Battling to save 40,000 children at risk from a Japanese encephalitis outbreak, health officials have had to cope with recalcitrant local militias, difficult travel logistics and parents who attribute the disease not to infection but to witchcraft.

The Department of Public Health launched an inoculation campaign in northern Shan State after four children died of the brain-swelling disease in the area since January. They started work on August 26 to cover 10 townships, but will not be able to complete the work by the deadline of today they had set in three of the remote townships: Laukkai, Konkyan and Panghsang/Pangkham.

Assistant program director Dr Aung Kyaw Moe told The Myanmar Times that, in addition to staff shortages and the inaccessibility of the locations, the health officials had to get consent from the local Wa district administration.

“As of yesterday, we were still negotiating with the Wa administration. We can’t proceed until they give permission. There are no midwives or health assistants in those areas, so we have to bring in qualified people from government hospitals in northern Shan State. I think they will let us go ahead, but I don’t know when,” he said.

He added that the health officials will not be allowed to carry out the vaccine program without the Wa’s consent.

In the Shan village of Nantpaung, about 30 miles (48 kilometres) from Lashio township, about 100 of the 300 residents are children. The village administrator, Sai Myat Han, said the parents of one child suspected of being infected with Japanese encephalitis would not allow health staff to vaccinate her.

“The health department were inoculating children in our village on August 28. They treated about 100 children aged from nine months to 15 years. But in one case, the parents would not allow them to inoculate their daughter. They knew nothing about health matters and thought the disease was the result of witchcraft,” he said.

Inoculation has proceeded in the remaining townships of Lashio, Kunlone, Thibaw/Hsipaw, Theinni, Kutkai, Tang Yan and Hopan.

Japanese encephalitis is a serious infection that occurs mainly in rural parts of Asia. It is spread through the bite of an infected mosquito but is not spread from person to person. Most victims show no symptoms, but others might experience a mild fever and headache, or encephalitis, as well as fever, neck stiffness, seizures, and coma. As many as 30 percent of patients with encephalitis dies, and up to half of those who survive are left with permanent disability. It is believed that infection in a pregnant woman could harm her unborn baby.

The cost of preventive vaccination is about K35,000.

The disease is also found in Ayeyarwady, Yangon and Bago regions and Kayin and Mon states.