Warning bell seemingly rings louder for Odisha when it becomes the only State in the country to post the highest rise in cases of Acute Encephalitis Syndrome (AES) this year till November first week. AES fatalities now are closing in with total malarial fatality in Odisha.
What looks grim then is AES is caused by 100 different pathogens ranging from virus, bacteria to fungi and parasites, where in 75 per cent cases, there has been no identifiable etiology (means causative organism) and almost in 90 per cent AES cases, there is no specific treatment (means non-responsive to anti-viral medicines).
The emerging health exigency here is Odisha, at least statistically, had no AES reported cases till 2014 and, in a significant twist, the State Health Department is now officially attributing most deaths in Malkangiri to AES rather than JE. Deaths due to JE have been around 31 only with AES accounting for rest of total around 90 deaths declared officially.
According to figures available with National Vector Borne Diseases Control Programme (NVBDCP), Odisha posted an around 21 per cent rise in AES cases till end of November first week vis-a-vis reported cases for full year of 2015. The AES cases till date are over 800 against around 660 in 2015. Assam followed Odisha with a rise of over 17 per cent, followed by UP with around 9 per cent rise.
However, in Case Fatality Rate (CFR) this year, Odisha with a rate of around 10.5 is at 5th slot led by UP with a rate of over 15. But the concern is Odisha’s CFR in 2015 was a mere 0.3, and when all endemic States like Bihar, Assam, UP and West Bengal have recorded a drop in CFR by around 3-4 points in 2016 vis-a-vis 2015.
What’s the way out for Odisha then to curtail the rising fatalityIJ As per an expert study with the Union Government, without assessing the disease burden correctly, mere fund allotment or planning health measures will not yield the desired result of curbing fatality rate. This is what happened in Malkangiri. As at any given time, encephalitis has multiple causes and the fact of treating all patients with anti-viral therapy assuming all cases to Japanese Encephalitis proved counter-productive. Because, the State health officials on record have said that in around 60 per cent of cases, treatment was symptomatic only without actual diagnosis.
Moreover, the Central team that visited Malkangiri has noted that high fatality rate in Odisha is mostly due to secondary injury to brain owing to encephalitis. “The secondary injury manifests in a patient because a patient has not been provided the timely supportive care to keep maintaining the glucose and oxygen supplies to brain, which is number one exigency factor in such scenario to prevent damage to brain or any organ, and that can be ensured in proper supportive care only,” observed a senior team member in an informal talk.