Health Ministry Notification on Japanese Encephalitis All confirmed Japanese encephalitis cases to be notified The Ministry of Health & Family Welfare has issued a notification on Japanese Encephalitis on Wednesday to the concerned health authorities of all the states and has requested the states of Assam, Bihar, Tamil Nadu, Uttar Pradesh and West Bengal where the number of JE cases has been reported to be high, to issue necessary notification under the Clinical Establishment (Registration & Regulation) Act, 2010 or relevant Act/Rules as applicable, to ensure necessary monitoring, prevention and control of the disease. 1. “Japanese Encephalitis (JE) is an important public health concern in the country accounting for substantial morbidity, mortality and disability. Early reporting of JE cases is necessary for effective implementation of preventive measures and case management. 2. In order to ensure early diagnosis & case management, reduce transmission, address the problems of emergency and spread of disease in newer geographical areas, it is essential to have complete information of all JE cases. Therefore, the healthcare providers shall notify every JE case to local authorities i.e. District Health Officer/Chief Medical Officer of the district concerned and Municipal Health Officer of the Municipal Corporation/Municipality concerned every week (daily during transmission period). 3. Accordingly, all laboratory-confirmed cases of Japanese Encephalitis should be notified as detailed below. (A) Definition of laboratory-confirmed JE case: Patient having any one of the following: • Presence of lgM antibodies specific to JE virus in a single sample of cerebrospinal fluid (CSF) or serum, as detected by an lgM-capture ELISA specifically for JE virus. • Detection of a fourfold or greater rise in antibodies specific to JE virus as measured by haemagglutination inhibition (Hl) or plaque reduction neutralization assay (PRNT) in serum collected during the acute and convalescent phase of illness. The two specimens for lgG should be collected at least 14 days apart. The lgG test should be done in parallel with other confirmatory tests to eliminate the possibility of cross-reactivity. • Isolation of JE virus in serum, plasma, blood, CSF or tissue. Detection of JE-virus antigens in tissue by immunohistochemistry; • Detection of JE-virus genome in serum, plasma, blood, CSF or tissue by reverse transcriptase polymerase chain reaction (PCR) or an equally sensitive and specific nucleic acid amplification test. (B) A suspected case is defined as: A person of any age, at any time of year, with the acute onset of fever, not more than 5-7 days duration 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 seizures). Other early clinical findings can include an increase in irritability, somnolence or abnormal behaviour greater than that seen with usual febrile illness. 4. For the purpose of this notification, healthcare providers will include clinical establishment run- or managed by the Government (including local authorities), private or NGO sectors and/or individual practitioners under Clinical Establishment (Registration & Regulation) Act, 2010. 5. The doctors in Government Health Institutions and the registered medical private practitioners of the private hospitals/clinics are required to immediately inform the office of the District Health Authority of concerned district, if a suspected case of JE is reported at their health institution. 6. The blood samples of the all JE suspected cases have to be sent to the JE Sentinel surveillance Hospital (SSH), to be tested by ELISA technique. The information of the positive case should be sent to the office of the District Health Authority immediately after the diagnosis. 7. The management of the JE cases need to be done as per the guidelines issued by the Government of the India from time to time and available on the website of Directorate of National Vector Borne Disease Control programme (NVBDCP), Government of India.” (Source: Press Information Bureau, Ministry of Health and Family Welfare, 21st September, 2016)

Incurable Japanese Encephalitis Threatens India

Incurable Japanese Encephalitis Threatens India A four-year-old girl in Manipur in July 2016 suffered convulsions, high fever, and bouts of unconsciousness succumbing to Japanese encephalitis (JE), leading to the first death in the state from the viral brain infection that is transmitted by the Culex mosquito since 2010. Japanese Encephalitis is the main cause of brain inflammation (viral encephalitis) in Asia. Fatality rates for severe infections according to the WHO are between 20-30%. Even when treated, it leaves serious neurological effects particularly in children and about 30-50% of survivors struggle to walk or contract other cognitive disabilities. The virus appeared previously in Odisha in October 2012 after two decades, when 272 cases were reported and 24 deaths were registered. 626 symptomatic JE cases were estimated in Kushinagar Uttar Pradesh in 2012, with 139 confirmed cases, according to the Public Health Foundation of India. The virus has a tendency to move to areas where there is stagnant water in paddy fields and also develops new habitats. Some subgroups of the Culex mosquitos have been found along the Yamuna banks in vegetation, confirmed the National Vector Born Disease Control Program (NVBDCP). A 2016 Journal of Paediatrics study showed that the unofficial count of JE cases could be significantly higher than the reported data. Routine immunisation covers JE in 197 districts with two doses administered over 18 months, and has proven successful mostly in South India (Andhra Pradesh, Karnataka, Tamil Nadu) and some districts of Bihar and Uttar Pradesh. Dr K.K Aggarwal