The increasing global threat of encephalitis and what the world should be doing

Dr. Ava Easton

Dr. Ava Easton, chief executive of Encephalitis International, has warned against the growing threat of encephalitis in the Philippines and globally and called on health professionals, policymakers, and global stakeholders to take action and implement recommendations to save lives and reduce disability from encephalitis.

In an interview, Easton said that while there is no precise figure for its prevalence, the available data—such as the Acute Meningitis-Encephalitis Syndrome (AMES) Registry (which recorded 1,437 cases and 77 deaths until its last update in 2020) and WHO estimates for Japanese encephalitis—indicate that encephalitis, in both infectious and autoimmune forms, is a significant and rising public health concern.

She said, “The healthcare delivery system in the Philippines is divided into public and private sectors. The majority of Filipino families do not have the financial means to avail of private medical services; hence, they would go to public hospitals, which are often understaffed and over capacity.”

“Moreover, the country’s topography isolates some rural areas, making it more challenging for people to access specialized healthcare services in tertiary or secondary hospitals,” Easton added.

Globally, encephalitis affects between one and 1.5 million people annually, resulting in around 100,000 deaths, underscoring its devastating impact worldwide.

Several factors contribute to this issue in the Philippines. The tropical climate is a double-edged sword. On one hand, it creates ideal conditions for mosquitoes to thrive. These vectors transmit arboviruses, such as those causing Japanese and dengue encephalitis.

In addition, the increasing incidence of HIV in the country renders a segment of the population immunocompromised and more susceptible to infections like HIV encephalitis.

The limited availability of diagnostic tools and treatment facilities adds to the complexity. Many hospitals lack advanced imaging technology and laboratory capabilities, such as cerebrospinal fluid analysis, which are crucial for timely and accurate diagnosis.

The challenges go beyond diagnostics. The Philippine healthcare system is bifurcated into public and private sectors, with most of the population relying on public hospitals.

These institutions are often understaffed and overburdened, and the country’s diverse topography means that rural communities are mainly isolated from specialized care found in tertiary or secondary hospitals. Financial constraints further complicate the scenario.

Although national insurance (PhilHealth) is available—with policies like the “no-billing policy” in public hospitals—coverage is insufficient for patients needing private care, especially when advanced or immunosuppressive therapies are required.

Public awareness is another critical gap. Insufficient information is disseminated about the signs and symptoms of encephalitis. This, in turn, leads many to self-medicate or delay seeking professional help, which can have dire consequences.

Misdiagnosis or mistreatment not only increases the risk of death but also leaves survivors with life-changing disabilities, thereby placing both emotional and financial strains on families.

Prevention, therefore, is paramount. Vaccination emerges as a crucial strategy since some causes of encephalitis are preventable. For instance, immunizations can protect against measles, herpes simplex virus (responsible for cold sores), and Japanese encephalitis. Public health campaigns and adherence to recommendations from organizations like the World Health Organization (WHO) are vital to improving immunization coverage and preventing outbreaks.

Another pressing issue is the shortage of specialized healthcare professionals. The Philippines faces a significant gap in trained neurologists and infectious disease specialists.

To bridge this gap, Dr. Easton advocates for implementing online training modules and closer collaborations with medical societies such as the Philippine Neurological Association and the Philippine Society for Microbiology and Infectious Diseases. Regular discussions between local physicians and international experts from countries like the UK and the US could further enhance diagnostic acumen and treatment strategies.

Personal stories, such as that of Judiel Diez—a nurse diagnosed with anti-NMDAR encephalitis—bring a human face to the crisis. Such narratives highlight patients’ resilience and serve as a catalyst for shaping more effective public health policies.

In summary, the document paints a picture of a multifaceted health challenge in the Philippines, where climatic, infrastructural, and socioeconomic factors converge to heighten the risk and impact of encephalitis.

The need for enhanced public awareness, better diagnostic capabilities, and improved training for healthcare professionals is evident. With a coordinated approach and increased investment in prevention and treatment, the country can better protect its citizens from the heavy toll of this disease.