Despite the vaccination drives since 2005, children - AES [acute encephalitis syndrome] incidence is highest among boys less than 14 years -- continued to die. Though the number of children testing positive for JE [Japanese encephalitis] dropped, children continued to die of AES symptoms of high fever, incoherence and disorientation, with or without seizures, followed by polio-like flaccid paralysis.
So, in 2006, JE outbreaks were renamed AES, a term used to describe the symptoms rather than the cause of the infection. The cause could be one or a combination of many. Gorakhpur is in the Terai region, where the warm, humid climate combined with paddy-fields and plenty of rain makes it an ideal breeding ground not just for mosquitoes but also bacteria, viruses and fungi. Children are at most risk because they are out playing and swimming in the innumerable ponds, which not just exposes them to mosquitoes but also water-borne infections.
"I don't know what's causing the deaths, all I know is that the paediatric wards are overcrowded and many parents leave the hospital devastated," says Kushwaha, who struggles to accommodate patients, many of whom are reach the hospital too late in the arms of their parents because they've already been struck by paralysis. The AES case fatality - number of deaths among the people diagnosed - is a high 20-25%, which is among the highest among any infection.
To a smaller degree, this holds true for Assam, Bihar, Karnataka and Tamil Nadu, the states that along with Uttar Pradesh account for roughly 80% of AES cases and deaths in India. With no specific anti-viral drugs or antibiotics available for AES and the vaccine effective only against 5-10% cases, it's imperative to solve the mystery of this monsoon brain fever striking Gorakhpur's young population.