Lucknow, 14th December: To address high case fatality due to Acute Encephalitis Syndrome (AES), in 2013- 2014, the Government of Uttar Pradesh established Encephalitis Treatment Centers (ETCs). This has led to a significant reduction in the number of AES cases from 3,018 cases in 2014 to 2,711 cases (until November 2015). The case fatality rate has also declined from 18.53 in 2014 to 15.53 in 2015.

With support from PATH, an expert committee group had recommended policy guidelines on the clinical management of AES and the setting up ETCs. The ETC model works on the basis that if suspected AES cases are oxygenated and treated within 30 minutes of the onset of fever in the nearest health facility, permanent brain damage and death can be prevented. As of date, 104 ETCs have been established in the primary and secondary health care centers across seven districts of Gorakhpur and Basti division.

The health facilities were upgraded with adequate infrastructure and trained manpower. Eight Intensive Care Units (ICUs) equipped with ventilators were supplemented with trained government health personnel available round the clock. Linkages were established with the existing free ambulance services to transport suspected AES patients to the ETCs within the minimum time possible.
Presenting an overview of AES and Japanese Encephalitis (JE) in Uttar Pradesh for the media in Lucknow, the Principal Secretary, Health, Mr. Arvind Kumar, IAS, said that AES and JE continued to be a major public health challenge not only in India but in other parts of Asia too. He said approximately 375 million people were at risk of developing AES in India, with an incidence rate of 0.46 per 100,000 population.
AES continues to be one of the most difficult syndromes due to its high morbidity and mortality rates. Japanese encephalitis is one of the leading viral causes of AES and evidence shows that it predominantly affects children below 15 years of age. Twenty four countries are endemic for JE and around the global, 67,900 cases of JE are reported annually. In the past few years, 24 districts of Gorakhpur, Basti, Devi Patan, Azamgarh, Faizabad and Lucknow division have been identified as JE endemic, which contribute to 90 percent of the AES and JE burden in Uttar Pradesh.
The Principal Secretary provided an overview on the Government of UP’s initiatives on AES and JE control. He said that in eastern Uttar Pradesh, with the onset of fever, most patients living in rural areas seek treatment from informal doctors or traditional healers. When the condition of the patient worsens family members rush them to distant hospitals or to the Baba Raghav Das (BRD) Medical College, Gorakhpur without seeking treatment at the nearby primary or secondary health care facilities. However, by the time the patient reaches the tertiary level of health facility, due to delay in treatment, irreversible brain damage sets in and around 30 – 40 percent cases develop disabilities and neurological disorders while around 30 percent cases die. At BRD Medical College, Gorakhpur, due to the large case load of AES and JE patients, a 100 bedded ICU facility is also available for pediatric patients.

Dr. Pradeep Haldar, Deputy Commissioner Immunization, Government of India said that in India there are 204 endemic districts in 21 states. Following a massive outbreak in 2005 in Uttar Pradesh and Bihar, the Government of India introduced the JE vaccination program in 2006, and till date about 11.5 crore children have been immunized. In 2015, JE vaccination campaigns were also conducted in three states – West Bengal, Assam and Uttar Pradesh due to the emergence in children above 15 and adults. In Uttar Pradesh, the adult campaigns were conducted in six districts of Gorakhpur and Basti Division where in 38 lakh beneficiaries were immunized. One hundred twenty one sentinel sites have been established across India to test for JE.

In 2015, Chief Minister, Akhilesh Yadav launched Information, Education and Communication (IEC) materials including an animation film to generate awareness within the communities on early recognition of danger signs, home based care, and preventive measures for AES/JE.

Mass awareness campaigns were also conducted and around 300 community meetings were conducted by PATH to generate awareness on prevention of AES/JE and to sensitize communities on the free services provided by the Government of UP for treatment of AES and JE. PATH supported the capacity building of over 30.000 medical officers, frontline workers and paramedics in 2014. In 2015, PATH also conducted a refresher’s training on AES and JE for over 12,000 medical officers, frontline workers and paramedics.

To evaluate the impact of the ETCs, a third party agency CORT conducted an assessment. The results showed that since the upgradation of health facilities, treatment at ETCs had increased and around 91 percent cases sought treatment at the district hospital. The average time for seeking treatment between the onset of symptom to hospitalization had also reduced to two days for those who availed services at ETCs.

Interim Country Program Leader, PATH India Evan Simpson said that PATH would continue to provide technical support to government of UP in the efforts to combat AES and JE. “The key areas of support will include strengthening ETCs, capacity building of health personnel, generation community awareness and strengthening the data management system,’ he added.

Integrated approaches taken by the Government of Uttar Pradesh
· Activities undertaken under the JE Program: Vaccination campaigns for children and adults and two doses of JE vaccine administered to children between nine months to two years of age.
· A Vector Borne Disease Surveillance Unit (VBDSU) and one JE sub-office was established at BRD Medical College, Gorakhpur, Uttar Pradesh. Physical, Medicine and Rehabilitation (PMR) department established at BRD Medical College, Gorakhpur for treating physical disabilities due to AES/JE.
· Community awareness
· Establishment of JE and AES wards to function as Encephalitis Treatment Centers.
· Integrated approach being used for addressing AES/JE. Interdepartmental coordination between Health, Water and Sanitation, Panchayati Raj Institutions, Public Health Engineering Department (PHED), National Commission for Protection of Child Rights, Education and Integrated Child Development Services (ICDS).

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