Gorakhpur, India experience of Japanese encephalitis management: A successful One Health approach

The Japanese Encephalitis Virus (JEV), a zoonotic flavivirus, is responsible for infecting humans and inducing reproductive complications in swine, with transmission primarily facilitated by mosquitoes. Predominantly observed in Southeast Asia, Japanese encephalitis (JE) primarily circulates between amplifying hosts, notably swine, and culicine mosquitoes, particularly Culex tritaeniorhynchus . The wading birds are the reservoir host of this disease. Utilizing real time polymerase chain reaction (RT-PCR) presents a potential approach for detecting JEV in mosquito populations. Manifesting primarily within the central nervous system, JEV infection can instigate severe inflammation, contributing significantly to mortality rates, notable in India, especially in Uttar Pradesh, where JE poses a substantial public health concern. The initial instances of JE in Indian territories were recorded in 1955 in the southern provinces of Vellore and Puducherry, and in 1978 in the northern regions. Uttar Pradesh, among the 24 states endemic to JE, accounted for over 75% of reported cases till 2021 and remained as the state with highest JE cases uptill 2017. The geographical landscape of Gorakhpur, characterized by low topography, susceptibility to flooding, heavy precipitation, paddy cultivation and silt accumulation in riverbeds, creates favorable conditions for mosquito breeding and subsequent JEV transmission. Recent data from India's National Centre for Vector Borne Diseases Control (NCVBDC) indicates a decline in acute encephalitis syndrome (AES) and JE cases in Uttar Pradesh including Gorakhpur which has been the hot bed for JE/AES. Effective coordination across diverse sectors supported by evidenced based research by Indian Council of Medical Research (ICMR) in Gorakhpur played an important role under comprehensive multi-sectoral "One Health Approach", which helped significantly in mitigating the disease burden with more than 90% reduction in morbidity and mortality. This article assesses the current scenario, key intervention measures, ongoing initiatives, and underscores the significance of adopting a One Health Approach in combating JE/AES as a "Gorakhpur experience" to be implemented in other parts of the country and elsewhere.