NATIONAL7Spotlight Weekly)]

The Toll Goes On

The deadly disease has claimed many lives and is claiming more each year

By Aruna Singh Pradhan

Every year Japanese Encephalitis (JE) has been receiving front-page coverage in the nation's leading newspapers and magazines. This year is no different. Since 1978 this deadly viral infection on the central nervous system, has claimed more than 4100 Nepali lives and is continuing to claim many more. This year, with about a month left of its peak, the monsoon season, there have been at least 700 cases and 90 deaths. This number is comparatively low from last year's all time high number of recorded JE cases. Among many other factors that may play a part in this, the government's effort to reduce JE cases is one. However, a lot more has to happen and many things have to be considered before we let the worries of a JE epidemic pass by.

The profile of JE in Nepal shows that the epidemic alternates every year. "One year we'll get more cases and another year there are less. It depends on the length of the monsoon season," said Dr. Mahendra Bahadur Bista, director, Epidemiology and Disease Control Division at the Department of Health Services. There is a clear pattern that the number of total cases and death fluctuates and goes down every other year. Last year there were 2767 cases and 404 deaths. This year there are less expected. "Our projection is that we'll get 1200 cases and 150 deaths by the end of this year," said Dr. Bista.

The period of transmission of JE increases during the cultivation season. The cases start to build up in the months of April-May and reach their peak during the months of August and September. With one of the peak months still ahead, the number of JE cases still has the possibility of increasing drastically.

The high fatality rate and frequent residual 'neuropsychiatric sequelae' in survivors along with dramatic increase in JE cases brought much needed government attention since last year. A vaccine program was organized by the Department of Health Services with the cooperation of South Korea. 250,000 vaccine doses were given to the most affected age group (1 to 15 years age). In Bardia district, the most affected district last year, 170,000 doses were distributed. "Till now, the vaccine has proved 100% effective but we are still following up," said Dr. Bista.

The most affected districts this year are Dang, Banke, Bardia, Kailali and Kanchanpur. "70% to 75% of the cases come from these five districts," said Dr. G. D. Thakur, executive director at the Vector Borne Disease Research and Training Center, Hetauda. This year 500,000 vaccine doses have been brought from China. "Bardia , the most infected district, will get 50% of the distribution doses. Kailali and Banke are our next priority," said Dr. Thakur.

There are many obstacles that Nepal faces in the eradication of this fatal disease. The life saving vaccine is very costly and unaffordable for the general public. One dose costs U.S. $5, about NRS.350. "The most affected group of JE are people in the villages and because of the poverty there, JE vaccine is not affordable to them," said Dr. Thakur. Since this is not a profitable and sustainable business, it is also not available commercially.

Poverty and living style have also come as a hindrance in preventing this incurable disease. The Tharu community in these areas depend on raising pigs and cultivating rice. "In Malaysia, they killed all the pigs at the first sight of JE, this is not possible in Nepal," said Dr. Bista. The carrier of this disease, mosquito, breeds in water pools and flooded rice fields. It then transfers the virus to human beings from infected pigs (intermediate host). "Some people know the preventive methods through health education but they don't have sufficient land to keep the pigs away from the house," said Dr. Thakur. Poverty in the rural area does not make it easy for the destruction of this killer disease.

Other barrier is the high population in the most affected areas. Tarai has an estimated population of 12-15 million people out of more than 22 million population of the country. "The government is not in a position to provide vaccine to the entire population in the affected areas," said Dr.Thakur.

The encouraging results of the last year JE vaccine trial and the larger number of vaccines available for distribution this year is a step toward the right direction. However, many are still dying from this preventable disease because there is inadequate health care, poverty and not enough vaccine to go around.

In Japan, Taiwan, South Korea and China, cases of JE have decreased dramatically as a result of human vaccination program, water management, immunization of pigs, systematic piggery and community awareness program. Nepal still has a long way to go before it reaches that point.