Kathmandu, September 1

While the country is grappling with major public health crises, especially a cholera outbreak in Birgunj and dengue cases throughout the country, cases of Japanese Encephalitis (JE) and related deaths have shot up, according to the Ministry of Health and Population's Family Welfare Division's most recent situation report.

As of August 31, 1,021 Acute Encephalitis Syndrome (AES) cases had been reported nationwide, including 118 laboratory-confirmed JE cases and 23 deaths from JE.

The JE cases have been reported from 80 municipalities across 36 districts in all seven provinces, with the Lumbini Province having the highest number. Lumbini has the most cases of 39, followed by Bagmati (18), Gandaki (18), and Koshi (17). The gender distribution among confirmed cases is 66 males and 52 females, while deaths are nearly equal: 12 males and 11 females.

Meanwhile, deaths have been disproportionately high among people over the age of 40, accounting for 74 per cent of fatalities. Outbreaks have been documented in seven municipalities across six districts spanning four provinces, necessitating immediate responses from mobilised rapid response teams providing public health interventions.

Talking to THT, Bibek Kumar Lal, director at the Family Welfare Division, stated that the majority of JE patients work in agriculture, and cases are primarily clustered near rice fields as well as pig and hen farms, emphasising the spreadability of this mosquito-borne disease carried by the Culex mosquito. 'To prevent transmission, the government has continued to administer JE vaccinations at the age of 12 months, with catch-up doses available to children up to five years old,' he said.

'Over 2,100 health workers and nearly 1,800 female community health volunteers received training, which improved early detection and response capabilities. Awareness campaigns and community monitoring programmes are being implemented across the country to educate the public and slow down disease spread,' Dr Lal added.

The JE trend from 2015 to 2025 shows a fluctuation in cases and deaths, with a recent increase in 2024 and 2025 consistent with current epidemic patterns.

'This disease primarily affects ducks, water birds and pig farming areas. It is spread by the mosquito species Culex. Our work focuses on the human health component. The symptoms of JE include fever and altered state of consciousness,' Dr Lal told THT. 'Usually, it is very tough to diagnose Japanese encephalitis in the initial stage. When people complain of high fever and altered consciousness, they may have caught JE or another encephalitis disease.'

According to Dr Lal, there is no definitive treatment for this disease. The only option is to treat the symptoms. 'The majority of cases indicate that patients of JE do not visit the health facilities on time. People may initially develop a fever and seek medical attention from pharmacies or traditional healers,' he said. 'By the time they show up at the hospital, encephalitis will have advanced, resulting in death or long-term disabilities due to brain damage.'

As a result, Dr Lal advises that if high fever with altered consciousness is observed, the patient should be taken to a hospital immediately. 'We have increased our surveillance and updated clinical management guidelines based on feedback from global experts.'

Our problem is that, while the government provides free JE vaccine routine immunisation for children as young as 12 months old, the source of infection persists, primarily due to pig and duck farming areas that serve as reservoirs, he explained. 'The risk persists until pig and duck farming practices are improved and the distance between these animals and human habitation is increased. In addition, mosquito bite prevention measures are critical for controlling transmission.' When asked about transmission, Dr lal replied that the JE virus lives in animals, particularly pigs and water birds such as ducks. The infected mosquito bites these animals, and the virus is then transmitted to a healthy mosquito by biting an infected animal. When that mosquito bites humans, it can infect them.

'Unlike dengue, the disease is not transmitted from person to person via mosquitoes. The virus spreads in pigs and birds, which act as reservoirs,' he added. However, he cautioned that while JE is safer in terms of transmission than dengue, it is more fatal. 'For example, 23 out of 118 confirmed JE cases had died by August 31. While many thousands may contract dengue with few deaths, JE causes a high mortality rate in fewer cases.'

According to the Epidemiology and Disease Control Division (EDCD), 3,586 dengue cases have been reported in 74 districts, with two confirmed deaths. Similarly, 897 cases of cholera have been reported, with 803 discharged and 94 cases in Birgunj, according to the Parsa District Health Office.