Japanese Encephalitis

This year, acute encephalitis syndrome, an infection from mosquito-borne Japanese encephalitis virus and other infections, has infected 1,219 and killed 330 people. 

The 330 deaths from another monsoon-shadowing outbreak in the eastern Uttar Pradesh district of Gorakhpur haven't created a ripple in any other part of the country. This year, acute encephalitis syndrome (AES), an infection from mosquito-borne Japanese encephalitis (JE) virus and other infections, has infected 1,219 and killed 330 people, mostly children under 14, in eastern Uttar Pradesh and western Bihar. While 92 deaths - 7.5% -- are attributed to JE, the cause of the rest is unidentified.

Gorakhpur, who has been tracking the disease since the first recorded outbreak in the Gorakhpur and six surrounding districts in 1978.

AES outbreaks are a regular as the monsoons in Gorakhpur -- 

a paddy growing  area, with clay soil and a very high water table

Unlike dengue, there was a vaccine against JE, so the Centre swung into action after the 2005 outbreak and carried mass vaccinations against JE in the region in 2006 and again 2011. JE vaccination was even made part of the Universal Immunisation Programme in 2013. On Friday, Union Health Minister Ghulam Nabi Azad proudly announced that India had developed an indigenous vaccine -vaccines imported from China were being used till now - to protect children from JE, but experts doubt whether this is will help end outbreaks.

Despite the vaccination drives since 2005, children - AES incidence is highest among boys less than 14 years -- continued to die. Though the number of children testing positive for JE dropped, children continued to die of AES symptoms of high fever, incoherence and disorientation, with or without seizures, followed by polio-like flaccid paralysis.

So, in 2006, JE outbreaks were renamed AES, a term used to describe the symptoms rather than the cause of the infection. The cause could be one or a combination of many. Gorakhpur is in the Terai region, where the warm, humid climate combined with paddy-fields and plenty of rain makes it an ideal breeding ground not just for mosquitoes but also bacteria, viruses and fungi. Children are at most risk because they are out playing and swimming in the innumerable ponds, which not just exposes them to mosquitoes but also water-borne infections.

With no specific anti-viral drugs or antibiotics available for AES and the vaccine effective only against 5-10% cases, it's imperative to solve the mystery of this monsoon brain fever striking Gorakhpur's young population.