Japanese encephalitis outbreak kills 1300 children in India

BMJ 2005; 331 doi: (Published 01 December 2005) Cite this as: BMJ 2005;331:1288
  1. Ganapati Mudur
  1. New Delhi

    An outbreak of Japanese encephalitis in the northern Indian state of Uttar Pradesh has killed more than 1300 children over the past four months. It has rekindled calls from public health specialists for more intensive efforts to prevent future outbreaks.

    Since the first cases in the current outbreak were reported in August, Indian authorities have reported 6171 cases nation-wide, including 5700 cases and 1315 deaths in Uttar Pradesh alone.

    “The outbreak in Uttar Pradesh is the longest and most severe in decades,” India's health secretary, Prasanna Hota, said last week. “It has not burned itself out yet. But it's going away.”

    Government officials said early and persistent rain through the monsoon season this year flooded rice fields and provided a breeding environment conducive for Culex tritaeniorhynchus, the species of mosquito that carries the Japanese encephalitis virus from pigs and infects humans through bites.

    Although Japanese encephalitis has progressively expanded into new territories in India over the past decade, government figures show that over the past five years the annual number of cases had not exceeded 3000, and annual mortality had always remained below 500.

    Uttar Pradesh has seen a steady increase in the number of cases of Japanese encephalitis in recent years. Public health experts believe that fresh outbreaks in areas that have long been classed as high risk zones show a failure in public health measures.

    “After an outbreak we typically see just fire fighting,” said Pradeep Das, director of the Vector Control Research Centre in Pondicherry. “What we need is a sustained and concentrated effort to prevent future outbreaks,” Dr Das said.

    Relatively simple steps, such as promoting the use of bed nets, excluding pigs from human habitations, and educating people to avoid going outdoors during the hours when the mosquitoes are most active, have not received adequate investment or resources, Dr Das said.

    A government doctor looking into the outbreak said the high numbers of cases and rapid progression to death in some villages seemed to have overwhelmed the medical infrastructure in parts of Uttar Pradesh. In the district of Saharanpur alone 97 villages have been affected.


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