Editorial

Awareness is key to JE prevention

A spike in cases of Japanese Encephalitis (JE) in Assam with ten fatalities so far paints a grim picture of the vector-borne disease continuing to pose serious health risks in the state.

Sentinel Digital Desk

A spike in cases of Japanese Encephalitis (JE) in Assam with ten fatalities so far paints a grim picture of the vector-borne disease continuing to pose serious health risks in the state. The disease is transmitted by Culex mosquitoes that get infected from pigs, birds such as pond herons, cattle, egrets, etc., but there is no human-to-human transmission. The disease control lies in vaccination, preventing mosquito bites and community awareness. A surge in the JE and Acute Encephalitis Syndrome cases in the state implies that vector control measures such as the use of insecticide-treated bed nets are inadequate. The National Centre for Vector Borne Disease Control (NCVBDC) data highlights that Assam accounts for the highest percentage of JE cases in the country, which is in the range of 30-50%. As the outbreak is seasonal and transmission peaks during the monsoon season, the communities can play a crucial role in its prevention by spreading awareness of vaccination, the use of bed nets and disease symptoms so that those infected by it can seek prompt medical care. Early diagnosis and prompt treatment can significantly reduce fatalities, and according to NCVBDC, there is no specific antiviral treatment for the disease, and management of JW primarily focuses on supportive care to provide relief from symptoms and complications.  Assam is the only state in the country to have launched an adult JE vaccination drive. JE vaccination is already included in routine immunisation for children, specifically in endemic states like Assam. Children are highly susceptible to JE infection, and a significant increase in the routine immunisation drive and the state maintaining 80% immunisation coverage since 2021 have led to better protection of the children in the state than in the past. It must not be forgotten that complacency could undo the significant progress made. Increasing the routine immunisation coverage to 100% and keeping it the cornerstone of public health strategy is critical to the state having a healthy population. The state has achieved significant progress in adult vaccination against JE, and intensifying the drive will help remove the tag of the state with the highest percentage of JE incidents. The community role in dealing with the public health emergency left important lessons to learn. Public health strategy adopted by the government can achieve the goals only when the community lends a helping hand and plays a proactive role in spreading awareness and strictly adhering to guidelines issued by the Health Department for disease prevention. The surge in JE cases in June has pressed the alarm bell for all stakeholders, including health officials, doctors, nurses and other hospital staff, community leaders, and grassroots health workers, to remain fully prepared for a worse spike in JE cases during the remaining period of the monsoon season and the next wave of floods. Awareness of JE prevention is making an integral part of flood preparedness with emphasis on the completion of the distribution of insecticide-treated bed nets through an intensified drive well ahead of the onset of the rainy season. Ensuring that the targeted people among whom such bed nets are distributed in areas with high JE prevalence are also motivated to use it regularly to prevent mosquito bites. These bed nets not only protect from mosquito bites; the insecticide on them instantly kills the mosquitoes already infected with JE from pigs or birds. Community awareness in rural areas focusing on maintaining hygiene in pig rearing is an essential pillar of JE control strategy. As pigs can carry the JE virus infection without showing any symptoms, many people often do not give adequate attention to maintaining the distance of pigpens from their residential houses, which allows easy transmission of JE.  Awareness of JE, including explaining to people rearing pigs to construct proper sheds with drainage, vaccination will not only protect from JE but also protect people from other zoonotic diseases transmitted from pigs. While preventive measures are crucial to keep JE cases in check, hospitals being equipped with adequate infrastructure, healthcare professionals, and required medicines is crucial to save lives. Wide publicity about JE symptoms will help people to suspect the onset of the disease and seek prompt medical care. Such a campaign being run round the year has a greater impact than those conducted during the monsoon period.  Persistent campaigns help the community to bust the myth and help convince people to change their behavioural practices in respect of use of bed nets, dos and don’ts on livestock rearing, seeking prompt medical care, etc. Use of social media networks and roping in elected representatives of panchayats and other local bodies, cultural workers, NGO activists, and celebrities to run aggressive awareness drives on JE and AES will supplement efforts by the health authorities in controlling the disease. It is time the state pushes for an intensified campaign against JE to save Assam from the deadly viral disease and ensure that task is not left for the health department and the community has a crucial stake in it.