Japanese Encephalitis, its causes, symptoms and status in Assam

Interview with experts Dr Harpal Singh Suri, Jt Dir, National Vector Borne Disease Control Programme & Dr Jyoti Bhuyan, Veterinary Dept.

At a time when the entire world continues to fight the Covid-19 pandemic, Assam is in a parallel combat against Japanese Encephalitis. Japanese Encephalitis a viral infection that is common in Assam during the months of June, July and August (or the rainy seasons).
In order to know more regarding Japanese Encephalitis, Fit Northeast interviewed two experts in this field. Dr Harpal Singh Suri, who is the current Joint Director cum State Programme Officer at the office of National Vector Borne Disease Control Programme in Guwahati and Dr Jyoti Bhuyan, who is a veterinary doctor spoke to this reporter and threw light on the disease, its causes, symptoms and its status in the State. 
Fit Northeast: What Japanese Encephalitis is?
Dr Harpal Singh Suri: To speak in summary, Japanese Encephalitis (or JE in short) is a viral infection which is spread by mosquito bites. The Culex mosquitoes are involved in spreading the infection which causes JE. In the term 'Encephalitis', the word 'encephal'' means brain and 'itis' means inflammation (which may be due to any infection).
Fit Northeast: What are the symptoms of JE?
Dr Harpal Singh Suri: The most common symptoms of JE are fever, headache, nausea, vomiting, diarrhoea followed by weakness. These symptoms might result in the progression of acute encephalitis if not given proper attention in the correct time. Seizers are common in children.
Fit Northeast: What might be the complications?
Dr Harpal Singh Suri: In extreme cases, there might be fatality but it is seen that even even after recovery, 20 to 30 per cent of people show long-lasting neurological symptoms like - upper and lower motor neuron weakness, cognitive impairment, speech impairment, recurrent seizures, learning and behavioural problems.
Fit Northeast: How does JE spread?
Dr Harpal Singh Suri: JE is mainly caused by mosquito bites principally Culex tritaeniorhynchus. Migratory birds like Herons and Cattle Egrets are the carriers of this virus. They are the permanent source of infection. Once they are positive, they remain positive for a lifetime. The mosquitoes take the virus from them by biting them. Then they bite the pigs and if they do not get any pig, they attach the virus to humans. The virus multiplies in the pigs. 
The most interesting thing in this infection-spreading cycle is that once the infection enters human body, it cannot transmit back to mosquitoes. There is no human to human transmission. The water-logging in fields might give a chance to the mosquitoes to increase their families. Paddy field and pig farms are sources of this virus.
The Culex mosquitoes are involved in spreading the infection which causes JE. In the term 'Encephalitis', the word 'encephal' means brain and 'itis' means inflammation (which may be due to any infection).
Fit Northeast: What has been the status of JE in Assam?
Japanese Encephalitis vaccine
Image: Japanese Encephalitis vaccine
Dr Harpal Singh Suri: If we see the recent history of JE in Assam, we observe that in the year 2019, JE cases were the highest with 642 and 161 deaths. In 2020, there were a total of 320 cases and 15 deaths. This year, till August 9, there were 172 cases and 23 deaths. Last year, there were more cases from Barpeta, Darrang, Morigaon and Sonitpur.
Fit Northeast: What initiatives have been taken to minimize the cases of JE in Assam?
Dr Harpal Singh Suri: In order to minimize the number of cases, National Vector Borne Disease Control Programme is working in association with various departments like veterinary, social welfare and PHE. The vaccinations play a vital role in controlling the spread of the disease. 
The government has taken up initiated in getting everyone vaccinated, which is given in two phases. The first phase is from 9 to 12 months and the second phase is from 18-24 months. It is as a result of the vaccination programs that the cases of JE are coming down year by year. 
For example, there has been 88% vaccination in Goalpara and in the year 2020, there has been 7 cases and 3 deaths. Temporarily the JE vaccination has been paused for a few months due to the ongoing Covid-19 vaccination drives all over the nation but there are plans to restart JE vaccinations from September or October.
Moreover, the people who have paddy fields are live in areas where there a lot of migratory birds, they are made aware of it and they keep on informing the forest department about it.
It is important to remember that these mosquitoes carrying the virus of JE comes out when the weather is comparatively cool from dawn to dusk. People are asked to take personal protection like wearing long shirts and pants to protect themselves, use mosquito nets. We even conduct fogging in the affected areas in every 15 days.
Dr Jyoti Bhuyan from the Veterinary department also spoke to Fit Northeast and added his views on the issue of spread of JE. 
Fit Northeast: How would you like to explain the spread of JE.
Dr Jyoti Bhuyan: Wild birds and the pigs act as the reservoirs of this infection. It is extremely unstable outside the body and is rapidly inactivated by disinfectants, heat and extremes of pH. 
It grows well in cell culture. Infection results from mosquito bites followed by viraemia. Virus may persist in spleen macrophages and has been demonstrated by RT-PCT (a Polymerase Chain Reaction) during winters which cannot be isolated from the pigs. Infection may be transmitted in semen.



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