The recent development in the Jal Jeevan Mission (JJM) has made headlines as it successfully provided tap water supply to more than 97 lakh households in five Japanese Encephalitis-Acute Encephalitis Syndrome (JE-AES) affected states – namely, Assam, Bihar, Tamil Nadu, Uttar Pradesh and West Bengal. By 2024, the scheme hopes to deliver 55 litres of water per person per day to every rural household through Functional Household Tap Connections (FHTC). Implemented by the Jal Shakti Ministry, this initiative aims to fight one of the biggest health threats in rural India – Acute Encephalitis Syndrome.
Understanding Acute Encephalitis Syndrome (AES)
Acute Encephalitis Syndrome is a serious condition characterized by high fever and inflammation of the brain, spread primarily via mosquitoes. In 2006, the World Health Organization (WHO) christened the term AES to denote diseases that may appear similar but are difficult to distinguish, particularly during an outbreak.
Primarily affecting children and young adults, AES can lead to significant morbidity and mortality. Although viruses account for most AES cases, other causative agents such as bacteria, fungi, parasites, spirochetes, chemicals, toxins, and noninfectious agents have also been identified over time. Despite various causative agents, AES does not have a preventative vaccine; treatments focus on symptom management.
The Indian Struggle with Japanese Encephalitis Virus (JEV) and AES
The Japanese Encephalitis virus (JEV) causes a large proportion of AES cases in India, ranging from 5% to 35%. Other agents like Herpes simplex virus, Nipah virus, Zika virus, Influenza A virus, West Nile virus, Chandipura virus, mumps, measles, dengue, scrub typhus, and S.pneumoniae have also caused AES. The illness presents with a high fever, confusion, disorientation, coma, inability to talk, vomiting, nausea, and unconsciousness.
Monitoring and Diagnosis of AES in India
India’s National Vector Borne Disease Control Programme (NVBDCP) has established a nationwide surveillance for AES through sentinel sites, with particular focus on detecting Japanese Encephalitis. In this network, AES/JE diagnosis is conducted by IgM Antibody Capture ELISA, while virus isolation is performed in the National Reference Laboratory.
As per NVBDCP, there were 10,485 diagnosed AES cases in 2018, resulting in 632 deaths spread across 17 Indian states. While India’s fatality rate in AES stands at 6%, the rate jumps up to 25% amongst affected children. States like Bihar, Assam, Jharkhand, Uttar Pradesh, Manipur, Meghalaya, Tamil Nadu, Karnataka, and Tripura are among the worst hit.
Government Initiatives against AES and JEV
To combat the high morbidity and mortality associated with AES, the Indian government has adopted a multi-pronged strategy that cuts across various ministries. This includes strengthening JE vaccination and public health activities, improving clinical management of AES/ JE cases, provisioning safe water supply, offering high-quality nutrition to vulnerable children, establishing District Disability Rehabilitation Centers, ensuring safe water supply in slums and towns, and providing special facilities for disabled children.
