The Fight Against AES in Uttar Pradesh: A Case Study

This isn’t just a case study about the Uttar Pradesh government; it’s a success story that has compelled many to believe that work done with genuine intent never goes in vain.

The purpose of writing this article is not to promote any political government. Instead, it highlights how effective and dedicated efforts can lead to real success.

We often spend so much time criticizing governments and their actions, but it’s equally important to acknowledge and appreciate when things are done right. This story is about celebrating those positive efforts.

In Uttar Pradesh, the battle against Acute Encephalitis Syndrome (AES) has been tough, with many children previously falling victim to this serious illness. But recent efforts by the UP government have made a huge difference. Today, no one dies from AES thanks to the steps taken in recent years.

What is AES and How Has it Affected UP?

Acute Encephalitis Syndrome (AES) is a severe illness affecting the brain, often starting with a sudden fever and worsening rapidly.?

Japanese Encephalitis (JE) is caused by the Japanese Encephalitis Virus (JEV), a flavivirus transmitted primarily by Culex mosquitoes.

The virus cycles between mosquitoes and intermediate hosts such as pigs and birds, with humans becoming incidental hosts through mosquito bites.

JEV infects the central nervous system, causing inflammation of the brain, which can lead to severe symptoms like fever, headache, and in extreme cases, coma or death.

JE is endemic in East and Southeast Asia, particularly in rural areas with high mosquito populations and animal reservoirs. Effective prevention includes vaccination and mosquito control measures.

AES mainly affects children under 15 and young adults, often starting with a sudden fever and worsening rapidly. This can lead to death within hours or, for survivors, long-term health issues.

A Look Back at the Impact

The first big AES outbreak in 1978 saw over 3,500 cases and 1,100 deaths. Over the years, things got worse before getting better, with the 2005 outbreak being particularly severe, causing over 5,000 cases and 1,300 deaths. Between 2008 and 2018, UP reported 36,509 cases and 5,700 deaths.

What Has Been Done to Combat AES?

The causes of AES can vary, so a targeted approach was needed. Initially, the Japanese Encephalitis Virus (JEV) was a major cause. To fight this, a large vaccination campaign started in 2006, targeting children in high-risk areas with a special vaccine. This was expanded in subsequent years, with more districts being covered.

By 2011, the vaccine was included in routine immunization programs across 181 districts. Children received the vaccine at 16 to 18 months and again at 9 months along with other vaccines.

WHO defined an AES case as “a person of any age, at any time of the year with an acute onset of fever and a change in mental status (including symptoms such as confusion, disorientation, coma, or inability to talk) and /or new onset of seizures (excluding simple febrile seizure)

Government Actions Over Time

1. Vaccination Campaigns:

• 2006: Mass immunization against JEV began in 11 districts. Children aged 1 to 15 received a single dose of the SA-14-14-2 vaccine.
• 2007-2009: Expanded to more districts each year.
• 2011: Introduced into routine immunization for 181 districts, targeting children at 16-18 months and again at 9 months.

2. Surveillance and Detection:

• 1978: Initial JE surveillance started under the National Malaria Elimination Programme (NMEP).
• 2006: A comprehensive AES surveillance system was established, identifying various causes of AES, including non-JE etiologies like enterovirus and scrub typhus.
• 2016: The establishment of an AES Cell in Gorakhpur to centralize data and testing.

3. Control Measures:

• 2009: Introduction of hygiene programs and safe drinking water due to enterovirus findings.
• 2015: Implementation of empirical doxycycline or azithromycin treatments for scrub typhus.

4. Strengthening Healthcare Infrastructure:

• 2017: Improved healthcare facilities, including the construction of Encephalitis Treatment Centers and Pediatric Intensive Care Units (PICUs). The "Dial 108" ambulance service was also introduced for timely patient transport.

5. Diagnostic and Therapeutic Advancements:

• 2011: Development of a reliable diagnostic kit for JEV by ICMR-NIV.
• 2015: Launch of the indigenous JENVAC vaccine for JE.
• 2016: New treatment protocols for scrub typhus were introduced, including empirical doxycycline or azithromycin for febrile illness.

Ongoing Efforts and Results

The government’s multi-faceted approach, including vaccination, surveillance, improved healthcare infrastructure, and treatment advancements, has significantly reduced AES mortality. For example, the mortality rate dropped from 33% in the 1980s to 12.6% between 2015 and 2019.

Surveillance and Research

Surveillance systems are crucial for understanding and managing AES. They include:

• Epidemiological Surveillance: Tracking disease trends and burden.
• Laboratory Surveillance: Identifying the specific causes of AES.
• Clinical Surveillance: Monitoring and reporting symptoms.
• Environmental and Entomological Surveillance: Studying factors like weather and vectors that affect disease spread.
• Veterinary Surveillance: Monitoring animal reservoirs that could spread diseases like JE.

Strengthening Healthcare Infrastructure

1. Expand Primary Healthcare Centers (PHCs): Set up and upgrade clinics in rural areas.
2. Telemedicine: Use online services for remote consultations.
3. Mobile Health Units (MHUs): Provide healthcare using mobile vans.
4. Upgrade Labs: Improve diagnostic facilities for better testing.

Enhancing Vaccination Coverage

1. Routine Immunization: Ensure children get all required vaccines.
2. Awareness Campaigns: Educate people about the importance of vaccines.
3. Disease Surveillance: Monitor and respond quickly to disease outbreaks.

Improving Health Education and Community Engagement

1. Health Education: Teach people about hygiene and healthy living.
2. Training for Workers: Regularly train doctors and nurses.
3. Community Health Workers: Support local health workers in providing care.

Addressing Nutritional Challenges

1. Supplementary Nutrition: Provide extra food and vitamins to vulnerable groups.
2. School Meals: Offer nutritious meals in schools.
3. Nutritional Education: Educate families about healthy eating.

Monitoring and Evaluation

1. Health Data Systems: Track health information and outcomes.
2. Impact Assessments: Check how well health programs are working.
3. Feedback Mechanisms: Collect input from communities to improve services.

The UP government has shown that when work is done with the right intention and dedication, success is sure to follow.