Lok Sabha Question No. 984 (UNSTARRED), answered on 2015-12-04
Subject: Cases of Encephalitis
Ministry: HEALTH AND FAMILY WELFARE
Asked by: (ADV.) JOICE GEORGE, PONNUSAMY VENUGOPAL

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

## LOK SABHA UNSTARRED QUESTION NO.984 TO BE ANSWERED ON 4 TH  DECEMBER, 2015

## CASES OF ENCEPHALITIS

## 984. ADV.  JOICE GEORGE: DR. P. VENUGOPAL:

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

(a) the number of cases of Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES) and related deaths reported in the country during each of the last three years and the current year, State/UT-wise;

(b) the measures taken by the Government for prevention, diagnosis, treatment and surveillance of JE and AES indicating the financial and technical assistance provided and utilized during the said period, State/UT-wise;

(c)  whether  the  aforesaid  measures  have  yielded  desired  results,  if  so,  the  details  thereof indicating decline in mortality and morbidity of JE and AES reported from endemic areas during the said period, State/UT-wise;

(d)  whether the Government proposes to launch any adult JE vaccination programme and has identified certain districts for its introduction, and if so, the details thereof, State/UT-wise; and

(e) the other steps being taken by the Government for effective control and management of JE and AES in the country?

## THE MINISTER OF HEALTH AND FAMILY WELFARE

## ANSWER (SHRI JAGAT PRAKASH NADDA)

(a):    State-wise number of cases of Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES) since 2012 is at Annexure- I.

(b):    Government of India is implementing National Vector Borne Disease Control Programme in the country for prevention and control of Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES) under the overarching umbrella of National Health Mission. The States/U.T's implement the programme activities and the technical guidance as well as financial assistance is provided  by  the  Central  Government.    A  multi-pronged  strategy  has  been  adopted  under  the National Programme for Prevention and Control of JE/AES in sixty high priority districts in 5 States of Assam, Bihar, Tamil Nadu, Uttar Pradesh and West Bengal with the participation of Ministry  of  Health  &  Family  Welfare,  Drinking  Water  &  Sanitation,  Housing  Urban  Poverty Alleviation,  Social  Justice  &  Empowerment,  Women  &Child  Development  and  Human Resource Development (Department of School Education & Literacy). The Major components under  the  Programme  include  strengthening  of  JE/AES  surveillance  by  establishing  sentinel laboratories,  reduction  in  case  fatality  rate  by  establishment  of  Pediatric  intensive  care  Unit (PICU)  at  district  level  in  60  high  burdened  districts,  capacity  building  in  critical  case management, JE vaccination, supply of safe drinking water, establishment of Physical Medicine and Rehabilitation Department (PMR) in 10 identified medical college of five states.

Number of Sentinel sites have been increased from 51 in 2005 to 121 at present. Apex Referral  Laboratories  increased  from  12  to  14.  Out  of  204  endemic  districts,  182  have  been covered under JE vaccination campaign in 1-15 years old children. JE vaccination campaign has been completed in all the 60 high endemic districts. The campaign is followed by two doses of JE  vaccine  under  Routine  Immunization  (at  9  months  and  16-24  months)  to  cover  the  new cohort. 23 districts (8 in UP, 7 in West Bengal, 4 in Assam and 4 in Tamil Nadu) have reported functional critical care facility. Till date funds have been released for 34 PICU. funds have been released for 9 PMR and 8 PMR are functional. State-wise allocation and release of funds are given at Annexure - II.

(c):        The  aforesaid  measures  have  yielded  desired  results  as  steady  decline  in  mortality  and morbidity of AES has been noticed.  8073 AES Cases and 1109 AES Deaths have been reported in the country during 2015 till November which is lower than AES cases (9394) and AES deaths (1472) reported during the corresponding period of 2014. Case fatality rate (CFR) of AES also declined to 13.7% in 2015 from 15.7% in the corresponding period of 2014.

Although a small increase has been observed in number of JE cases in the country (1548) in 2015 (till November) compared to JE cases (1503) in corresponding period of 2014, number of deaths have declined from  280 to 268 during the period; CFR due to JE also declined from 18.6% to 17.3% during the period.

(d):     Government proposed for adult JE vaccination in identified 20 high burden districts of the States of Assam, Uttar Pradesh and West Bengal in November, 2014.  The details are as follows:

| State         | Name of Districts                                                                             |
|---------------|-----------------------------------------------------------------------------------------------|
| Assam         | Barpeta, Darang, Nagaon, Sonitpur and Udalgiri                                                |
| Uttar Pradesh | Basti, Gorakhpur, Maharajganj, Siddarth Nagar, Deoria, Kushinagar and Sant Kabir Nagar        |
| West Bengal   | Bankura, Burdwan, Dakshin Dinajpur, Darjeeling, Hooghly, Jalpaiguri, Malda and Uttar Dinajpur |

Adult  JE  vaccination  has  been  completed  in  Darang,  Nagaon  and  Sonitpur  district  of Assam, and Darjeeling and Jalpaiguri in West Bengal.

(e):    Besides  strategies  implemented  under  the  programme,  multi-disciplinary  Central  Teams comprising of clinicians/ epidemiologist /microbiologist and NVBDCP officials was deputed to the States of Assam, Uttar Pradesh and West Bengal during 2015 in view of increase in number of JE/AES cases. Furthermore, Central Medical Teams were deputed to districts of Dibrugarh, Sivasagar and Golaghat to assist the state for case management on 25.07.2015.

Encephalitis Treatment Centre has been established under State initiative at Block level.

The  programme  is  monitored  at  the  level  of  Hon'ble  HFM,  Secretary  (H),  and  other senior officers.

………..

## Number of AES and JE Case (C) and Death (D) - 2012 to 2015 (till 29.11.2015)

| Sl. No   | States/ UTs       | Year   | Year   | Year   | Year   | Year   | Year   | Year   | Year   | Year   | Year   | Year   | Year   | Year                      | Year                      | Year                      | Year                      |
|----------|-------------------|--------|--------|--------|--------|--------|--------|--------|--------|--------|--------|--------|--------|---------------------------|---------------------------|---------------------------|---------------------------|
| Sl. No   | States/ UTs       | 2012   | 2012   | 2012   | 2012   |        |        |        |        | 2014   | 2014   | 2014   | 2014   | 2015 (P) (till 29.11.2015 | 2015 (P) (till 29.11.2015 | 2015 (P) (till 29.11.2015 | 2015 (P) (till 29.11.2015 |
| Sl. No   | States/ UTs       | AES    | AES    | JE     | JE     | AES    | AES    | JE     | JE     | AES    | AES    | JE     | JE     | AES                       | AES                       | JE                        | JE                        |
| Sl. No   | States/ UTs       | C      | D      | C      | D      | C      | D      | C      | D      | C      | D      | C      | D      | C                         | D                         | C                         | D                         |
| 1        | Andhra Pradesh    | 64     | 0      | 3      | 0      | 345    | 3      | 7      | 3      | 31     | 0      | 0      | 0      | 23                        | 0                         | 0                         | 0                         |
| 2        | Arunachal Pradesh | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 102    | 11     | 32     | 3      | 73                        | 2                         | 30                        | 2                         |
| 3        | Assam             | 1343   | 229    | 463    | 100    | 1388   | 272    | 495    | 134    | 2194   | 360    | 761    | 165    | 1323                      | 260                       | 614                       | 135                       |
| 4        | Bihar             | 745    | 275    | 8      | 0      | 417    | 143    | 14     | 0      | 1358   | 355    | 20     | 2      | 255                       | 80                        | 62                        | 10                        |
| 5        | Delhi             | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 1                         | 0                         | 1                         | 0                         |
| 6        | Goa               | 84     | 0      | 9      | 0      | 48     | 1      | 3      | 1      | 17     | 0      | 0      | 0      | 0                         | 0                         | 0                         | 0                         |
| 7        | Haryana           | 5      | 0      | 3      | 0      | 2      | 0      | 2      | 0      | 6      | 1      | 5      | 1      | 2                         | 0                         | 2                         | 0                         |
| 8        | Jharkhand         | 16     | 0      | 1      | 0      | 270    | 5      | 89     | 5      | 288    | 2      | 90     | 2      | 143                       | 1                         | 42                        | 1                         |
| 9        | Karnataka         | 189    | 1      | 1      | 0      | 162    | 0      | 2      | 0      | 75     | 0      | 13     | 0      | 243                       | 1                         | 21                        | 1                         |
| 10       | Kerala            | 29     | 6      | 2      | 0      | 53     | 6      | 2      | 0      | 6      | 2      | 3      | 2      | 13                        | 1                         | 2                         | 1                         |
| 11       | Maharashtra       | 37     | 20     | 3      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 43                        | 0                         | 6                         | 0                         |
| 12       | Manipur           | 2      | 0      | 0      | 0      | 1      | 0      | 0      | 0      | 16     | 0      | 1      | 0      | 34                        | 0                         | 6                         | 0                         |
| 13       | Meghalaya         | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 212    | 3      | 72     | 3      | 74                        | 8                         | 39                        | 8                         |
| 14       | Nagaland          | 21     | 2      | 0      | 0      | 20     | 0      | 4      | 0      | 20     | 1      | 6      | 0      | 10                        | 1                         | 0                         | 0                         |
| 15       | Punjab            | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 2      | 0      | 0      | 0      | 1                         | 0                         | 0                         | 0                         |
| 16       | Tamil Nadu        | 935    | 64     | 25     | 4      | 77     | 8      | 33     | 0      | 346    | 4      | 36     | 3      | 714                       | 0                         | 46                        | 0                         |
| 17       | Tripura           | 0      | 0      | 0      | 0      | 211    | 0      | 14     | 0      | 323    | 0      | 14     | 0      | 350                       | 4                         | 23                        | 4                         |
| 18       | Uttarakhand       | 174    | 2      | 1      | 0      | 0      | 0      | 0      | 0      | 2      | 0      | 2      | 0      | 2                         | 0                         | 2                         | 0                         |
| 19       | Uttar Pradesh     | 3484   | 557    | 139    | 23     | 3096   | 609    | 281    | 47     | 3329   | 627    | 191    | 34     | 2730                      | 422                       | 340                       | 39                        |
| 20       | West Bengal       | 1216   | 100    | 87     | 13     | 1735   | 226    | 140    | 12     | 2385   | 348    | 415    | 78     | 1938                      | 329                       | 308                       | 67                        |
| 21       | Telengna          | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 0      | 155    | 5      | 0      | 0      | 101                       | 0                         | 4                         | 0                         |
|          | Grand Total       | 8344   | 1256   | 745    | 140    | 7825   | 1273   | 1086   | 202    | 10867  | 1719   | 1661   | 293    | 8073                      | 1109                      | 1548                      | 268                       |

## Annexure-I

| Annexure-II   | Annexure-II    | Annexure-II   | Annexure-II   | Annexure-II   | Annexure-II   | Annexure-II   | Annexure-II   | Annexure-II                     | Annexure-II                     | Annexure-II                     |
|---------------|----------------|---------------|---------------|---------------|---------------|---------------|---------------|---------------------------------|---------------------------------|---------------------------------|
| Sl. N o.      | States/UTs     |               |               |               | 2013-14       | 2013-14       | 2013-14       | 2015-16 (prov. upto 31.10.2015) | 2015-16 (prov. upto 31.10.2015) | 2015-16 (prov. upto 31.10.2015) |
| Sl. N o.      | States/UTs     | Allocation    | Released      | Expenditure   | Allocation    | Released      | Expenditure.) | Allocation                      | Released                        | Expenditure/ Released (Prov.)   |
| 1             | Andhra Prd.    | 2316.32       | 650.01        | 809.48        | 2510.00       | 767.24        | 781.00        | 858.00                          | 403.88                          | 403.88                          |
| 2             | Arunachal Prd. | 1876.65       | 1016.31       | 887.50        | 1291.00       | 1166.76       | 608.00        | 1273.00                         | 989.34                          | 989.34                          |
| 3             | Assam          | 5168.19       | 3813.45       | 3627.12       | 3036.00       | 2673.05       | 2211.00       | 2592.00                         | 1426.71                         | 1426.71                         |
| 4             | Bihar          | 6038.31       | 4633.44       | 3633.90       | 4800.00       | 11474.31      | 12296.00      | 4085.00                         | 4972.64                         | 4972.64                         |
| 5             | Chattisgarh    | 2999.22       | 1150.42       | 1561.82       | 2990.00       | 1343.50       | 2039.00       | 2545.00                         | 311.70                          | 311.70                          |
| 6             | Goa            | 125.81        | 55.87         | 80.63         | 128.00        | 90.75         | 47.00         | 98.00                           | 47.50                           | 47.50                           |
| 7             | Gujarat        | 1612.71       | 736.94        | 992.80        | 2380.00       | 1198.20       | 1121.78       | 1148.00                         | 857.81                          | 857.81                          |
| 8             | Haryana        | 203.50        | 87.49         | 167.08        | 363.00        | 247.50        | 90.00         | 255.00                          | 191.25                          | 191.25                          |
| 9             | Himachal Prd.  | 120.55        | 54.01         | 15.00         | 140.00        | 99.75         | 12.00         | 104.00                          | 0.00                            | 0.00                            |
| 10            | J&K            | 110.33        | 76.11         | 53.57         | 155.00        | 89.86         | 68.00         | 92.00                           | 44.50                           | 44.50                           |
| 11            | Jharkhand      | 3836.09       | 1161.29       | 2262.41       | 4139.50       | 3162.25       | 2779.04       | 5537.00                         | 3053.37                         | 3053.37                         |
| 12            | Karnataka      | 1630.66       | 796.39        | 1049.81       | 2320.00       | 1810.27       | 1245.00       | 1954.00                         | 163.02                          | 163.02                          |
| 13            | Kerala         | 745.56        | 642.94        | 520.71        | 1007.00       | 720.75        | 720.75        | 726.00                          | 544.50                          | 544.50                          |
| 14            | Madhya Prd.    | 2053.50       | 877.79        | 1434.24       | 2390.00       | 1796.90       | 1395.55       | 2442.00                         | 1703.77                         | 1703.77                         |
| 15            | Maharashtra    | 1557.04       | 817.05        | 921.56        | 2187.00       | 648.41        | 679.00        | 639.00                          | 490.31                          | 490.31                          |
| 16            | Manipur        | 1007.41       | 211.63        | 320.55        | 1091.00       | 907.05        | 780.02        | 917.00                          | 645.00                          | 645.00                          |
| 17            | Meghalaya      | 1146.96       | 445.54        | 414.08        | 1162.00       | 934.82        | 818.30        | 966.00                          | 549.32                          | 549.32                          |
| 18            | Mizoram        | 1398.49       | 614.19        | 759.56        | 1248.00       | 1199.05       | 929.18        | 1220.00                         | 757.65                          | 757.65                          |
| 19            | Nagaland       | 1678.25       | 439.32        | 487.45        | 1533.00       | 1108.92       | 778.17        | 1203.00                         | 616.12                          | 616.12                          |
| 20            | Orissa         | 4603.18       | 2483.66       | 2665.24       | 5170.00       | 2086.03       | 1906.48       | 3888.00                         | 2583.75                         | 2583.75                         |
| 21            | Punjab         | 296.00        | 53.94         | 206.13        | 550.00        | 409.31        | 150.00        | 398.00                          | 178.90                          | 178.90                          |
| 22            | Rajasthan      | 652.67        | 578.36        | 724.61        | 990.00        | 1404.50       | 1404.50       | 2614.00                         | 1454.93                         | 1454.93                         |
| 23            | Sikkim         | 50.00         | 27.36         | 71.88         | 70.00         | 51.92         | 49.67         | 53.00                           | 31.73                           | 31.73                           |
| 24            | Tamil Nadu     | 1971.75       | 1971.75       | 2428.42       | 2250.00       | 1561.50       | 580.00        | 1619.00                         | 1195.50                         | 1195.50                         |
| 25            | Telangana      |               |               |               |               | 429.00        | 183.87        | 487.00                          | 423.76                          | 423.76                          |
| 26            | Tripura        | 1779.88       | 735.34        | 210.78        | 1459.00       | 1353.85       | 1109.78       | 1400.00                         | 652.03                          | 652.03                          |
| 27            | Uttar Pradesh  | 3469.29       | 2694.72       | 255.76        | 3905.50       | 3808.53       | 2015.00       | 4335.00                         | 1704.26                         | 1704.26                         |
| 28            | Uttarakhand    | 117.50        | 0.71          | 106.36        | 125.00        | 127.33        | 127.32        | 205.00                          | 122.78                          | 122.78                          |
| 29            | West Bengal    | 3381.03       | 3057.17       | 2012.76       | 3500.00       | 1709.51       | 1650.00       | 1800.00                         | 287.92                          | 287.92                          |
| 30            | Delhi          | 309.50        | 232.12        | 0.00          | 584.00        | 444.00        | 5.00          | 170.00                          | 0.00                            | 0.00                            |
| 31            | Puducherry     | 53.87         | 7.73          | 44.52         | 56.00         | 39.81         | 39.81         | 49.00                           | 36.33                           | 36.33                           |
| 32            | A&N Islands    | 537.20        | 556.32        | 540.42        | 250.00        | 140.83        | 157.69        | 352.00                          | 242.62                          | 242.62                          |

| 33   | Chandigarh   |    75.50 |    63.19 |    32.88 |   96.00 |    56.25 |    45.00 |   80.00 |    59.90 |    59.90 |
|------|--------------|----------|----------|----------|---------|----------|----------|---------|----------|----------|
| 34   | D &NHaveli   |    79.44 |    50.74 |    75.83 |      98 |    29.96 |    45    |      95 |   132.54 |   132.54 |
| 35   | Daman &Diu   |    54.49 |    23.56 |    34.3  |      72 |    39.01 |    13.13 |      68 |    74.49 |    74.49 |
| 36   | Lakshadweep  |    43.15 |     6.93 |    15.25 |      54 |     0.95 |     0.95 |      46 |    40.05 |    40.05 |
|      | Total        | 53100    | 30823.8  | 29424.4  |   54100 | 45131.6  | 38882    |   46313 | 26989.9  | 26989.9  |