Outlook – July 06, 2019

hal compared to the non-viral. What is known about them?

JEV is an arbovirus, transmitted to humans by insects—typ-

ically, the culex mosquito. The Chandipura Virus (CHPV) is

a rhabdovirus, a poorly characterised new virus that is, that

mutates incessantly—making it particularly lethal. CHPV is

transmitted by sand flies and culex mosquitoes. Bats are

reservoir of many highly infectious AES pathogens: Nipah

virus and West Nile virus to Kyasanur forest disease virus.

Herpes Simplex Virus, the most common cause of AES

among children in Eastern India, spreads person-to-person.

Enteroviruses, increasingly recognised as an important

pathogen for AES, spread via water, food and soil. Rotavirus,

the prime culprit behind the daily deaths from diarrhoea

among children, can also cause hypoglycaemia (extremely

low sugar in blood) and convulsions. And, despite the 1.2 lakh

diarrhoeal deaths among children every year, Bihar is still to

introduce the free rotavirus vaccine.

Tinkering with nature

The biggest challenge lies elsewhere. As the viral theory gains

ground, AES becomes a spectrum of zoonotic diseases, where

the pathogen jumps species and is transferred from animals

to humans. In the 21st century, zoonotic diseases have caught

the world unprepared: from the Severe Acute Respiratory

8 July 2019 OutlOOk 35

Graphics by Saji C.S.

THE SPREADING TENTACLES

How Acute Encephalitis Syndrome has spread through the country

Siliguri

Nipah virus,

2001

Warangal

Chandipura virus, 2003

2003

Odisha (Bhubaneswar,

Dhenkanal, Khurda,

Malkangiri, Keonjhar,

Balasore, Kendrapara,

Jharsuguda and Debgarh)

Scrub typhus virus, 2014-17

Muzaffarppur

Enterovirus, 2017

Gaya

Chandipura virus, 2017

Champaran

1978

Lucknow

2005

Assam

2000

Dimapur

1985

Manipur

1982, 1995

Bankura*

1973

Cuttack

1989

Raipur

1980

Anantapur

1999

Kolar

1978

Tamil Nadu

1978, 1981, 1999

Goa

1982

Sangi

1997

Vadodara

2004

Haryana

1990

Chandigarh

Measles virus, 1997

1997

Sikkim

Scrub typhus, 2003–04

Darjeeling

Scrub typhus, 2007

Aizawl

Scrub typhus

virus 2017-18

Gorakhpur

Enterovirus,

scrub typhus,

2006-18

JEV,

1978-2005

Kozhikode

West Nile virus, 2018

Kochi Nipah virus, 2018

Shimoga

Kyasanur forest

disease, 2018

Nagpur

Chandipura virus,

2012-14

Eastern Gujarat

Chandipura virus

2004, 2009-12

Jodhupur and Jaipur
Herpes simplex virus, 2018

Himachal Pradesh**

Scrub typhus, 2003–2004

Old AES: Outbreak

attributed to Japanese

encephalitis virus (JEV)

New AES: Outbreak

attributed to other

* Bankura, Bardhaman: First JEV outbreak identified in 1973 pathogens

* * First non-JEV outbreak (measles) identified in Himachal Pradesh, 1997

Udaipur

West Nile virus, 1997

map not to scale