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CASES OF
JAPANESE ENCEPHALITIS IN GORAKHPUR, UTTAR PRADESH
A central multi-disciplinary team, headed by
Professor of Pediatricts, Kalawati Saran Children’s Hospital and consisting
of epidemiologist and microbiologist from NICD and entomologist from NVBDCP
carried out an epidemiological investigation of the cases between 18th
and 22nd August 2005 and recommended control measures. A high
level central team consisting of Director General Health Services, Director
National Institute of Communicable Diseases and Director National Vector
Borne Disease Control Programme then visited the state on 20th
August 2005 to review the situation and made suitable recommendations
JE Epidemiological
situation:
JE is endemic in Gorakhpur and Basti divisions of
Eastern UP covering 7 districts, mainly, Maharjganj, Kushinagar, Gorakhpur,
Sant Kabi nagar, Siddharthnagar, Deoria, and Basti. Current distribution of
cases and districts affected are depicted in the map. The current occurrence
of cases started on 29th July 2005 and is continuing. As on 29th
August 2005, 1100 cases and 292 deaths have been reported from Uttar Pradesh.
Refer to table below.
The central team which visited the affected on 20th
August 2005, reviewed the data of cases admitted in BRD Medical College,
Gorakhpur. Out of the admitted cases, 139 cases recovered from illness and
111 deaths were reported. JE cases from nieghbouring districts of Bihar and
Nepal were also admitted in this hospital.
Village-wise analysis of cases revealed that in
majority of villages there was only one reported case of acute encephalitis.
Table: As per
information received from BRD Medical College
Table: Age
distribution of cases
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AGE-GROUP
|
NO. OF CASES
|
PERCENTAGE
|
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0-5
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98
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35.0
|
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6-10
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140
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50.0
|
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11-15
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38
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13.7
|
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16+
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2
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0.7
|
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TOTAL
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278
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100.0
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Entomological
survey:
The entomological survey in the sample villages in
Gorakhpur district by the central team revealed high density of Culex
tritaenorhyncus and Culex vishnui group – the vectors of JE
Laboratory
confirmation:
 A
team from Microbiology department of Sanjay Gandhi Post-graduate Institute, Lucknow has been deputed and assigned the task of
training in and establishing laboratory facilities for JE diagnosis in Gorakhpur district.
The
Regional laboratory at Lucknow
has tested 168 serum and/ or CSF samples of which 98 were positive for IgM to
JEV.
68
(38 CSF & 30 serum) samples were drawn from 38 patients and 1 convalescent
case of acute encephalitis syndrome by the investigating central team. 27 CSF
and 16 serum samples have been found positive for the presence of IgM
antibodies to JEV. Serum sample collected from the convalescent case was
found negative for the presence of IgM antibodies to JEV.
Control
measures being implemented:
Standard
case management guidelines have been issued to the hospitals for better
patient care and reducing case mortality and morbidity.
Fogging
with Technical Malathion has been intensified and covering priority villages
and populations. About 40 functional fogging machines and 3 vehicles mounted
fogging machines are being used for fogging operations.
Anti-larval
operations have been limited due to the vast water bodies including paddy fields.
Health
education: intensive health education campaign using cable TV network,
miking, and inter-personal communication have been implemented. Messages
include emphasis on keeping pigs away from human dwellings, adapting personal
protective measures against mosquito bites, early reporting of cases to
hospital facilities for early case management.
Use
of ITN by vulnerable groups is under consideration
The
role of vaccination during the inter-epidemic period has been discussed and
is under review indigenously manufacturing 3-5 lakh doses of the inactivated
mouse-brain vaccine. This supply is unable to meet the demand of 75 lakh
doses required for immunizing children in Uttar Pradesh. Ministry of Health
& FW has called for a meeting of experts on 1st September 2005 to discuss
the importation of tissue-culture based vaccines from China and other
countries in the context of non-WHO-pre-qualified vaccines available
internationally.
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