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Encephalitis killing children in Asia who have no access to vaccines

Updated:
HANOI, Vietnam (AP) _ A Japanese encephalitis outbreak that has killed hundreds of children in northern India and Nepal in recent weeks has no cure or effective treatment. It is easily preventable, but the necessary vaccines are simply not available to millions.

The disease has overwhelmed hospitals in Uttar Pradesh, India's most populous state, since an outbreak began there last month. More than 260 have died and about 1,100 others remain hospitalized. Blinding headaches, seizures, nausea and high fever usually precede death.

Last week in the state capital of Lucknow, a rickshaw driver's 6-year-old son died in his father's arms, gasping for breath outside a government hospital. There were no beds and not enough doctors to help in the overcrowded facility.

``We can understand the anguish of a father. But what can we do?'' asked Dr. Anurag Yadav, a physician at the hospital. ``We do not have space to admit any more children.''

In Nepal, the disease has also been spreading since April in the country's south, across the border from Uttar Pradesh. Nearly 100 have died there.

About 50,000 cases of Japanese encephalitis are recorded each year, according to the World Health Organization. Of the survivors, up to 75 percent suffer disabilities, including paralysis and mental retardation.

Though closely related to West Nile virus, this illness isn't as widely known as other mosquito-borne diseases such as malaria or dengue fever. It is found only in Asia and kills about 15,000 people each year.

A Chinese vaccine, made from a weakened form of the virus, has been used widely within the communist country since 1988. Last year, about 200 deaths were reported nationwide there, according to the Chinese Ministry of Health.

Dr. Scott B. Halstead, an American research director at the Pediatric Dengue Vaccine Initiative, has seen its promise firsthand. He conducted a study in Nepal that showed one injection of the Chinese vaccine was effective almost immediately with no side effects.

So far only South Korea, Nepal and Sri Lanka have licensed the Chinese vaccine, but it is still not being widely used in many places there. The United States and many other nations, including India, rely on limited supplies of another vaccine derived from mice brains. It is more expensive, causes more side effects, and requires multiple doses and at least a month to take effect, said Dr. Julie Jacobson, director of the Japanese Encephalitis Project at the U.S.-based nonprofit PATH.

No Japanese encephalitis vaccines have been added to the WHO's prequalified list, which keeps U.N. agencies from procuring them and may also deter some countries from licensing them.

``If the product is not prequalified, it doesn't mean you cannot use it. It doesn't mean the product is bad,'' said the WHO's Joachim Hombach in Geneva. ``It just means we have not seen it.''

Halstead urged affected countries not to wait for the WHO's endorsement but to license the Chinese vaccine now and begin immunizing children in high-risk areas.

``Here with Japanese encephalitis, you've got a vaccine that really works,'' he said. ``There's no need to sputter or procrastinate.''

Japanese encephalitis is spread mostly from pigs to people via mosquitos. Annual outbreaks occur across Asia, often near rice paddies after water is left following monsoon rains. Like polio, only about 1 in 250 people infected ever develop symptoms. Japanese encephalitis has also expanded, reaching northern Australia in the 1990s.

In India, Dr. O.P. Singh, Uttar Pradesh state's director-general of health, said it would cost about $58 million to vaccinate more than 7 million children. The state's entire health budget is only $25 million.

Jacobson's project works to raise awareness about Japanese encephalitis and push for countries like India to license and administer the Chinese vaccine.

She said one hurdle is convincing leaders that the traditional spraying of houses with mosquito repellant and using bed nets do little to prevent this disease because the mosquitos that carry it typically bite people outside.

``The first JE patient that I saw just broke my heart,'' Jacobson said. ``It's this little girl in this hospital lying there in this beautiful little pink dress and she had slipped into a coma, and there she was lying there in a pool of her own urine, completely unconscious while her family was there holding her hand.''
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