Statement of Union Health Minister regarding the Situation Arising out of Spread of Encephalitis

1. In recent months, upsurge in cases of Encephalitis has been reported from Eastern Uttar Pradesh ( in Gorakhpur, Kushi Nagar, Siddharth Nagar, Maharajganj, Deoria, Basti, Sant Kabir Nagar), Bihar ( in Muzaffarpur, East Champaran, Vaishali, Sitamarhi), West Bengal ( in Malda, Jalpaiguri, Coochbehar, Darjeeling, Uttar and Dakshin Dinajpur) and Assam (in Barpeta, Baksa, Darrang, Dibrugarh, Jorhat, Kamrup (Rural), Kamrup (Metro), Nalbari, Sivsagar, Sonitpur). In 2014, the total number of cases due to Acute Encephalitis Syndrome (AES) reported from the States of Uttar Pradesh, Bihar, West Bengal and Assam are 501, 857, 1183 and 1217 respectively. For the said States, the number of deaths due to AES for the same period are 123, 159, 208 and 197 respectively. The number of Japanese Encephalitis (JE) cases in Uttar Pradesh, Bihar, West Bengal and Assam are 9, nil, 176 and 466 respectively whereas the deaths are 2, nil, 31and 80 respectively. 2. Hon’ble Members are well aware that Encephalitis is inflammation of the brain which can be caused due to various pathogens including virus, bacteria and protozoa. While JE is a Vector Borne Disease transmitted through Culex vishnui group of mosquitos, Encephalitis can also be caused by entero-viruses which are water borne. Recently in Muzaffarpur and Malda, cases reported for Encephalitis were neither due to Japanese Encephalitis nor due to entero-viruses. Normally, Encephalitis is affecting children below 15 years of age. However, in the last few years, epidemiological data has revealed that many adults are also being affected and cases of morbidity and mortality, particularly for JE, have been observed in adults in Assam and now in the districts of North Bengal. 3. Three distinct types of Encephalitis cases have been observed. The recent out-break in the districts of North Bengal and Assam is due to JE. The cases in Gorakhpur and adjoining districts are due to entero-viruses. In Malda and Muzaffarpur, the preliminary assessment by expert teams suggests encephalopathy rather than encephalitis. The encephalopathy has no infective aetiology. The cause could be due to toxins, nutritional, heat-stress related or metabolic factors. Soon after I took over as the Health Minister, on receiving reports of out-break of Encephalitis in Muzaffarpur, I had convened a meeting with some of the Hon’ble MPs from Uttar Pradesh and Bihar where senior officers from the States and my Ministry were also present. Thereafter, I especially visited Muzaffarpur along with the Secretary (Health & Family Welfare) and Director, National Vector Borne Disease Control Programme (NVBDCP) to assess the field level situation. I also visited SKM Medical College and KMG Hospital in Muzaffarpur, where cases of encephalitis were being managed. Teams from National Centre for Disease Control (NCDC) with support from Centre for Disease Control (CDC), Atlanta, and from Indian Council for Medical Research (ICMR) were already in the field, investigating the causes of the outbreak. Their investigation ruled out JE virus, Entero virus, West Nile virus, Chandipura Virus and Nipah virus. Further investigation of the samples for identification of toxins and other factors which could cause Encephalopathy is being undertaken at CDC, Atlanta. During my visit to the United States of America in June this year, where I also had extensive discussions with Director CDC, I have requested for prioritizing this investigation. I would like to share with the Hon’ble Members, that as per our reports, many children who had been brought to the hospitals at Muzaffarpur had very low sugar levels (hypoglycaemia). Further, the affected children were usually from rural areas with poor socio-economic background and resided near fields.I would also like to inform the Hon’ble Members that immediately on receipt of information about upsurge of Encephalitis cases in North Bengal Districts of West Bengal, a five members team of experts from NVBDCP, Dr. RML Hospital and ICMR was sent to assist the State Health Authorities for containment of the outbreak and to provide technical assistance. I have, thereafter, also written to the Hon’ble Chief Minister of West Bengal, offering all assistance from my Ministry. 4. In view of high burden of JE/AES in five States, namely Assam, Bihar, Tamil Nadu, Uttar Pradesh and West Bengal, which account for around 85% of JE/AES burden in the country, a National Programme with a multi pronged strategy for Prevention and Control of JE/AES in sixty high endemic districts of these five States has been started in 2012-13 involving the Ministries of Health & Family Welfare, Drinking Water & Sanitation, Women & Child Development, Social Justice & Empowerment and Housing and Urban Poverty Alleviation. The Programme focuses on strengthening and expansion of JE vaccination in affected districts, strengthening of surveillance, vector control, strengthening of case management by setting up 10 bedded paediatric ICUs in 60 district hospitals, timely referral of serious and complicated cases, providing access to safe drinking water and proper sanitation facilities to the target population in affected rural and urban areas, provision of adequate facilities for physical, medical, neurological and social rehabilitation, improvement of nutritional status of children at risk of JE/AES and intensified IEC/BCC activities. 5. I would also like to share with the Hon’ble Members the action taken by Government under the above National Programme. For JE vaccination, out of 60 high priority districts, vaccination has been completed in 57 districts, it is ongoing in two districts of Bihar (Saran and Darbhanga) and the remaining one district (Kanpur Dehat) will also be covered during this year. We have already released funds for setting up of Paediatric ICUs in 30 districts. Funds for the remaining 30 districts will be released this year. We are following up with the State Governments for setting up the Paediatric ICUs on priority. This requires civil work, procurement of equipment and recruitment of manpower. While the Physical & Medical Rehabilitation department at BRD Medical College, Gorakhpur is already functional, the Units at K.G. Medical College, Lucknow; BHU, Varanasi; Bankura Medical College; North Bengal Medical College; Gaya Medical College and Patna Medical College require up gradation. Units are required to be set-up at Assam Medical College, Dibrugarh and at Guwahati Medical College. In this regard, a Rs. 5 crores per State has been already released by us. Vector control and surveillance activities are being supported under National Vector Borne Disease Control Programme. Surveillance is also being undertaken through the Integrated Disease Surveillance Project under NCDC. 6. The Department of Drinking Water and Sanitation has informed that in Assam, out of 1638 habitations targeted for provision of Potable Water Supply, 921 or 56% have been provided with this facility. Similarly out of 363 hand pumps to be installed, 280 or 77% have been installed. In Bihar, out of 80 habitations identified for provision of Potable Water Supply, 38 or 47% have been provided with this facility. Similarly, out of 6170 hand pumps to be installed, 4515 or 73% have been installed. In Tamil Nadu, out of 1562 habitations targeted for Potable Water Supply, nearly all have been covered. In Uttar Pradesh, out of 3378 habitations, 1364 or 40% have been provided with Potable Water Supply. For Hand pumps, out of 7902, the figure is 2422 or 30%. In West Bengal, out of 799 habitations, 712 or 91% have been covered under the Potable Water Supply Scheme. Out of 440 hand pumps to be installed, 294 or 67% have been installed in the identified 10 districts. The Ministry of Women & Child Development has informed that training of master trainers to sensitize Anganwadi workers regarding JE and AES is being conducted at New Delhi, Lucknow and Guwahati. 7. National Institute of Virology (NIV), Pune, manufactures and supplies indigenous JE IgM MAC ELISA diagnostic kits. These kits have high sensitivity and specificity. NIV has upscaled the production of these kits to meet the emerging requirement. ICMR has established a Field Unit of NIV at Gorakhpur within the premises of BRD Medical College. This unit is dedicated for the diagnosis of AES/JE in the entire Eastern Uttar Pradesh region. ICMR will establish 160 Viral Research & Diagnostic Laboratories (VRDL) in the entire country during the 12th plan period under the approved scheme on “Establishing a network of labs for managing epidemics and natural calamities”. As of now, 27 labs under ICMR are already functional and are involved in surveillance and providing effective diagnosis for all viral infections including JE. ICMR is taking proactive steps to establish VRDLs in regions of Bihar like Muzaffarpur and Gaya, which are affected with AES/JE. Seven ICMR Institutes are working together on a research cum intervention project in the area to identify pathogens and seventeen new neurotropic Entero-viruses have been identified so far. Effects of intervention on vectors and presence of pathogens will be correlated. 8. I would like to further elaborate on JE vaccination. This was started in 2006 and was scaled up in a phased manner over years. The strategy for JE vaccination is to conduct a one- time campaign (which targets all children from 1-15 years of age), after which JE vaccination is included as a part of routine immunization in that area. Initially, only one dose of JE vaccine was provided at the age of 16 to 24 months (with DPT/OPV booster). From April, 2013 onwards, two doses for JE vaccination are scheduled under routine immunization, the first at 9 to12 months and second at 16 to 24 months of age. Out of 178 JE endemic districts in the country, 148 districts have been covered by vaccination from 2006 to 2014. Further, a catch up round to cover children missed out during the campaign and Routine Immunization rounds has been carried out on 22-23 June, 2014 for ten districts of Uttar Pradesh and eight districts of Bihar. Due to recent cases of JE in adults, this issue was discussed in the National Technical Advisory Group on Immunization. It was decided that we can take up vaccination for adults too from districts where such cases are being reported. The Assam Government has covered adults with JE vaccination in nine districts. This has been beneficial. Our strategy will need to be suitably amended taking into account the aspect of adult vaccination for JE. Further, it is necessary that the coverage of immunization remains high. Our reports show that Routine Immunization undertaken by the States may not have high coverage in all the target districts. States must, therefore, focus on this important aspect. 9. Under the National Programme, funds proposed for 2014-15 for the five States for JE/AES is Rs. 48.75 crores. Besides this, financial support has also been given to BRD Medical College, Gorakhpur from time to time for strengthening of Paediatric Ward along with additional manpower. Nearly Rs. 22.59 crores have been released to the said hospital for strengthening the case management infrastructure. Similar support amounting to Rs. 6.28 crores has also been released to Government of Bihar for Gaya Medical College and Muzaffarpur Medical College. 10. I would like to share with the Hon’ble Members that prevention and control of Encephalitis requires a coordinated, effective and continuous effort by all stakeholders. These include the Union and State Governments, Panchayats and Municipalities, civil society, medical fraternity and the community itself. Within the Government, there has to be effective action and coordination by different Ministries and Departments. For example, availability of clean and potable drinking water will prevent Encephalitis due to entero-virus. Better nutrition, in particular for children, will not only enhance immunity against diseases but will also prevent hypoglycaemia. Vector control measures and source reduction, reduce the incidence of JE. Improving practices of pig rearing and better sanitation also help in prevention and control of JE. Medical fraternity, whether from Government health institutions or in the private sector, must assess the cases of fever for neurological symptoms and immediately refer the cases with Encephalitis symptoms to hospitals equipped with the required facilities. The States must utilize the funds released for strengthening the hospital infrastructure and for undertaking various activities for prevention and control of JE & AES. 11. Madam Speaker, with your permission, I also use this opportunity to appeal to Hon’ble MPs, especially from AES/JE affected districts, to undertake a campaign in their areas to educate the public to drink water after boiling, use deep bore wells as a source of drinking water and ensure Routine Immunization for their children. All patients with fever and symptoms of encephalitis should be rushed to the hospital. The Ministry of Health and Family Welfare is closely monitoring the situation in the affected States. We are available 24 by 7 for any assistance. I will also be very happy to receive feedback and guidance from the Hon’ble Members of Parliament on this matter. Courtesy : pib.nic.in