By Henry Neondo
A new Technical Brief launched today by the World Health Organization and Encephalitis International calls for concerted global action to confront and tackle the growing public health threat from encephalitis, which is inflammation and swelling of the brain
The brief, released ahead of the World Encephalitis Day (22 February, 2025), notes that unless prompt action is taken, encephalitis will continue to drive avoidable deaths and disability.
“The WHO Encephalitis technical brief aims to focus attention on the increasing global threat of encephalitis, prevention strategies and existing gaps in the diagnosis, treatment and care which will help enable more people affected to receive the treatment and care they need to live fulfilling and healthy lives,” said Dr Tarun Dua, Brain Health Unit, Department of Mental Health, Brain Health and Substance Use.
Encephalitis, a serious neurological condition, leading to high mortality and morbidity rates worldwide affects three people every minute globally, but its incidence may be considerably higher.
Regrettably, the withdrawal of support for the WHO and potential dissolution of USAID by President Donald J Trump’s Administration, among other recent executive actions, threaten to worsen an already challenging situation.
Encephalitis is caused by both infectious and autoimmune causes (where the body’s defences attack the brain) but in many cases the cause remains unknown. Some can be prevented by vaccination, and for others there is no specific treatment available.
Encephalitis does not discriminate – it affects individuals of any age, from babies to the elderly, and from every social class and ethnicity. The condition does, however, disproportionately affect people in low-to-middle-income countries (LMICs), where health services and resources are often more limited.
The Technical Brief, Encephalitis: Global threats, trends and public health implications, outlines the need for a series of interventions from policymakers, public health professionals, researchers and other stakeholders, and an international campaign to increase awareness of this life-threatening condition among healthcare providers and the wider general public.
Globally, challenges in encephalitis diagnosis result in delayed recognition and treatment, increasing the risk of death and severe complications.
Survivors of encephalitis may experience long-term morbidities including cognitive deficits, physical impairments, emotional and behavioural difficulties, and seizures, requiring life-long assistance in personal care and the activities of daily living. As a result, encephalitis is associated with significant costs to individuals and society.
An annual cost of >£23 million (US$35 million) has been estimated in England based on an incidence of 5.23 cases/100,000/year, a mean hospital length of stay of 34 days, and a bed-day cost of £261.
This, however, does not include the cost of intensive care, expensive investigations, in-patient rehabilitation, or long-term care and loss of productivity among many working-age survivors. Thus, the cost of encephalitis is likely substantially higher.
In a USA study, the mean charges for hospitalisation for a child with encephalitis was $64,604 and for those requiring critical care was $260,012. In this study, 40% of the 7,298 children admitted with encephalitis between 2004 and 2013 were admitted to paediatric intensive care, incurring a total cost of >$750 million. Encephalitis-associated hospitalisations in the USA were estimated to cost $2 billion in 2010.
Studies from low-income and lower-middle-income countries show how great the cost burden of encephalitis is for families. In Nepal, for example, for children with severe/moderate impairment due to encephalitis the median out-of-pocket cost to families was US $1,151, which is 10 times their median monthly income.
Among a series of recommended interventions around diagnosis and treatment, the Technical Brief calls for: public and healthcare professional education targeting early clinical recognition; adoption of standardised clinical guidelines and the WHO Essential List of Diagnostics to aid diagnostics; prioritising relevant medicines in national essential medications lists and treatment protocols; better availability/affordability of medicines; and training of the health workforce to recognise and treat encephalitis in a timely manner.
“Our recent research has shown that many of the interventions needed to improve diagnosis and treatment of encephalitis are not particularly expensive. A lot of it is about increasing surveillance and recognition of the condition, providing simple equipment for early diagnosis, and making sure the right treatments, many of which are very affordable, are available,” said Professor Tom Solomon CBE, President of Encephalitis International and advisor to the WHO.
Vaccines exist for several important causes of infectious encephalitis. Many should be a part of routine childhood vaccination schedules, while others are recommended in at-risk populations.
Unfortunately, global vaccination coverage decreased during the COVID-19 pandemic, and vaccine hesitancy contributes to disease resurgence.
The Technical Brief’s recommendations include incorporating measles, mumps, and Japanese encephalitis vaccinations into national childhood immunisation programmes, and catch-up vaccinations for adults and at-risk groups; and developing and funding public education and information campaigns to promote vaccination uptake.
Encephalitis surveillance has not been universally developed, and the quality is variable among existing systems. The Technical Brief calls for measures that will strengthen disease surveillance capacity to enable countries to better identify disease prevention priorities, plan ahead, sensitise beneficiaries, focus workable evidence-based interventions and monitor disease trends.
“Whilst the launch of this seminal WHO technical brief on encephalitis is a groundbreaking moment for the disease, those it affects, and those researching it, recent actions by President Trump not only have profound implications for the advancement of the report’s actions, but also for the health of the people of the United States, and many others around the world,” said Dr Ava Easton, CEO Encephalitis International.