The Rapti Municipality of the Chitwan district reported Japanese encephalitis (JE) cases in the first week of July. However, the local unit has not taken any measures against the debilitating disease.

Of the two patients who tested positive, one died, and the health condition of the other is not known, as health workers serving there have not even followed up on the case.

“One of the patients succumbed to infection while receiving treatment. We are not keeping track of the other patient’s condition,” said Ram Mani Silwal, a senior auxiliary health worker at the municipality. “We have also not taken any preventive measures against the JE due to a lack of budget.”

Rapti Municipality is among the 79 municipalities in the country that have reported JE cases this year. Many of these local units complain either about not having a budget to launch preventive measures or about not getting help from the federal government.

JE is a viral brain infection endemic to Asia and parts of the Western Pacific. According to the World Health Organisation, it is a mosquito-borne flavivirus belonging to the same family as dengue, Zika, yellow fever, and West Nile viruses. The virus kills a third of those who fall ill and leaves up to half of the survivors with severe lifelong disabilities, according to the UN health body.

Over the past two months, at least 23 people have died and 90 others have been infected with JE, which has spread to 36 districts.

The death rate is rising alarmingly by over 20 percent. Most of those who died were unvaccinated. Doctors warn that the actual number of cases could be higher, as testing has been limited to hospitalised patients.

According to Silwal, the outbreak in Rapti Municipality was confirmed on July 6, the last week of the fiscal year 2024-25. He said the municipality at the time did not have the budget to launch preventive measures.

“We could not start the awareness drive immediately after the start of the new fiscal year, as the official concerned was on leave and it took time to approve the budget,” said Silwal. “We cannot launch a programme without a budget. Now that we have allocated a budget, we will probably launch the awareness drive next week.”

Bardhaghat Municipality of Nawalparasi-West also reported two deaths from JE infection. The victims were aged 74 and 50 and unvaccinated. Officials say that health workers in local health facilities subsequently launched an awareness campaign.

“We mobilised health workers on our own to make people aware of the risks,” Madhav Gyawali, chief of the Municipality’s health section, told the Post over the phone from Nawalparasi-West. “No one from the federal government has contacted us to inquire about the latest situation.”

The JE virus is the number one mosquito-borne killer in Nepal. Vaccination is a proven and effective method to contain the spread of the deadly disease and reduce deaths. But Nepal’s health authorities say they lack funds to vaccinate the unvaccinated adult population.

“We are aware that vaccination is an effective method to prevent infection, severity and deaths from JE,” said Dr Abhiyan Gautam, chief of the Immunisation Section at the Family Welfare Division under the Department of Health Services. “We have also repeatedly requested the Global Alliance for Vaccines and Immunisation for vaccines, but have not been able to convince them yet.”

Health workers deployed for rapid response in the disease-hit areas reported that family members of the deceased, infected people, and their neighbours are frightened and have requested for vaccination.

“We are aware of the vaccine's importance, have trained health workers for inoculation, and are also interested, but we do not have doses for the adult population,” said Gautam. “We know many deaths could be prevented in the coming years if we could vaccinate adults.”

This year, JE cases have been reported in all seven provinces—17 in Koshi province, 14 in Madhesh, 18 in Bagmati, 16 in Gandaki, 37 in Lumbini, two in Karnali and nine in Sudurpaschim province.

Experts say the alarming rise in infections and deaths indicates a resurgence of the disease, which has killed and infected thousands of people in the past.

Experts from the National Immunisation Advisory Committee, however, argue that vaccination is not a solution for controlling the current outbreak but is crucial to preventing future infections.

“Authorities must administer JE vaccine to unvaccinated children first, take measures for mosquito control, implement protocol for symptomatic treatment,” said Dr Ramesh Kanta Adhikari, chief of the National Immunisation Advisory Committee. “Accurate data on JE prevalence, deaths among the unvaccinated population must be generated before recommending mass immunisation with the vaccine.”

In 2005, JE killed nearly 2,000 people in Nepal—mostly children from Tarai districts. Nepal started administering the vaccine in 2006, eight years before the World Health Organisation officially issued prequalification certification (to ensure the vaccine is safe and meets global standards), due to the high rates of infection and deaths from the virus at the time.

In the first phase, all populations of the highly affected four districts—Banke, Bardiya, Dang, and Kailali—reveived the JE vaccine. Later, the vaccination programme was expanded to 19 other affected districts, and children under 15 were inoculated.

The government integrated the JE vaccine into routine immunisation in 2015. Still, people continue to die and dozens get infected by the deadly virus every year.

Public health experts say this is the right time to vaccinate all those at risk.

The JE virus is transmitted to humans through the bite of infected Culex mosquitoes. Pigs and ducks are considered natural reservoirs of the virus. Complications from JE infection can cause permanent injuries to the brain and the nervous system. The disease has no cure, so treatment focuses on managing symptoms. However, safe and effective vaccines have been developed to prevent infection.

Doctors advise avoiding mosquito bites, such as by using mosquito repellents, wearing long-sleeved clothes, and getting vaccinated if one lives in or travels to disease-endemic areas. They also stress the importance of awareness and timely treatment to prevent infections and deaths.

An estimated 12.5 million people are thought to be at high risk of JE infection in Nepal.