Sanjeev Kumar Patro

Bhubaneswar:  Signalling an ominous trend of sorts for the State hit by cyclone Fani, Odisha has topped the country with maximum cases of Acute Encephalitis syndrome (AES) during the first four months (January - April) of 2019.  Fani had hit the State on May 3.

The State has also recorded the second most highest Japanese Encephalitis (JE) cases in the country during the period.

However, the saving grace for the State Government is till date no single mortality case has been reported due to AES/JE infection. But the caveat here is with the districts like Puri, Khurda, Jajpur and Balasore are being affected by cyclone Fani, there is every chance of AES cases or mortalities posting a rise as these are the districts that had reported AES infection for the last three consecutive years.

Moreover, the warning shot for the State is cases of encephalitis are set to rise high in September - October. While the JE is a mosquito borne disease and could be controlled via vector control and vaccination, the AES and other encephalitis are not so easily targeted. The health department has to take up JE vaccination in districts of Puri and Khurda as a preventive strategy.

Why a strategy to control AES is needed in Fani affected regions is unsafe drinking water is also responsible for the spurt in encephalitis cases in the State as entero-viruses are the causative agents of the AES and its ilk. Moreover, a district wise analysis reveals that encephalitis cases had been reported from areas with poor access to potable water and high mosquito density.

The prevention could be State's best armory as AES is caused by 100 different pathogens ranging from virus and bacteria to fungi, parasites. The fact of concern is in 75 per cent cases, there has been no identifiable etiology (means causative organism) and almost in 90 per cent AES cases, there is no specific treatment (means non-responsive to anti-viral medicines).

In order to prevent a Malkangiri redux, health department need to sensitize doctors in the cyclone affected  districts to remain alert about AES symptoms and not let any secondary injury to brain. In Malkangiri, most deaths were due to the secondary injury that manifested in patients as they were not provided the timely supportive care to maintain the glucose and oxygen supplies to brain, which in turn had damaged brain and other organs. Mortalities could be prevented, if a patient has not suffered any damage to brain or any other organs.

What looks essential for the health department to keep a tab on AES in cyclone affected districts is the cases of AES keep on rising every year in the State. Odisha had reported nil cases of AES/JE till 2014. The State saw a whopping 660 AES cases and 33 JE cases in 2015. In 2018, the total AES cases spiked to 1,720 with 10 succumbing to the infection. The JE cases registered were 143 in 2018.

It needs reminding here is Odisha has recorded the highest ever 143 mortalities due to AES infection in 2016, and the toll was 42 in JE infected cases. Most of JE mortalities were reported from Malkangiri that sparked a national wide debate - both in political and medical fraternity.