title: Who's failure? encephalitis kills!
abstract: Encephalitis continues to be one of the most dreaded diagnoses because a high rate of morbidity and mortality are accepted even before starting the treatment. Most encephalitis cases occur in rural areas due to poor environmental sanitation, high-vector density, shortage of protected water supplies and lack of health education. Vaccination, environmental sanitation, vector control, health education and attention to prompt diagnosis and treatment in rural hospitals are the four essential pillars for reducing case fatality rate (CFR) of encephalitis. Frequently, virulence of the virus, immunological state of the host, unavailability of antiviral drugs and lack of enough tertiary care hospitals (TCH) are not responsible for the high CFR. Basic supportive care is not being practiced meticulously in Primary and Secondary Care Hospitals (PSCH), and their services are not being utilized fully. Main causes of high mortality and morbidity rates are hypoxia and ischemia of brain and other organs precipitated by preventable, controllable or treatable complications due to lack of basic medical and nursing care during transport to the TCH. Undiagnosed Rickettsial infections are suspected to be partly responsible for the high CFR in some areas. Improving rural hospitals and their ambulance services are the most economical way to reduce CFR. "Treatment facilities must be made available at places where cases occur." The best way to reduce CFR of encephalitis in developing and underdeveloped countries is to increase and improve PSCH and sensitize politicians, administrators, medical/nursing professionals and more importantly to impress and convince the public to utilize them.
authors.affiliation: Consultant, Japanese Encephalitis Projects, PATH; Chairman, AES/JE Expert Committee, Uttar Pradesh, Team Leader and Facilitator, Joint Monitoring Mission of Government of India and World Health Organization 2014; Former Professor and Head of the Department of Neurology/Pediatric Neurology, Osmania Medical College/Niloufer Hospital/Osmania General Hospital, Hyderabad, Telangana, India.
authors.forename: Nagabhushana Rao
authors.initials: NR
authors.lastname: Potharaju
mesh_terms: D000208:Acute Disease; D003906:Developing Countries; D004660:Encephalitis / Q000401:mortality* / Q000517:prevention & control*; D004777:Environment; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D007194:India / Q000453:epidemiology; D009032:Mosquito Control / Q000379:methods; D012499:Sanitation; D014611:Vaccination