 AES (WHO Definition) - A case with acute

febrile illness, AND

 change in mental status (such as confusion,
disorientation, inability to talk, coma) AND/OR
 new onset seizures, excluding simple febrile
seizures. (* Simple febrile seizure: a single
seizure lasting < 15 minutes with recovery of
consciousness within 60 minutes, in a child
aged 6 months to 6 years).
 Sudden Fever
 Lethargy
 Headache
 Change In Consciousness
 Irritability And Restlessness
 Tremors And Convulsions
 Vomiting and diarrhea and
 Acute encephalitic stage may include-
 Neck rigidity,
 Hemiparesis,
 Convulsions and
 Coma
 Has paralleled with that of the Japanese
encephalitis virus (JEV)
 First report in 1955 from Vellore, Tamil Nadu.
 The first outbreak of JEV - Bankura district,
West Bengal in 1973.
 Based on various surveillance reports and
outbreak investigations, history of AES in India is
classified into 3 phases:
 (a) PERIOD BEFORE 1975 - A few cases with JE
aetiology were identified;
 (b) Between 1975 And 1999 –
▪ More JEV cases were reported with
▪ Frequent Outbreaks
▪ Development of JE endemic regions near the Gangetic plains
and in parts of Deccan and Tamil Nadu;
 (c) Between 2000 And 2010-
▪ Dramatic change in the AES scenario
▪ Rise in non-JE outbreaks mostly caused by viruses such as
Chandipura virus (CHPV), Nipah virus (NiV), and other
enteroviruses and Scrub Typhus .
 2005, a massive outbreak hit UP and Bihar

and neighboring districts of Nepal – JE

positivity was as high as 58%.
 JE vaccination was introduced in 2006, over

36.1 million beneficiaries immunized. During

Re-campaigns; 16.2 million immunized.
 GorakhpurDivision:Gorakhpur, Kushinagar,
Deoria, Maharajganj,
 Basti Division : Siddharth Nagar, Sant Kabir
Nagar, Basti
 Azamgarh, Mau, Balia, Bahraich,
Shrawasti, Balrampur, Gonda,
Lakhimpur’Kheri, Raebareli, Hardoi,
Sitapur, Kanpur Dehat and Saharanpur
 The most affected age group - between 1-5 years followed by
5-10 years and 10-15 years*
 Hardly any JE infections among infants.
 Although AES cases appear round the year, the trend shows an
increase in cases from July to October which tapers off from
November onwards.
 Most AES cases in UP are:
Of low socio-economic status
Live in rural areas
Their famiies have an occupation of agriculture labor
Primary or below primary level of education.
 Lack of Sanitation
 Lack of safe drinking water
 Water-logging (Results in mosquito-breeding)
 Open defecation
 Rodents
 Lack of Awareness about disease and factors
responsible for it’s spread
 Poor involvement of local civic bodies –
 In vector control measures
 In awareness generation
 Effective vector control
 Delay in seeking treatment (Increases Mortality
and spread of disease)
2014 (AES 2015 (AES 2016 (AES
cases=249) cases=370) cases=407)

29.3
31% %
35
% 58.3%

61 7%
62%
2.6% 8.2%

Scrub Typhus Japanese Scrub + JE Others Unknown

Encephalitis etiology
ICMR Study: *Based on IgM antibodies and/or
PCR positivity
10
Scrub Typhus Japanese Encephalitis

Suncus murinus Rodent ear pinna

infested with
trombiculid mites
Culex vishnui
 JE Vaccination Districts-
39
Newly proposed district-
1 (Rampur) in Routine
Immunization for JE
Vaccination due to incidence
of 7 JE cases during2014-2016
Most affected Districts-
07(Districts of Gorakhpur &
Basti Divisions)
Over the past 4 years, more no. of cases are also being reported by 3 districts – Lakhimpur
Kheri. Sitapur and Bahraicj
Year AES Confirmed JE
Cases Deaths CFR Cases Deaths CFR

2015 2900 491 16.93 355 47 13.24

2016 3911 641 16.39 442 74 16.74

2017 4759 595 12.5 693 93 13.42

  Routine Immunization- (9 months to 02 years)
 Special Campaign-(1 year to 15 years)

Year Target Achievement % Achievement

2014-15 (R.I.) 30,18,799 20,03,158 66.36
2015-16 (R.I.) 31,63,193 20,65,393 65.29
2016-17 (R.I.) 32,25,439 22,11,747 68.57
2017-18 (R.I.) -Nov 2017 32,67,818 15,78,976 48.32
88,62,413 91,95,952 103.76
Special JE Campaign
(May-June 2017)
 BRD Medical College, Gorakhpur Encephalitis Treatment Centers (ETCs)
Year
Cases Deaths CFR in % Cases Deaths CFR in %

1958 544 1370 103

2014 27.78 7.52
(58.83%) (84.08%) (41.17%) (15.92%)

1558 386 1342 105

2015 24.78 7.82
(53.72%) (78.62%) (46.28%) (21.38%)

1765 466 2146 175

2016 26.40 8.15
(45.13%) (72.70%) (54.87%) (27.30%)

2015 456 2744 139

2017 22.63 5.07
(42.34%) (76.64%) (57.66%) (23.36%)
 Year wise situation of the AES/JE Disease in UP

Year A.E.S. JE Confirmation % of J.E. +ve

Confirme Of total case
J.E.
Cases Deaths CFR d J.E. CFR / of total Lab
Death
Cases result
2015 2900 491 16.93 355 47 13.24 12.24 / 13.52
(355 in 2625 tested)
11.27 / 6.90
2016 3911 641 16.39 442 74 16.74 (442 in 6407
tested)
14.23/8.66
2017 4759 595 12.50 677 81 11.96 (677 in 7819
tested)
5000 18
4500 16
4000 14
3500 12
3000
10
2500
8 Cases
2000
1500 6 Deaths
1000 4
CFR %
500 2
0 0
2015 2016 2017
Cases 2900 3911 4759
Deaths 491 641 595
CFR % 16.93 16.39 12.5
 800 18
700 16
Confirm
ed J.E. 600 14
Cases 12
500
10
J.E. 400
Death 8
300
6
200 4
CFR(%)
100 2
0 0
2015 2016 2017
Confirmed J.E. Cases 355 442 677
J.E. Death 47 74 81
CFR(%) 13.24 16.74 11.96
 Status of AES patients treated at BRDMC & in other
hospitals in last 03 years.

Year BRD Medical College, Gkp Treated in other hospitals

Cases Deaths CFR in % Cases Deaths CFR in %
1958 544 1370 103
2014 27.78 7.52
(58.83%) (84.08%) (41.17%) (15.92%)
1558 386 1342 105
2015 24.78 7.82
(53.72%) (78.62%) (46.28%) (21.38%)
1765 466 2146 175
2016 26.40 8.15
(45.13%) (72.70%) (54.87%) (27.30%)
2015 456 2744 139
2017 22.63 5.07
(42.34) (76.64) (57.66) (23.36)

AES Cases AES Deaths

80 100 84.08 78.62
58.83
53.72 54.87 57.66 72.7 76.64
60 45.13 42.34 46.28
41.17
40 50
27.3 23.36
20 15.92 21.38

0 0
BRD MC Other Hospitals BRD MC Other Hospitals

2014 2015 2016 2017 2014 2015 2016 2017 20

  Routine Immunization- (9 months to 02 years)
 Special Campaign-(1 year to 15 years)

Year Target Achievement % Achievement

2014-15 (R.I.) 30,18,799 20,03,158 66.36
2015-16 (R.I.) 31,63,193 20,65,393 65.29
2016-17 (R.I.) 32,25,439 22,11,747 68.57
2017-18 (R.I.) -Nov 2017 32,67,818 15,78,976 48.32
88,62,413 91,95,952 103.76
Special JE Campaign
(May-June 2017)
 District wise AES and JE cases in Gorakhpur and
Basti divisions 2016-2017
1200
1023
1000
874
773 769
800 701 687
600
419 424
400 284
214 238 237 198 241
200 145
36 49 82 41 59 67 41 57
34 9 34 17 22
0

2016-AES Case 2016-JE Case 2017-AES Case 2017-JE Case

In 2016, Kushinagar reported the highest no. of AES cases and Deoria reported the highest no. of JE cases.
In 2017, Gorakhpur reported the highest number of AES Cases, whereas JE cases were highest in Deoria
1200 30%
1023
1000 26% 25%
874
773 769 21%
800 701 20% 687 20% 20%
17%
16% 17%
600 16% 15%
14% 14% 14%
13%
419424
400 11%
10% 10%
284
238 237 241
198
200 145 5%

0 0%

2016-AES Case 2017-AES Case 2016-AES CFR 2017=AES CFR

In 2016, the highest CFR due to AES was in Sant Kabir Nagar, whereas in 2017, the highest CFR
was in Basti
Source: VBDCP,
Lucknow
A suspected case which meets the clinical case definition for AES should be
classified in one of the following four ways)
 a) Laboratory-confirmed JE: A suspected case that has been laboratory-
confirmed as JE.
 b) Probable JE: A suspected case that occurs in close geographic and
temporal relationship to laboratory-confirmed case of JE, in the context
of an outbreak.
 c) Acute encephalitis syndrome (due to agent other than JE): A suspected
case in which diagnostic testing is performed and an etiological agent
other than JE virus is identified like typhoid, dengue, malaria,
chikungunya, meningococcal, tubercular, etc.
 d) Acute encephalitis syndrome (due to unknown agent) : A suspected
case in which no diagnostic testing is performed or in which testing was
performed but no etiological agent was identified or in which the test
results were indeterminate.
 Scrub typhus is the commonest occurring
Rickettsial infection in India.
 The infection is transmitted through the
larval mites or ‘chiggers’ belonging to the
family Trombiculidae.
 Only the larval stages take blood meal.
 Small rodents particularly wild rats of
subgenus Rattus are natural hosts for scrub
typhus.
 The field rodent and vector mites act as
reservoir and between the two the infection
perpetuates in nature.
 Endemic foci are usually associated with
specific habitats such as abandoned
plantations, gardens or rice fields, overgrown
forest clearings, shrubby fringes of fields
and forests, river banks and grassy fields.
 These ecological patches which attract the
natural host of mite vectors are called ‘mite
islands’.
 Scrub typhus can occur in areas where scrub
vegetation consisting of low lying trees and
bushes is encountered, and also in habitats
as diverse as banks of rivers, rice fields,
poorly maintained kitchen gardens, grassy
lawns which can all be inhabited by
chiggers.
 The Chiggers (too small to be seen by the
naked eye) feed usually on rodents and
accidentally on humans, and transmit the
infection during the prolonged feeding which
can last for 1-3 days.
 Incidence of scrub typhus is higher among
rural population.
 2014 – 2018 –Initiatives undertaken by GoUP

Equipped
104 ETCswith
andtrained
10 380 ambulance
Linkage with Labs testing of Lab
Over 400 various
HR,
PICUs essential personnel trained etiologies
personnel trained
ambulance system
equipment and drugs

Community awareness Community sensitization

12267 rallies
campaigns
Over 2500 community OverCapacity
30000 health
conducted meetings
sensitization meetings building
personnel trained
conducted

JE vaccination re-
campaign: 9.1 million AES Technical Advisory Launch of Dastak
children immunized Group campaign by CM
30