"Only DC can grant emergency leaves to doctors, medical officials:" Himanta Biswa Sarma 

The minister of health, the government of Assam, Himanta Biswa Sarma held a press conference today where he announced a series of steps taken to tackle Japanese Encephalitis (JE) which already claimed 49 lives in 2019 and 190 more have been reported positive.

For early transportation of the fever cases from the villages to the district Hospital or Medical Colleges, 108 Mritunjoy ambulances are earmarked. A total of 3622 fever cases have been transferred to the health facilities during June 2019. The minister emphasised on the need for early treatment said that if Mrityunjoy ambulances are not there to drive patients to government hospitals then Government will bear a cost of Rs 1000 to pay off a private vehicle.

He also announced that leaves for all doctors and paramedical staff including surveillance workers will be kept on hold. “Any kind of emergency leave will be granted only with the prior approval of the Deputy Commissioner of the District. Unauthorised absence from the place of posting even after duty hours will be treated seriously amounting to criminal dereliction of duty and an FIR will be filed in such cases,” said Sarma.

He also mentioned that All ADC health, JD, DMO in the district will compulsorily tour affected areas regularly along with visiting of at least 2 hospitals per week.

The health minister said the State is equipped to handle the situation, “Diagnostic services for J.E along with Elisa kits are already made available in all District Hospitals & Medical Colleges. A total of 1650 ELISA tests have been conducted out of which 159 are found to be JE positive,” he said.

Having said so, he also added, “However, we recognise that the ICU facilities in government (hospitals) are limited. In order to overcome the same, where an AES/JE positive patient is admitted to an ICU in any private hospital within Assam, due to non-availability of government ICU beds, a consolidated ICU treatment allowance up to Rs. 1 Lakh per patient will be paid directly to the private hospital in the name of the treating patient.” 

Adding, “In order to avail the benefit of the same, the attendant accompanying the patient shall inform the same with details to the JE central control room or the Joint Director Health Services of the district concerned immediately on admission. The JD of the district will verify the patient in the ICU and immediately transfer the allowance.” 

How JE spreads, what should one do and what is the State Government doing: Here all that you need to know:

Assam is currently undergoing a transmission season for Japanese Encephalitis (JE) with 190 reported positive cases of JE and 49 reported JE deaths till 05th July’2019 from this year January onwards. All districts of Assam except Kokrajhar district are currently under influence of JE.

AES- Acute Encephalitis Syndrome is inflammation of Brain, spinal cord caused due to viral, bacterial, and parasitic causes out of which J.E is virus transmitted through Culex mosquito. The primary reservoir of this virus is migratory birds like Heron, Cattle Egrets and pigs which acts as an amplifying host. Those people who come in contact with these pigs or birds when affected may suffer from JE. From affected human cases J.E cannot be spread to other human beings by the bite of culex mosquito The general population should be aware of this transmission cycle and take necessary precautionary measures. The pigs should be kept away from the homes as well as wearing full sleeve shirts while in agriculture fields should be practiced. Sleeping under mosquito nets is encouraged.

JE can be easily identified through symptoms like High fever with a headache, change in mental status like confusion, disorientation with or without a seizure. The diagnosis of suspected JE can be done by testing of Blood Serum by Mac Elisa Test and cerebra-spinal fluid (CSF) of an admitted patient with a neurological sign and blood Serum. In our state, all medical colleges and district hospital have sufficient diagnostic facilities with Elisa readers and kits. A total of 1650 ELISA tests have been conducted out of which 159 are found to be JE positive.

Assam is an ecologically favourable region for the spread of J.E. due to heavy rainfall, large paddy fields with big water body, piggery farming or domestic pig rearing almost throughout the state which supports the virus propagation.

The signs and symptoms of J.E in the early stage are similar to other fevers. High fever with headache and concussion are early clinical symptoms of JE. But as soon it reaches the brain it may cause unconsciousness and seizures. So from the onset of fever to the development of the Neurological sign is the Golden Hour in regards to the safety of the patient. Delaying the treatment may cause more chances of fatality or disability. J.E has no specific treatment and only supportive treatment is required. All drugs like Paracetamol, Mannitol, IV fluids, and other antibiotics are available free of cost in every public health institutions.

All-District Hospital and Medical Colleges have designated beds for AES/J.E cases. Ventilator Facilities are available in Nine (9) districts of Assam viz.. Dibrugarh, Jorhat, Sonitpur, BarpetaCachar, Golaghat, Kamrup (M), Lakhimpur, Sivasagar. ICU in Goalpara Civil Hospital has been operationalized recently.

For early transportation of the fever cases from the villages to the district Hospital or Medical Colleges, 108 Mritunjoy ambulances are earmarked. A total of 3622 fever cases have been transferred to the health facilities during June 2019.

Vaccination for JE through the routine immunization for children is currently going on regularly. Realizing the importance of Adult vaccination was done in 20 Districts of Assam during 2016-17 where the coverage was about 68%. However, there is a need for adult vaccination mop up to prevent the outbreak in all the remaining districts. The Govt, of India, has accepted to support the adult vaccination programme across the state during the current year after the JE season is over. The Govt of India has also accepted to support the human resources for 5 years to be operationalized 60 bedded JE hospital in AMCH Dibrugarh.

The situation in the state is under close watch and all preventive measures are being taken. Therefore to combat the situation, the State has already put the following measures in place:

1. 12.8 Lakhs Blood slides have been collected by our fever surveillance network of 2663 MPW, 963 Surveillance workers, 80 MTS and 30940 Asha workers.

2. Diagnostic services for J.E along with Elisa kits are already made available in all District Hospitals & Medical Colleges

3. After identification of AES/ J.E Cases, the villages/area affected are covered extensively for awareness generation, intensified fogging operation etc. A total of 1094 affected villages have been covered through intensified fogging operations already.

4. Transportation of suspected fever cases from the community to the district hospital and medical colleges are made free through Mrintunjoy 108/102 Ambulances