Six per cent of children visiting the paediatric neurological department of Kanti Children's Hospital are suffering from encephalitis. Most of them visit the hospital only when their health condition is already complicated.

"The hospital runs its neurological OPD on Tuesdays and Fridays. It sees at least 60 patients a day. The patients are referred from all the 77 districts.

But they come when their condition is already complicated," said Anshu Jha, senior consultant paediatrician.

"We went to a traditional healer when my child had fever.

His fever subsided. But later, he developed high grade fever and was rushed to a private hospital. His health condition worsened and I lost hope. He was then referred to Kanti Hospital, where he was diagnosed with meningoencephalitis," said one of the parents whose child suffered from encephalitis.

He was sharing his experience at an event organised in the capital today.

"There are many parents who delay taking children to the hospital. Patients usually take paracetamol tablets and stay at home. As a result, the infection spreads, and they need intensive care. It is difficult to save life then," said Ajit Rayamajhi, head of Paediatric Medical Department, Kanti Children's Hospital.

To raise awareness about encephalitis, save lives and build better future, World Encephalitis Day is celebrated each year on February 22.

The day was marked in the capital to increase awareness about the disease and preventive measures. Doctors Rayamajhi and Bina Prajapati Manandhar of Kanti Children's Hospital presented papers on encephalitis and the current scenario of the disease in the country at an event organised in the hospital today.

Parents of children who suffered from encephalitis also shared their experience and said that early treatment was necessary. Encephalitis is inflammation of the brain – a neurological condition that can leave survivors with permanent brain injury.

According to the World Health Organisation, the case-fatality rate among those with encephalitis can be as high as 30 per cent. Permanent neurological or psychiatric sequelae can occur in 30 to 50 per cent of those with encephalitis.

From among the types of encephalitis Japanese encephalitis is more common in Nepal, the doctors say.

Japanese encephalitis virus is transmitted to humans through bites from infected mosquitoes of the Culex species, mainly Culex tritaeniorhynchus.

The virus exists in a transmission cycle between mosquitoes, pigs and/or water birds (enzootic cycle). The disease is predominantly found in rural and peri-urban settings, where humans live in closer proximity to these vertebrate hosts.

"About 99 per cent of Japanese encephalitis is without symptoms," said Rayamajhi.

Symptoms of encephalitis vary but can include flu-like illness or headache, drowsiness, uncharacteristic behaviour, inability to speak or control movement, psychiatric manifestations, memory problems and seizures.

"While some develop behavioural changes, and show tantrums, the children are taken to psychiatrists and treatment is delayed. Medical practitioners too should be trained to detect the disease early," said Bina Prajapati Manandhar, senior consultant paediatrician.

As the virus is transmitted through mosquitoes, people must use nets, mosquito repellents, clean the surroundings, wear long sleeved shirts and long pants. Pig sties should be kept away from residential areas. Crops should be planted in cycles as water deposited in the field for rice plantation can become a breeding ground for the mosquitoes.

The doctors also stressed on conducting sero prevalence survey to determine the situation of Japanese encephalitis in the country as a number of cases have been reported from mountainous areas such as Solukhumbu.

"The government should conduct survey to find whether the effects of climate change are being seen in the mountainous areas or is it the effect of migration," said Rayamajhi.

If we are to lessen the number of cases, coverage of vaccination against Japanese Encephalitis must be increased in our National Immunisation Programme. Also, the number of human resources and health centres to treat the disease should be increased.

Medicines necessary for treatment should be made available across the country so that people will not have to come to Kathmandu, said Rayamajhi.

"Death rates from the disease are high. Survivors can be left with an acquired brain injury resulting in a wide range of difficulties such as problems with memory and other cognitive skills, changes in personality, emotional and behavioural difficulties, epilepsy, fatigue and other physical difficulties," said Prajapati Manandhar.

The government should also make rehabilitation centres to help patients, doctors say. Rani Pokhari was illuminated with red colour in the evening to raise awareness about the disease.

A version of this article appears in the print on February 23, 2021, of The Himalayan Times.