin in the seeds of the plant. The toxin, anthroquinone, acts as a biochemical agent and causes hepatomyoencephalopathy, a medical condition where the brain is damaged.

According World Health Organisation, hepatomyoencephalopathy is one of the many conditions that fall under the broader term of Acute Encephalitis Syndrome. It also results in damage of liver and muscle cells.

In Malkangiri, his team took urine samples of five children whose blood samples did not show the presence of antibodies against Japanese encephalitis virus. The urine samples were sent to Council of Scientific and Industrial Research-Indian Institute of Toxicology Research in Lucknow. In all five cases, the samples showed the presence of the anthroquinone compound. A battery of investigations had already confirmed liver and muscle damage in the five children, who later succumbed to the disease.

For John, this was enough to confirm his hypothesis that the toxin in the bada chakunda plant was responsible for the deaths of the children who had not tested positive for Japanese encephalitis.

In his view, the district was seeing not one but ?two diseases occurring as outbreaks?.
...
Dr Veena Shatrugna, former deputy director, National Institute of Nutrition, Hyderabad, said presence of the toxin in urine samples does not establish anything. ?If they had looked for pesticides or any other toxin in the urine sample, they might have also found that,? she said.

Dr Mukul Das who conducted the tests at the Lucknow laboratory admitted that blood or serum is a better sample to look for the toxin, but he defended the results. ?These children were so lean and thin, it was extremely difficult to draw a blood sample from them,? he said.
...
http://newsdog.today/a/article/5836359712907151224dded3/

Uttar Pradesh
Encephalitis claimed three more
B Publish Date: Thu, Nov. 2016 02:22 twenty-four common (East) | Date Updated: Thu, Nov. 2016 02:22 twenty-four common (East)
Gorakhpur

In eastern encephalitis deaths continues to recruit patients. BRD Medical College in the last twenty-four hours to eight new patients were admitted and three others were killed. Nehru, 64 patients are being treated in hospital.

Among the three people killed in six years of habitation and Kushinagar weather husband of two years, including two years' revenue. Among those admitted Gorakhpur, Deoria and Kushinagar, Basti and Sntkbirnagr of the two and one patient. Since January this year, the Medical College has recruited 1849 patients, of which 474 have died.
...
http://www.jagran.com/uttar-pradesh/gorakhpur-city-15089041.html

Comment: At least 75 deaths have occurred at facilities other than BRD raising Uttar Pradesh's toll to at least 549 with 11 deaths in the past 4 days. - Ro

Ronan Kelly · Nov 24, 2016

JE claims one more life in Malkangiri, toll reaches 121

Published on 24 November 2016 By Prameya News7 (author)

Bhubaneswar: Even as the State Government claims to have brought Japanese Encephalitis under control, the deadly disease yet took life of another child in Malkangiri district on Thursday.

The deceased child was identified as Pramila Padiami, a resident of Bendaguda village under Korukonda block of the district.

With the death of Pramila, the toll due to Japanese Encephalitis reached to 121 in the last 77 days.
...
- See more at: http://www.prameyanews7.com/en/nov2...-in-MalkangiriOdisha.htm#sthash.bGNUIofC.dpuf

Ronan Kelly · Nov 24, 2016

Odisha
GOVT TO CONSTRUCT PIG SHELTERS IN MALKANGIRI TO CHECK SPREAD OF JAPANESE ENCEPHALITIS
Friday, 25 November 2016 | PNS | BHUBANESWAR | in Bhubaneswar

The State Government has decided to take up construction of pig shelters under the MGNREGS.

Fisheries and Animal Resources Development Department Secretary Bishnupada Sethi had proposed construction of piggery shelters under the MGNREGS in individual lands to provide livelihood support to rural poor. The initiative would also improve the health status of pigs for better productivity and reduce the spreading of the vector-borne disease Japanese Encephalitis (JE) from pigs.

Accordingly, the Panchayati Raj Department has issued instruction to all district Collectors in this regard.

The State is currently witnessing JE outbreak in Malkangiri district, where about 120 children have died. Although the exact cause of the death is being still investigated, one of the possible risk factors is the pig population, which acts as a carrier for the JE virus.
...
http://www.dailypioneer.com/state-e...to-check-spread-of-japanese-encephalitis.html

Ronan Kelly · Nov 27, 2016

Odisha
Two kids die, JE panic in Mayurbhanj
By Express News Service | Published: 27th November 2016 02:37 AM |
Last Updated: 27th November 2016 02:37 AM | A+A A- |

BARIPADA: After Malkangiri and Koraput, death of two children of suspected Japanese Encephalitis (JE) in Mayurbhanj district has spread panic among the locals.

The children identified as Nandi Chatra (7), daughter of Ladu Chatra and Sita Chatra (8), daughter of Matai Chatra of Jharjhari village under Thakurmunda block died while undergoing treatment at two separate hospitals.

While Nandi was admitted in Karanjia sub-divisional hospital after she suffered from fever Sita was died at a local primary health centre at Thakurmunda. Though the cause of deaths is yet to be ascertained, but locals feared they died of JE as the symptoms they developed were similar to the deadly disease.
...
According to district health officials, 19 children were admitted in Baripada District Headquarters Hospital on the suspicion that they are suffering from Japanese encephalitis. They came from PHCs and CHCs in the district. Five among them have been found JE positive and they are under treatment, they said.

District malaria officer Dr Sashikanta Sethi, however, claimed that no death due to JE has been reported in this district so far.
...
http://www.newindianexpress.com/sta...-kids-die-je-panic-in-mayurbhanj-1543082.html

Ronan Kelly · Nov 27, 2016

[TABLE="class: display dataTable, border: 0, cellpadding: 0, cellspacing: 0, width: 852"]
[TR="class: gradeX odd, bgcolor: #FFDDDD"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFC4C4"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFD1D1"]
[/TD]
[TD="width: 5%"]90[/TD]
[TD="width: 7%"]Male[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]November 26, 2016
Time : 4:20 pm[/TD]
[TD="width: 6%"]City : BIJNOR
Distt. : BIJNOUR
State : UTTAR PRADESH[/TD]
[/TR]
[TR="class: gradeX even, bgcolor: #FFEEEE"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFD5D5"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFE2E2"]
[/TD]
[TD="width: 5%"]36[/TD]
[TD="width: 7%"]Male[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]November 26, 2016
Time : 4:10 pm[/TD]
[TD="width: 6%"]City : Laldhang
Distt. : HARIDWAR
State : UTTRANCHAL
[/TD]
[/TR]
[/TABLE]
ages in months
http://idsurv.org/display-data.php

Ronan Kelly · Nov 30, 2016

Odisha
JE claims one more life in M?giri, toll rises to 123

11-30 07:32 Prameya News7 / View source

Bhubaneswar: There is no let up in the continuous death of children in Japanese Encephalitis (JE) in Malkangiri district with one more kid succumbing to the vector-borne disease on Wednesday.

The deceased was identified as Rabi Kumbhar, a resident of Pitakata village under Korukonda block of the district. With the death of Rabi, the toll due to the vector-borne disease rose to 123.
...
http://newsdog.today/a/article/583e885612907151225c3ad8/

Ronan Kelly · Dec 2, 2016

Ministry of Health and Family Welfare02-December, 2016 13:10 IST

Japanese Encephalitis

As per the reports submitted by the States/UTs, 257 districts are affected by JE and 442 districts are affected by AES.
Statements indicating State/UT-wise, number of JE and AES cases and deaths reported during the last three years and the current year, are given below:

State wise Number of JE Case (C) and Death (D) - 2013 to 2016 (till 27.11.2016) [TABLE="align: center, border: 0, cellpadding: 0, cellspacing: 0, width: 586"]
[TR]
[TD]Sl. No[/TD]
[TD]States/ UTs[/TD]
[TD]No. of Districts[/TD]
[TD="colspan: 8"]Year [/TD]
[/TR]
[TR]
[TD="colspan: 2"]2013[/TD]
[TD="colspan: 2"]2014[/TD]
[TD="colspan: 2"]2015[/TD]
[TD="colspan: 2"]2016 (P)
till 27.11.2016[/TD]
[/TR]
[TR]
[TD]C[/TD]
[TD]D[/TD]
[TD]C[/TD]
[TD]D[/TD]
[TD]C[/TD]
[TD]D[/TD]
[TD]C[/TD]
[TD]D[/TD]
[/TR]
[TR]
[TD]1[/TD]
[TD]Andhra Pradesh[/TD]
[TD]1[/TD]
[TD]7[/TD]
[TD]3[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]2[/TD]
[TD]Arunachal Pradesh[/TD]
[TD]11[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]32[/TD]
[TD]3[/TD]
[TD]32[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]3[/TD]
[TD]Assam[/TD]
[TD]28[/TD]
[TD]495[/TD]
[TD]134[/TD]
[TD]761[/TD]
[TD]165[/TD]
[TD]614[/TD]
[TD]135[/TD]
[TD]416[/TD]
[TD]85[/TD]
[/TR]
[TR]
[TD]4[/TD]
[TD]Bihar[/TD]
[TD]23[/TD]
[TD]14[/TD]
[TD]0[/TD]
[TD]20[/TD]
[TD]2[/TD]
[TD]66[/TD]
[TD]12[/TD]
[TD]82[/TD]
[TD]20[/TD]
[/TR]
[TR]
[TD]5[/TD]
[TD]Delhi[/TD]
[TD]8[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]1[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]6[/TD]
[TD]Goa[/TD]
[TD]2[/TD]
[TD]3[/TD]
[TD]1[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]1[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]7[/TD]
[TD]Haryana[/TD]
[TD]5[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]5[/TD]
[TD]1[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]2[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]8[/TD]
[TD]Jharkhand[/TD]
[TD]16[/TD]
[TD]89[/TD]
[TD]5[/TD]
[TD]90[/TD]
[TD]2[/TD]
[TD]116[/TD]
[TD]8[/TD]
[TD]43[/TD]
[TD]5[/TD]
[/TR]
[TR]
[TD]9[/TD]
[TD]Karnataka[/TD]
[TD]16[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]13[/TD]
[TD]0[/TD]
[TD]27[/TD]
[TD]1[/TD]
[TD]1[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]10[/TD]
[TD]Kerala[/TD]
[TD]7[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]3[/TD]
[TD]2[/TD]
[TD]2[/TD]
[TD]1[/TD]
[TD]2[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]11[/TD]
[TD]Maharashtra[/TD]
[TD]3[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]7[/TD]
[TD]0[/TD]
[TD]4[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]12[/TD]
[TD]Manipur[/TD]
[TD]8[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]1[/TD]
[TD]0[/TD]
[TD]6[/TD]
[TD]0[/TD]
[TD]44[/TD]
[TD]1[/TD]
[/TR]
[TR]
[TD]13[/TD]
[TD]Meghalaya[/TD]
[TD]8[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]72[/TD]
[TD]3[/TD]
[TD]41[/TD]
[TD]8[/TD]
[TD]34[/TD]
[TD]4[/TD]
[/TR]
[TR]
[TD]14[/TD]
[TD]Nagaland[/TD]
[TD]8[/TD]
[TD]4[/TD]
[TD]0[/TD]
[TD]6[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]15[/TD]
[TD]Odisha[/TD]
[TD]15[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]33[/TD]
[TD]2[/TD]
[TD]221[/TD]
[TD]39[/TD]
[/TR]
[TR]
[TD]16[/TD]
[TD]Punjab[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]1[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]17[/TD]
[TD]Tamil Nadu[/TD]
[TD]28[/TD]
[TD]33[/TD]
[TD]0[/TD]
[TD]36[/TD]
[TD]3[/TD]
[TD]53[/TD]
[TD]0[/TD]
[TD]36[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]18[/TD]
[TD]Telangana[/TD]
[TD]7[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]8[/TD]
[TD]1[/TD]
[TD]4[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]19[/TD]
[TD]Tripura[/TD]
[TD]8[/TD]
[TD]14[/TD]
[TD]0[/TD]
[TD]14[/TD]
[TD]0[/TD]
[TD]28[/TD]
[TD]4[/TD]
[TD]77[/TD]
[TD]1[/TD]
[/TR]
[TR]
[TD]20[/TD]
[TD]Uttar Pradesh[/TD]
[TD]32[/TD]
[TD]281[/TD]
[TD]47[/TD]
[TD]191[/TD]
[TD]34[/TD]
[TD]351[/TD]
[TD]42[/TD]
[TD]353[/TD]
[TD]68[/TD]
[/TR]
[TR]
[TD]21[/TD]
[TD]Uttarakhand[/TD]
[TD]1[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]22[/TD]
[TD]West Bengal[/TD]
[TD]20[/TD]
[TD]140[/TD]
[TD]12[/TD]
[TD]415[/TD]
[TD]78[/TD]
[TD]342[/TD]
[TD]75[/TD]
[TD]153[/TD]
[TD]33[/TD]
[/TR]
[TR]
[TD="colspan: 2"]Grand Total[/TD]
[TD]257[/TD]
[TD]1086[/TD]
[TD]202[/TD]
[TD]1661[/TD]
[TD]293[/TD]
[TD]1731[/TD]
[TD]291[/TD]
[TD]1474[/TD]
[TD]256[/TD]
[/TR]
[/TABLE]

State wise Number of AES Case (C) and Death (D) - 2013 to 2016 (till 27.11.2016) [TABLE="align: center, border: 0, cellpadding: 0, cellspacing: 0, width: 620"]
[TR]
[TD]Sl. No[/TD]
[TD]States/ UTs[/TD]
[TD]No. of Districts[/TD]
[TD="colspan: 8"]Year[/TD]
[/TR]
[TR]
[TD="colspan: 2"]2013[/TD]
[TD="colspan: 2"]2014[/TD]
[TD="colspan: 2"]2015[/TD]
[TD="colspan: 2"]2016 (P)
till 27.11.2016[/TD]
[/TR]
[TR]
[TD]C[/TD]
[TD]D[/TD]
[TD]C[/TD]
[TD]D[/TD]
[TD]C[/TD]
[TD]D[/TD]
[TD]C[/TD]
[TD]D[/TD]
[/TR]
[TR]
[TD]1[/TD]
[TD]Andhra Pradesh[/TD]
[TD]13[/TD]
[TD]345[/TD]
[TD]3[/TD]
[TD]31[/TD]
[TD]0[/TD]
[TD]50[/TD]
[TD]0[/TD]
[TD]4[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]2[/TD]
[TD]Arunachal Pradesh[/TD]
[TD]17[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]102[/TD]
[TD]11[/TD]
[TD]73[/TD]
[TD]2[/TD]
[TD]1[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]3[/TD]
[TD]Assam[/TD]
[TD]28[/TD]
[TD]1388[/TD]
[TD]272[/TD]
[TD]2194[/TD]
[TD]360[/TD]
[TD]1409[/TD]
[TD]260[/TD]
[TD]1668[/TD]
[TD]183[/TD]
[/TR]
[TR]
[TD]4[/TD]
[TD]Bihar[/TD]
[TD]40[/TD]
[TD]417[/TD]
[TD]143[/TD]
[TD]1358[/TD]
[TD]355[/TD]
[TD]285[/TD]
[TD]90[/TD]
[TD]269[/TD]
[TD]90[/TD]
[/TR]
[TR]
[TD]5[/TD]
[TD]Delhi[/TD]
[TD]8[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]1[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]6[/TD]
[TD]Goa[/TD]
[TD]2[/TD]
[TD]48[/TD]
[TD]1[/TD]
[TD]17[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]12[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]7[/TD]
[TD]Haryana[/TD]
[TD]14[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]6[/TD]
[TD]1[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]2[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]8[/TD]
[TD]Jharkhand[/TD]
[TD]24[/TD]
[TD]270[/TD]
[TD]5[/TD]
[TD]288[/TD]
[TD]2[/TD]
[TD]217[/TD]
[TD]8[/TD]
[TD]288[/TD]
[TD]5[/TD]
[/TR]
[TR]
[TD]9[/TD]
[TD]Karnataka[/TD]
[TD]32[/TD]
[TD]162[/TD]
[TD]0[/TD]
[TD]75[/TD]
[TD]0[/TD]
[TD]335[/TD]
[TD]1[/TD]
[TD]193[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]10[/TD]
[TD]Kerala[/TD]
[TD]14[/TD]
[TD]53[/TD]
[TD]6[/TD]
[TD]6[/TD]
[TD]2[/TD]
[TD]29[/TD]
[TD]3[/TD]
[TD]13[/TD]
[TD]3[/TD]
[/TR]
[TR]
[TD]11[/TD]
[TD]Maharashtra[/TD]
[TD]27[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]51[/TD]
[TD]0[/TD]
[TD]28[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]12[/TD]
[TD]Manipur[/TD]
[TD]10[/TD]
[TD]1[/TD]
[TD]0[/TD]
[TD]16[/TD]
[TD]0[/TD]
[TD]34[/TD]
[TD]0[/TD]
[TD]437[/TD]
[TD]1[/TD]
[/TR]
[TR]
[TD]13[/TD]
[TD]Meghalaya[/TD]
[TD]11[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]212[/TD]
[TD]3[/TD]
[TD]174[/TD]
[TD]8[/TD]
[TD]89[/TD]
[TD]4[/TD]
[/TR]
[TR]
[TD]14[/TD]
[TD]Nagaland[/TD]
[TD]12[/TD]
[TD]20[/TD]
[TD]0[/TD]
[TD]20[/TD]
[TD]1[/TD]
[TD]10[/TD]
[TD]1[/TD]
[TD]0[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]15[/TD]
[TD]Odisha[/TD]
[TD]30[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]660[/TD]
[TD]2[/TD]
[TD]960[/TD]
[TD]106[/TD]
[/TR]
[TR]
[TD]16[/TD]
[TD]Punjab[/TD]
[TD]22[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]1[/TD]
[TD]0[/TD]
[TD]1[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]17[/TD]
[TD]Tamil Nadu[/TD]
[TD]44[/TD]
[TD]77[/TD]
[TD]8[/TD]
[TD]346[/TD]
[TD]4[/TD]
[TD]847[/TD]
[TD]0[/TD]
[TD]624[/TD]
[TD]2[/TD]
[/TR]
[TR]
[TD]18[/TD]
[TD]Telangana[/TD]
[TD]10[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]155[/TD]
[TD]5[/TD]
[TD]157[/TD]
[TD]1[/TD]
[TD]57[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]19[/TD]
[TD]Tripura[/TD]
[TD]8[/TD]
[TD]211[/TD]
[TD]0[/TD]
[TD]323[/TD]
[TD]0[/TD]
[TD]459[/TD]
[TD]4[/TD]
[TD]306[/TD]
[TD]1[/TD]
[/TR]
[TR]
[TD]20[/TD]
[TD]Uttar Pradesh[/TD]
[TD]43[/TD]
[TD]3096[/TD]
[TD]609[/TD]
[TD]3329[/TD]
[TD]627[/TD]
[TD]2894[/TD]
[TD]479[/TD]
[TD]3599[/TD]
[TD]569[/TD]
[/TR]
[TR]
[TD]21[/TD]
[TD]Uttarakhand[/TD]
[TD]13[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]2[/TD]
[TD]0[/TD]
[TD]0[/TD]
[TD]0[/TD]
[/TR]
[TR]
[TD]22[/TD]
[TD]West Bengal[/TD]
[TD]20[/TD]
[TD]1735[/TD]
[TD]226[/TD]
[TD]2385[/TD]
[TD]348[/TD]
[TD]2165[/TD]
[TD]351[/TD]
[TD]1601[/TD]
[TD]235[/TD]
[/TR]
[TR]
[TD="colspan: 2"]Grand Total[/TD]
[TD]442[/TD]
[TD]7825[/TD]
[TD]1273[/TD]
[TD]10867[/TD]
[TD]1719[/TD]
[TD]9855[/TD]
[TD]1210[/TD]
[TD]10152[/TD]
[TD]1199[/TD]
[/TR]
[/TABLE]

? AES is caused by various reasons like bacteria, virus etc. of which only JE is vaccine preventable disease, for which vaccination is provided.

? As on date, out of 216 endemic districts, 198 have been covered under JE vaccination campaign in 1-15 years children. The campaign is followed by two doses of JE vaccine under Routine Immunization (at 9-12 months and 16-24 months) to cover the new cohort under Universal Immunization Programme (UIP) since 2006.
? Adult JE vaccination has been completed in 5 districts of Assam and selected blocks of 7 districts of UP and 9 districts of West Bengal. More Blocks have been identified for Adult JE vaccination campaign (>15-65 years) in the States of West Bengal and Assam.
? A multi-pronged strategy has been adopted under the National Programme for Prevention and Control of JE/AES approved by the cabinet on 18.10.2012 in sixty high priority districts in 5 States of Assam, Bihar,
Tamil Nadu, Uttar Pradesh and West Bengal with the participation of Ministry of Health & Family Welfare, Ministry of Drinking Water & Sanitation, Ministry of Housing & Urban Poverty Alleviation, Ministry of Social Justice & Empowerment, Ministry of Women &Child Development and Ministry of Human Resource Development (Department of School Education & Literacy). The Major components under the Programme include strengthening of JE/AES surveillance by establishing sentinel laboratories, reduction in case fatality rate by establishment of Pediatric Intensive Care Unit (ICU) at district level in 60 high burdened districts, capacity building in critical case management, JE vaccination, supply of safe drinking water, establishment of Physical Medicine and Rehabilitation Department in 10 identified medical college of five states.
? Number of sentinel sites increased from 51 in 2005 to 130 at present.
? Apex Referral Laboratories increased from 12 to 15.
? Out of 216 endemic districts, 197 districts covered under JE vaccination campaign in 1-15 years children.
? Adult JE vaccination completed in 5 districts of Assam and selected blocks of 7 districts of UP and 9 districts of West Bengal. More Blocks have been identified for Adult JE vaccination campaign (>15-65 years) in the States of West Bengal and Assam.
? Till date funds released for 42 Pediatric Intensive Care Unit (PICU).
? Funds have been released for 10 Physical Medicine Rehabilitation (PMR).

The Minister of State (Health and Family Welfare), Sh Faggan Singh Kulaste stated this in a written reply in the Lok Sabha here today.

*****

MV/LK

(Release ID :154771)
http://pib.nic.in/newsite/erelease.aspx?relid=154771

Ro' Comments: We have reports in this thread of 123 confirmed encephalitis deaths in Odisha to November 30th. Two fatalities were reported in Karnataka to July 10. Delhi reported a death on July 22. Manipur reported 4 deaths to August 10. Madhya Pradesh reported 37 cases with 14 fatalities to August 11. Telangana reported a fatality on Aug 14. Maharashtra reported 3 cases of AES, 1 fatal in the Week 28 IDSP report. Chhattisgarh has reported 14 deaths to Nov 1st.

Putting all of this together, confirmed fatalities now total to 1,252 an increase of 44 since Nov 23rd.

Comparison of NVBDCP numbers to similar period in previous years:
Year // AES Cases/ Deaths/ JE Cases/ Deaths
2015// 9,854 / 1,210 / 1,730 / 291 for full year
2014// 9,358 / 1,467 / 1,484 / 275 to December 1st
2013// 7,825 / 1,273 / 1,086 / 202 for full year
2012//7,685 / 1,143 / 704 / 136 to November 19th
2011// 7,137 / 1,064 / NA / NA to December 1st

Ronan Kelly · Dec 3, 2016

Uttar Pradesh
States
Posted at: Dec 3 2016 10:15PM

Toll mounts to 489 in UP after 3 deaths due to encephalitis
Gorakhpur, Dec 3 (UNI) After three more deaths of children due to encephalitis in Baba Raghav Das Medical College Hospital during past 24 hours, the toll rose to 489 today.
Sources said 1899 patients of encephalitis have been admitted to Baba Raghav Das Medical College Hospital since past January 1 which included 489 children who died due to the disease.
Sources said 4 new patient of encephalitis have been admitted recently.
...
Read more at http://www.uniindia.com/toll-mounts...s/states/news/707115.html#COmevSP64194EAXD.99

Comment: Uttar Pradesh has reported 569 deaths to Nov 27th indicating that at least 83 deaths have occurred at facilities other than BRD, Gorakhpur. - Ro

Ronan Kelly · Dec 4, 2016

Odisha
CONFUSION PERSISTS AS NO LETUP IN M?GIRI CHILD DEATHS
Monday, 05 December 2016 | SANJEEV KUMAR PATRO | BHUBANESWAR | in Bhubaneswar

When how many children died in Malkangiri of Japanese Encephalitis (JE)/ Acute Encephalitis Syndrome (AES) or now labelled Acute Hepatomyo Encephalopthy syndrome (AHE) is the burning question, the State Health Department seems to be in complete confusion leaving the people at Malkangiri crestfallen with climbing fatalities.

While State Health Department has put the death toll figure at around 122 till date, the Union Health and Family Welfare Ministry?s regional office here pegs mortalities at around 140 (of which 137 deaths recorded till November last and around 3 in December). The detailed data shows that JE related deaths were around 36-39 and rest owing to AES.

Significantly, when the death toll still keeps ticking, the State Government seems wriggling out of the mess with the alibi that Cassia occidentalis consumption is cause of deaths in Malkangiri courtesy the discovery by State appointed expert team led by Dr Jacob John.
...
http://www.dailypioneer.com/state-e...rsists-as-no-letup-in-mgiri-child-deaths.html

Ronan Kelly · Dec 7, 2016

Assam
JE surging in Assam

With 85 JE deaths this year, Assam currently topping casualty list; national programme for prevention & control of vector-borne diseases failing badly in State

STAFF REPORTER

GUWAHATI, Dec 6: Assam has recorded the highest number of Japanese Encephalitis (JE) deaths in the country this year, reflecting the dismal condition of healthcare in the state.
...
Sources have pointed out that despite the Centre pumping huge amounts of funds into Assam to keep vector-borne diseases at bay, such diseases are far from being controlled.

Official figures suggest that the NVBDCP has been a total failure in Assam. This programme is being implemented across the country for the prevention and control of vector-borne diseases ? malaria, dengue, Japanese encephalitis (JE), Acute Encephalitis Syndrome (AES), chikungunya, lymphatic filariasis, kala-azar etc.

As per official data, under the NVBDCP, the Centre released Rs 3,813.45 lakh against an allocation of Rs 5,168.19 lakh in 2013-14 fiscal, Rs 2,673.04 lakh against an allocation of Rs 3,036 lakh in 2014-15, Rs 3,260.14 lakh against an allocation of Rs 2,591 lakh in 2015-16 and only Rs 586.64 lakh against an allocation of Rs 2,395.10 lakh till October 31 in the current fiscal.
http://www.sentinelassam.com/mainne...0&id=290607&dtP=2016-12-07&ppr=1#.WEfw8_krKUk

Odisha
Japanese Encephalitis Vaccination Drive Begins in Malkangiri-2016

Date: 05 Dec 2016

Vaccination for Japanese Encephalitis (JE) began in Malkangiri district on Monday. As many as 2.18 lakh children aged between 1-15 years identified for vaccination. District Collector K Sudarshan Chakravarty inaugurated the drive against JE in the district today.

The programme would be carried out from 8 AM to 3 PM everyday for 15 days. A total 175 teams have been formed for this. Total 2,18,027 children aged between 1 and 15 years have been identified for the vaccination. In the first phase, schools having larger number of students would be covered.
http://www.nuaodisha.com/ContentDetails.aspx?cid=21139&todo=news

India Encephalitis 2016, 1,376 fatalities

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020

Retired 2020