Among the initial set of activities conducted by RCZI, was a study that examined the kind of research required for controlling zoonoses in India within a five-year time frame. This was a first-of-its-kind priority setting exercise for zoonotic diseases in the South Asian region, providing key insights in informing and guiding RCZI’s research agenda in the first five years of its work.
Priority setting methods developed by the Child Health and Nutrition Research Initiative (CHNRI) were adapted for diverse sectors, disciplines, diseases and populations that are relevant for zoonoses in the country. A multidisciplinary group of experts from across sectors and those working in different roles were interviewed using a standard framework. Eleven priority zoonoses or classes of diseases were identified and within them, knowledge gaps along with proposed research options to address these gaps. Japanese Encephalitis (JE) emerged as one of the priority zoonoses that was identified by the expert group.
Japanese Encephalitis, a flavivirus transmitted through certain species of mosquitoes that causes neurological infection in humans, is more than just a zoonotic disease, especially in South Asia, where majority of worldwide cases are found. It causes frequent seasonal outbreaks in rural India with high morbidity and mortality in children, specifically in eastern Uttar Pradesh. Because JE transmission is primarily restricted to rural areas, where 70% of India’s population lives, it is of special importance to the Indian setting. JE mainly affects a younger age group (under 15 years), and if left untreated, can have long-lasting debilitating health, social and economic effects. The estimated global impact of JE in 2002 was 709,000 Disability-Adjusted Life Years (DALYs), with India itself representing 226,000 (32%) of those DALYs. Clearly, effectively addressing JE will provide enormous economic benefits to rural and vulnerable communities and address the development priorities of India at large.
Currently, interventions for JE prevention and control in endemic areas in India include removal or segregation of piggeries, experiments with intermittent wet-dry rice paddy cultivation, and human vaccination. However, these interventions do not convincingly explain the occurrence of JEV infection in human populations considering the ecological and socio-economic heterogeneity between states in India. Interventions such as human vaccination are being implemented in endemic regions in India as well though these have been unsuccessful in controlling the spread of the virus, which is now spreading to newer areas and populations with evidence of increasing heterogeneity. Despite repeated outbreaks of JE, limited information exists on these risk drivers. Effective surveillance and control of JE requires an integrative approach across human and animal populations along with a sound understanding of the role played by diverse ecosystems in propagating the JE virus (JEV) in nature. Therefore, the human-animal-environment linkages underscore the need for an eco-health approach that focuses on micro-ecosystems in order to study this disease to arrive at evidence-based solutions for controlling and eliminating JE.
RCZI’s JE Study in Kushinagar: 2011-13
As part of RCZI’s research prioritisation exercise that identified JE as one of 11 priority zoonotic diseases to research on, RCZI observed that JE was indeed a poorly understood condition in India. For RCZI, it was crucial to study this virus in the Indian context because it has had increased epidemic activity in northern and central parts of the country since the early 1970s.
In India, 171 districts with a total population of 330 million people have reported cased of JE. While it is seasonally endemic to the Terai region bordering the states of Uttar Pradesh and Bihar, and Nepal in its north, this re-emerging virus has been gradually spreading to non-endemic areas as well, further necessitating urgent action to stop its spread and transmission.
The state of Uttar Pradesh, which borders Nepal and contributes highest number of JE cases in India became the focus of RCZI’s study, specifically looking at the highest burden district of Kushinagar. The selection of this border state and district further contributed to the multi-country South Asian initiative because it provided RCZI relevant data that could enable them to comment on ecosystem-based similarities and differences in community practices and regional strategies for prevention and control of JE.
JE outbreaks are being reported from previously unknown foci. Further, encephalitis outbreaks of other aetiologies in endemic areas have only added to their complexity. For programme managers, researchers and community health professionals, access to accurate and updated information is key to planning interventions and other relief measures.read more