Statement by Shri Jagat Prakash Nadda, Minister of Health & Family Welfare on 22nd December, 2014 in Lok Sabha in response to the call attention motion regarding the situation arising out of spread of "Encephalitis'' in Uttar Pradesh and other parts of the country and steps taken by the Government in this regard

Hon'ble Members will recall that my predecessor in office and esteemed colleague had on 4th August, 2014 apprised the Hon'ble Members regarding the situation arising out of spread of Encephalitis in Eastern Uttar Pradesh and other parts of the country and steps being taken by the Government for the same. That we are again discussing this topic today is an indicator of the significance of this important issue impacting large sections of our population especially in the eastern parts of the country. Though many Hon'ble Members, I am sure, are already aware, it would be useful to apprise this august House regarding certain basic facts of Encephalitis also known as brain fever. Encephalitis is inflammation of the brain which can be caused due to various pathogens including virus, bacteria and protozoa. While Japanese Encephalitis is a Vector Borne Disease transmitted through Culex group of mosquitos, Encephalitis can also be caused by entero-viruses which are water borne. Recently in Muzaffarpur and Malda, cases reported for Encephalitis were neither due to Japanese Encephalitis nor due to entero-viruses. Normally, Encephalitis is affecting children below 15 years of age. However, in the last few years, epidemiological data has revealed that many adults are also being affected and cases of morbidity and mortality, particular for JE, have been observed in adults in Assam and recently in the districts of North Bengal. The total numbers of Encephalitis cases reported were 5167 in 2010, 8249 in 2011, 8344 in 2012, 7825 in 2013 and 9912 cases this year up to 17th December. For mortality the numbers were 679 in 2010, 1169 in 2011, 1256 in 2012, 1273 in 2013 and 1495 up to 17th December, this year. In terms of distribution of cases this year we find that the maximum reported numbers of 3291 cases were from Uttar Pradesh, followed by 2317 cases in West Bengal, 2194 cases in Assam and 866 cases in Bihar. If we look at the districts, the main districts affected in Uttar Pradesh are Khushinagar, Deoria, Maharajganj Gorakhpur and Sidharthnagar; in Bihar the district Muzaffarpur; in West Bengal, the districts Jalpaiguri, Bankura, Darjeeling, Coochbehar, Burdwan and Bankura and in Assam, the districts Sonitpur, Golaghat, Dhimaji, Shivsagar, Dibrugarh, Kamrup (Metro) and Tinsukia The Government of India launched a National Programme for Prevention and Control of JE/AES in the end of 2012-13. This Programme envisages a multipronged strategy in 60 high priority districts in five high endemic States of Assam, Bihar, Uttar Pradesh, Tamil Nadu & West Bengal. The districts covered include 20 in Uttar Pradesh, 15 in Bihar, 10 in Assam, 10 in West Bengal and 5 in Tamil Nadu. The stakeholder Ministries include Ministry of Drinking Water and Sanitation with the task to provide safe drinking water and sanitation facility; Ministry of Social Justice & Empowerment with the task to provide rehabilitative services to disabled children; Ministry of Women & Child Development to provide nutrition to children in the affected districts; Ministry of Housing & Poverty Alleviation to provide drinking water facility in urban slums and Ministry of Human Resource Development (Education Department) to develop special curriculum for mentally and physically disabled children. The Ministry of Health and Family Welfare is the nodal Ministry with the task to vaccinate the children in the endemic districts, to improve the case management by establishing Pediatric ICUs at district hospitals, to establish Physical Medicine and Rehabilitation Departments and to strengthen public health measures including information-education-communication/behavior-change-communication for prevention and control of JE/AES. I would like also to share with the Hon'ble Members the action taken by Government under the National Programme. For JE vaccination, out of 60 high priority districts, vaccination has been completed in 59 districts, the remaining one District (Kanpur Dehat) will also be covered during this financial year. Funds have been released for setting up of Pediatric ICUs in 27 districts. We are following up with the State Governments for setting up and complete operationalization of these Pediatric ICUs on priority. This requires civil work, procurement of equipment and recruitment of manpower. While the Physical & Medical Rehabilitation Department at BRD Medical College, Gorakhpur is already functional, the Units at K.G. Medical College, Lucknow; BHU, Varanasi; Bankura Medical College; North Bengal Medical College; Gaya Medical College and Patna Medical College require upgradation. Units are required to be set-up at Assam Medical College, Dibrugarh and at Guwahati Medical College in Assam. Out of total 10 proposed Physical Medicine and Rehabilitation Units, Rs. 25 crores has already been released for 5 Physical Medicine and Rehabilitation units in 2013-14 and for another 4 units release of Rs. 20 crores is under process. Vector control and surveillance activities are being supported under National Vector Borne Disease Control Programme. Surveillance is also being undertaken through the Integrated Disease Surveillance Project under the National Centre for Disease Control (NCDC). For detection of non JE pathogens, Indian Council of Medical Research has already established a field unit of National Institute of Virology, at BRD Medical College, Gorakhpur. In addition, ICMR is conducting research-cum-intervention projects. NIV, Pune is supplying IgM ELISA kits to sentinel laboratories for the detection of JE cases. These kits are funded by the Directorate of National Vector Borne Disease Control Programme, Government of India. I would like to further elaborate on JE vaccination. This was started in 2006 and was scaled up in a phased manner over years. The strategy for JE vaccination is to conduct a one- time campaign (which targets all children from 1-15 years of age), after which JE vaccination is included as a part of routine immunization in that area. Initially, only one dose of JE vaccine was provided at the age of 16 to 24 months (with DPT/OPV booster). From April, 2013 onwards two doses for JE are scheduled under routine immunization, the first at 9 to12 months and second at 16 to 24 months of age. Out of 179 JE endemic districts in the country, 152 districts have been covered by vaccination from 2006 to 2014. Further, a catch up round to cover children missed out during the campaign and routine immunization rounds has been carried out on 22-23 June, 2014 for ten districts of Uttar Pradesh and eight districts of Bihar. Due to recent cases of JE in adults, this issue was discussed in the National Technical Advisory Group on Immunization. It was decided that we can take up vaccination for adults too in districts where such adult cases are being reported. The Assam Government has covered adults with JE vaccination in nine districts. This has been beneficial. It is crucial that the coverage of immunization remains high. Our reports show that routine immunization undertaken by the States may not have high coverage in all the target districts. States must, therefore, focus on this important aspect also. On 5th of December this year, a coordination committee under the Chairmanship of Secretary (Health and Family Welfare) has reviewed the progress on the implementation of Programme. Ministry of Drinking water and Sanitation has initiated one week awareness campaign regarding the installation of IM-II hand pumps in the affected districts and till date 75% of 60 programme districts have been covered under this awareness programme. To monitor the programme in Uttar Pradesh, a sub-committee has been formed which will periodically review the progress. The Ministry of Women and Child Development has made provisions for take home rations under Integrated Child Development Services Scheme for the moderately mal-nourished children and also initiated a training programme for Anganwadi Workers. Disability Rehabilitation Centers have been established in 11 districts out of proposed 15 districts by Ministry of Social Justice and Empowerment. NCERT is developing special curriculum for children affected by disability due to JE/AES. The State of Assam has informed that additional 5 districts (Barpeta, Darang, Naogaon, Sonitpur and Udalgiri) have been identified to be taken up under adult JE vaccination. It is informed by the State of West Bengal that Critical Care Units are functional and doctors from the District Hospitals are undergoing one month hands on training at SSKM Hospital, Kolkata. Tamil Nadu has informed that Paediatric ICUs of district hospitals are already functional though they need upgradation as per the specifications suggested under the National Programme. The State further informed that the procurement of equipment needed for PMR Deptt of Madurai Medical College, is under process. In Tamil Nadu Medical Officers from the District Hospitals are undergoing training in critical care management at Institute of Child Health, Egmore. Funds released under National Vector Borne Diseases Control Programme during 2014-15 to Assam were Rs. 9.16 crores, Bihar Rs. 28.57 crores, Tamil Nadu Rs. 15.61 crores, Uttar Pradesh Rs. 23.76 crores and West Bengal Rs.18 crores. These funds are to be used for prevention and control of Vector Borne Disease including implementation of the JE/AES activities. In addition, Rs 5.35 crores has been released under NHM flexi pool to support the contractual human resources at JE/AES wards at BRD Medical College, Gorakhpur. Similarly, in 2011-12 and 2012-13 too an amount of Rs. 3.05 crores was released under NHM to improve the manpower situation at BRD Medical College, Gorakhpur. Hon'ble Members will appreciate that prevention and control of AES/JE requires concerted and coordinated action along with expeditious setting up of infrastructure being supported under the programme. This entails effort by all stakeholders including both Central and State Governments, local self-governments, medical fraternity and non-government organizations. Provision of clean drinking water is critical for prevention of AES. For JE, effective vaccination coverage and vector control measures are necessary. Vector control measures include source reduction, sanitation and improving practices to pig rearing. For quick response, doctors, whether from government or from private institutions, must assess cases of fever for neurological symptoms and refer such patients to higher health facility without delay. The programme for Prevention and Control of AES/JE is being regularly monitored and I would especially appeal to the State Governments to utilize the funds already released or being released to them. The Ministry of Health and Family Welfare will continue to closely monitor the situation. I will be very happy to receive guidance from the Hon'ble Member for any further action in the matter.

Also Read

Shri J P Nadda takes charge as Minister of Health & Family Welfare

Health Minister Shri J P Nadda speaks to CM, Kerala on Avian Flu Cases

Suicide prevention a health priority: Health Minister Universal Health Assurance Programme to cover mental health

Shri Shripad Naik takes charge as MoS (IC), AYUSH and MoS, Health & Family Welfare

Health Minister Shri J P Nadda: Committed to prevention, early diagnosis and treatment of disorders in children with special abilities

Explore News