Sources reveal that while the state government had ordered the construction of a 100-bed hospital for AES patients – to be built at a cost of Rs.18 crore – the tendering for the same is still on. According to government timelines, the “lenter of the ward” would be up by March 2013. The story is the same with paediatric wards to be set up in the nine districts affected by AES. The wards are still not complete. There is thus no place where ventilators (124 of them, according to an announcement by the Samajwadi Party government in June) can be installed.

Of the 22 ventilators installed at the Baba Ram Das Medical College in Gorakhpur, most are on lease from other medical colleges of the state, said principal secretary (Health) Sanjay Agarwal, who also candidly admitted that apart from statistics which show a marginal decrease in JE deaths from 5.97 percent last year to 4.02 percent in the corresponding period till November this year, a lot was still to be done. The fact that the deaths have not stopped and that hundreds of kids have fallen prey to encephalitis has forced chief secretary Javed Usmani to shoot off a terse message to district magistrates of the JE-hit districts in eastern Uttar Pradesh and health officials, urging that they “ensure that no JE deaths are reported in the next season” or be ready for stringent action.

In a letter to these officials, Usmani has fixed responsibilities and clearly spelt out that officials would be personally held accountable for deaths in their respective zones.

He has also directed health officials to immediately hold meetings to coordinate efforts for rehabilitation, housing, facilitation and physiotherapy of children disabled by the disease. A special mop up immunization drive has also been ordered between Dec 1 and Dec 31.

The state government had in June pressed panic buttons after 88 people succumbed to the killer disease in a ‘pre-disease period’ that usually begins July. Officials admit that while AES-afflicted people had swarmed various primary health centres, hospitals, other medical facilities and the Baba Ram Das Medical College in Gorakhpur, the preparedness of the health department as a whole is still far from adequate. The disease, which claimed more than 600 lives in the last season, peaked in areas around Gorakhpur division – Gorakhpur, followed by Kushinagar, Deoria and Maharajganj, reported maximum deaths yet again.

But while Gorakhpur basks in government attention, especially since the chief minister’s visit there Oct 31, when he ordered a special unit and an MRI facility at the medical college, doctors regret that other areas are neglected. Sanjay Agarwal says immunization and deployment of immediate ambulance service and child specialists at every primary health centre have had the desirable change.

The fever tracking system in some areas has also helped, but larger infrastructural changes remain to be carried out to deal with the situation effectively. The battle against AES has been largely left to PHCs, which were still to be equipped with ventilators. “Paediatric wards are being constructed at the PHCs and by June next year I think all the things would be in place,” the principal secretary said.

Since AES is largely a water-borne disease, sanitation is being given special attention, though belatedly ; the availability of potable water is a concern, an official said. Meanwhile, an awareness campaign was launched and literature distributed as part of it.

The ambulance service, which earlier functioned at a charge of Rs. 5 per kilometre, is now a free service.

Though some of these measures will help, there is need for much more focus and also a “less bureaucratic attitude,” say doctors.

The state government also plans to utilize the Rs.51 crore funding received from the government of India for the purpose of fighting the encephalitis scourge by June 2013.

While 444 cases were brought to the BRD Medical College in Gorakhpur this year, even the districts have reported 11 percent cases, something which officials say is “encouraging enough.”

While steps are being taken to provide good treatment to others affected by it, the medical experts’ opinion is that this disease is largely because of unhealthy drinking water supply and lack of cleanliness in rural areas, said Union rural development minister Jairam Ramesh. “If the state governments give proper attention to supply of potable water, this epidemic can be checked to a great extent,” he said. He has asked the state governments to send a proposal to his ministry for additional assistance. ”In 2012-13, Rs 10,500 crore has been allocated for rural water supply across the country of which Rs 525 crore has been earmarked only for improving quality of drinking water. Of this Rs 525 crore, Biharwill get Rs 61 crore,” he said.

“Bihar is facing scarcity of drinking water but it failed to utilize the funds. In two years, the state failed to avail Rs 500 crore which was to be given as second instalment. In 2012-13, Bihar has been sanctioned Rs 497 crore,” Ramesh said.

Contamination of the drinking water by arsenic, fluoride, iron etc are also of great concern and about 1.08 lakh habitations across the country are facing this problem. “Arsenic is a serious problem and it leads to cancer. This problem is grave in Bihar, West Bengal and Assam while fluoride is found in Bihar, Karnataka, Rajasthan and MP,” he added.

More deaths of AES patients, mostly children from poor families, from the states have been reported and the outbreak of the ailment seems far from being contained. With nine more children dying of AES in Bihar’s Gaya, Muzaffarpur and Patna districts, according to officials Saturday, the toll has risen to a shocking 159 in just three weeks. ”Fresh AES cases have been reported from all 10 affected districts,” a state health department official said.

In Uttar Pradesh, 88 people have succumbed to various strains of AES in the last two weeks, prompting the state government to press the panic button.  Most of the cases have come from the eastern district of Gorakhpur, near Bihar.

In Bihar, as many as 409 children have been detected with AES and of them, 159 have died and 82 admitted to hospitals, said Additional Secretary (Health) R.P. Ojha. The rest have been discharged, he said. 

The worst affected districts include Patna, Gaya, Muzaffarpur, Sitamarhi, East Champaran and Vaishali.

Health officials say AES has killed lives of 100 children in Muzaffarpur alone. 

Alarmed, Health Minister Ashwani Kumar Choubey has asked the striking junior doctors of the Patna Medical College Hospital to resume work.

A team from New Delhi is now in Muzaffarpur, around 75 km from Patna, to help contain the fatal viral disease. 

“All medical colleges and hospitals have been directed to provide free medicines to patients having AES symptoms,” said Health Secretary Vayasji.

However, Bihar is yet to declare AES an epidemic. 

In Uttar Pradesh, health officials say that till June 10, 467 cases of AES came to primary health centres, hospitals and the BRD Medical College in Gorakhpur.

Director General of Medical Health Ram Ji Lal said: “The disease has begun spreading a little early this time round, but we are ready to take on it.”

The disease, which killed more than 600 people last season, is peaking in areas around Gorakhpur, officials say. 

Lal said the maximum number of deaths have been reported from Gorakhpur followed by Kushinagar, Deoria and Maharajganj.

However, no infection of Japanese encephalitis, a virulent strain, has been reported, said health officials. 

But they caution that this did not mean that the disease had been contained.

“We are keeping our fingers crossed and doing our best to prevent the epidemic-like situation as last year,” an official told IANS.