Bihar must learn from this tragedy
Encephalitis can be contained if children are admitted in time
At least 100 children have died in Muzaffarpur this summer from acute encephalitis syndrome (AES), which the state government and district administration are blaming on hypoglycaemia (sudden fall in blood sugar), heat wave, and inadequate intensive care units (ICU) in hospitals. What has conveniently been left unsaid is that the district administration, yet again, has failed to respond to an annual outbreak of encephalitis that severely affects 11 districts, including Muzaffarpur, with seasonal regularity. While symptoms of Japanese encephalitis (JE) and AES are similar —inflammation of the membrane of the brain that leads to sudden-onset fever, headache, disorientation, tremors, convulsions, and paralysis — the cause is different. Vaccine-preventable JE is a mosquito-borne flavivirus from the same genus as dengue and yellow fever viruses.
AES may be caused by a range of factors, including toxins in unripe lychee fruit, viruses, bacteria, fungi, parasites and chemical poisons. If not treated within hours of appearing, 30% of those affected die. In India, AES outbreaks in the past in Muzaffarpur have been linked to young, malnourished children eating unripe lychee fruit. Unripe lychees contain the toxins, hypoglycin A and and methylenecyclopropyl-glycine (MCPG) that cause vomiting and a sudden drop in blood sugar. In severely malnourished children, rapid fall in blood glucose levels can kill within hours.
India has a standard operating JE/AES containment procedure, which mandates grassroots health workers, including auxiliary nurse-midwives, accredited social health activists, and anganwadi workers, to do household surveys to check children for JE/AES symptoms. But these measures have clearly not been implemented in Bihar. In Uttar Pradesh, the state government’s (knock at the door) campaign has brought together health, rural development and primary education officials to promote clean drinking water, sanitation, vaccination and early referral to hospitals. If children with sudden fever are referred within hours of developing symptoms as mandated, simple glucose is all that is needed to save many young lives.