When Malkangiri district has been evidencing a growing incidence of the Japanese Encephalitis virus (JEV) since long, the State Government keeps ignoring it blissfully. And the result is history exploded with a bigger tragedy this time. With over 50 deaths in little over a month to its discredit in 2016, Odisha has now figured in the top-5 list of JEV-induced fatalities in the country.
Exactly, in the same timeframe of September to till early November (post-monsoon) in 2012, Malkangiri district had recorded almost a dozen deaths, mostly of children below 10 years, due to JEV. A study of JEV endemicity by the Regional Medical Research Centre (RMRC), Bhubaneswar in Malkangiri then had reported how the district is having an environment prone to acquire JEV, especially the environmental risk factors or the early warning signals like human dwellings in very close proximity (less than 2 feet) to paddy fields and piggeries, which respectively, serve as the host breeding reservoir for the vector and the virus.
And the RMRC had specifically counselled the State health authorities then the need to have public health vigilance in such prone areas of the district as it found the JEV vector culex vishnui mosquito per man hour density quite high vis-à-vis other mosquito species.
Above all, it then had cautioned the State over resurfacing of JEV in Odisha after two decades of the last reported case in Sundargarh district. But interventions by the health authorities in the intervening period (2012-15) have almost been nil. The result: JEV exploded in Malkangiri quite virulently to propel Odisha among the JEV-endemic States in 2016.
Malkangiri could have saved this day had the health authorities post 2012 had carried out further epidemiological study to gather evidence to be presented to the Union Government in order to extend the JE vaccination programme in the entire district. Because JE vaccination is the most surefire strategy to deal with the JEV as the disease has a very complex eco-epidemiology that throws hurdles in vector control, etc., remarked a senior RMRC scientist.
A top official in the Health Department explained why the fatality rate in Malkangiri is yet to be brought under control. “Since there is no specific treatment for the disease, patients need more supportive therapy, which requires close monitoring, and for that a well-equipped and at least 10-bedded Pediatric Intensive Care Unit (PICU) in the district hospital is the ultimate necessity. Its dearth is responsible for shooting up the fatality toll,” she explained.
She added that since the treatment to JEV is symptomatic, health institutions attending to patients (outdoor and indoor) in the district should have consciously noted down any patient exhibiting signs and symptoms of even Acute Encephalitis Syndrome (AES) and informed the same to higher health authorities Then, it would have been easier to contain the outbreak, she observed.