Lok Sabha Question No. 3358 (UNSTARRED), answered on 2019-07-12
Subject: Acute Encephalitis Syndrome
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sougata Ray, Sudheer Gupta, Alok Kumar Suman, Ram Kripal Yadav, Pankaj Chowdhary, Sanjay Sadashivrao Mandlik, Su Thirunavukkarasar, Sushil Kumar Singh, Jagdambika Pal, Sajda Ahmed, Gajanan Chandrakant Kirtikar, M. Selvaraj, Bhola Singh, Anto  Antony, Sakshi Ji Swami Maharaj, Kaushalendra Kumar, Bidyut Baran Mahato, Ajay (Teni) Misra, Poonam (Mahajan) Vajendla Rao, S. Gnanathiraviam, Prasun Banerjee

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 3358 TH

TO BE ANSWERED ON 12 JULY, 2019

## ACUTE ENCEPHALITIS S YNDROME

3358. PROF. SAUGATA RAY:

SHRI SUDHEER GUPTA:

DR. ALOK KUMAR SUMAN:

SHRI RAM KRIPAL YADAV:

SHRI PANKAJ CHAUDHARY:

SHRI SANJAY SADASHIV RAO MANDLIK:

SHRI SU. THIRUNAVUKKARASAR:

SHRI SUSHIL KUMAR SINGH:

SHRI JAGDAMBIKA PAL:

SHRIMATI SAJDA AHMED:

SHRI GAJANAN KIRTIKAR:

SHRI M. SELVARAJ:

SHRI BHOLA SINGH:

SHRI ANTO ANTONY:

DR. SWAMI SAKSHIJI MAHARAJ:

SHRI KAUSHALENDRA KUMAR:

SHRI BIDYUT BARAN MAHATO:

SHRI AJAY MISRA TENI:

SHRIMATI POONAM MAHAJAN:

SHRI GNANATHIRAVIAM S.:

SHRI PRASUN BANERJEE:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether cases of Acute Enc phalitis Syndrome (AES) and Japanese Enc phalitis (JE) have been reported in the country, particularly in Bihar and if so, the details thereof indicating the number of AESand JE related cases along with deaths reported in th e country during the current season, State/UT - wise;
- (b) whether any study/research has been carried out by the Government on various aspects of AES/JE  including  the reasons  for  their  manifestation  and  if  so, the  details  and  the  findings thereof;
- (c) whet her the Government has constituted a seven member team to monitor the outbreak of AES in Bihar and if so, the details thereof;
- (d) whether there is any proposal to provide fi nancial and technical assistance to Bihar to combat the said diseases and if so, the details thereof; and

(e) the further measures being taken by the Government to prevent the said diseases and the amount of financial as well as other assistance given to the families of affected persons?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

(a)  Yes. The  number  of  cases  and  deaths  due  to Acu e  Encephalitis  Syndrome  (AES) and Japanese Encephalitis (JE) in Bihar in the year 2019 are as under:

(till

|        |   AES (till 08.07.2019) |   JE 07.07.2019) |
|--------|-------------------------|------------------|
| Cases  |                     872 |               16 |
| Deaths |                     176 |                1 |

The State/UT -wise details of cases and deaths due to AES and JE for other States of the co in the year 2019 is given in Annexure .

(b)Officials from Indian Council of Medical Research (ICMR) visited Muzaffarpur, Bihar investigating the AES outbreak, in June 2019. Following are the salient features of ICMR t

- It  was  observed  that  majority  of  the  children  presented  with  hyperacute and  early morning  illness  in  a  previously  healthy  child.  Children  presented  with  seizure altered  sensorium.  Hypoglycemia  was  also  present  in  a  sizeable  number  of  childr These findings are consistent with earlier reports of 2013 - 14.
- Limited number o f serum samples and litchi fruit samples were tested for MCPG toxin Atleast half of the serum and litchi fruit samples were found to be positive for toxin.
- Around 90 samples were tested for infectious agents at ICMR and non -ICMR Institutes. Though,  f ew  samples  were  found  to  be  positive  for  dengue,  chikungunya  and  JE, majority of the samples tested negative. This indicates a predominantly non - infectious etiology.
- Next Generation Sequencing (NGS) was conducted on a limited number of samples. All were fo und to be negative for infectious etiology.
- Culex mosquito samples collected from Muzaffarpur, Bihar tested negative for JE.
- (c) to (e) As per Constitutional provisions, 'Health' is a state subject.

Union Ministry of Health and Family Welfare(MoHFW) have taken measures to support State in containment of AES cases as follows:

- Union  Health  &  Family  Welfare  Minister  (HFM) had  reviewed  the  situation  with Health Minister of Bihar and also with officials from Ministry.
- MoHFW had deputed a Central team of experts consisting of Public Health Specia from various Central Government Institutes to assist the State Government containment and management measures.
- HFM  visited  Bihar  along  with  Minister  of  State  (HFW)  and  team  of officers.  HFM reviewed  the  situation  and  also  visited  Shri  Krishna  Medical  College  &  Hospi (SKMCH), Muzaffarpur.
- MoHFW  deployed  another  high  level  multi - disciplinary  team  to  Muzaffarpur  drawing senior Paediatricians from various central government Ins titutes to advise state in their efforts to manage the cases. Epidemiologists from National Center for Disease Con (NCDC), senior paediatricians, Laboratory technicians from central level are prese Muzaffarpur since 12 th June 2019.
- Strategic Healt h Operations Centre (SHOC) facility of NCDC was activated to monitor the AES situation in Muzaffarpur and co - ordinate tasks at the field level.
- MoHFW had further deputed 5 teams of Doctors along with technicians from Central Government Hospitals to SKMCH to support clinical management.
- Central team consisting experts from Indian Council of Medical Research (ICMR) wa also deployed at SKMCH. The team is also scrutinising and reviewing the case record discharge  and  deceased  patients  using  a  standardised tool  to  know  the  reasons  for mortality.
- Orientation training of all Paediatricians of SKMCH on clinical case management a treatment  protocol  of  AES  was  conducted  on  regular  basis  by  the  Central  Team paediatricians.

Further, National Vector Borne Dise ase Control Programme (NVBDCP) is working for Prevention and Control of Japanese Encephalitis (JE) which is one of the important cau AES. Under NVBDCP, Sentinel sites report number of AES cases and also confirm Japanese Encephalitis  (JE)  by  testing  of samples  (Serum/CSF)  by  IgM  Mc  ELISA  kits  provided  by Government of India. Numbers of Sentinel sites have gradually been increased from 51 in to 142 at present. Apex Laboratories increased from 12 to 15 for testing of non JE patho AES cases and quality control. 355 JE Kits have been supplied in 2019 as on 30.06.2019.

## Annexure

## State - wise Cases and Deaths due to Acute Encephalitis Syndrome and Japanese Encephalitis in 2019 (till 07.07.2019)

| S. No.           | States            |        | JE    | JE      |
|------------------|-------------------|--------|-------|---------|
|                  | Cases             | Deaths | Cases | Deaths  |
| 1                | Andhra Pradesh    | 0      | 0     | 1 0     |
| 2                | Arunachal Pradesh | 0      | 0     | 0 0     |
| 3                | Assam             | 128    | 215   | 947 56  |
| 4                | Delhi             | 0      | 0     | 0 0     |
| 5 Goa            | 37                | 0      | 0     | 0       |
| 6 Haryana        | 0                 | 0      | 0     | 0       |
| 7 Jharkhand      | 305               | 2      | 11    | 2       |
| 8 Karnataka      | 182               | 0      | 11    | 0       |
| 9 Kerala         | 0                 | 0      | 0     | 0       |
| Maharashtra      | 71                | 1      | 7     | 10 1    |
| Manipur          | 42                | 1      | 8     | 11 1    |
| Meghalaya        | 101               | 0      | 9     | 12 0    |
| Nagaland         | 8                 | 0      | 0     | 13 0    |
| 14 Odisha        | 611               | 1      | 55    | 1       |
| 15 Punjab        | 0                 | 0      | 0     | 0       |
| 16 Tamil Nadu    | 348               | 0      | 72    | 0       |
| 17 Telangana     | 44                | 0      | 21    | 0       |
| 18 Tripura       | 87                | 0      | 14    | 0       |
| 19 Uttar Pradesh | 502               | 21     | 27    | 2       |
| 20 Uttarakhand   | 0                 | 0      | 0     | 0       |
| 21 West Bengal   | 464               | 30     | 15    | 3       |
| Total            | Total             | 184    | 465   | 3750 66 |