Via First Post: Gorakhpur hospital tragedy: Encephalitis a perennial issue in Uttar Pradesh; over 26,000 cases reported since 2010. Excerpt:
BRD Medical College and Hospital is at the centre of most encephalitis outbreaks in Uttar Pradesh. Located in Gorakhpur in eastern Uttar Pradesh, it is one of the major government public health centres in the region which has the doctors and facilities to treat this affliction. Some of the children who died at the hospital, reportedly due to lack of oxygen supply, were suffering from encephalitis.
Encephalitis is a deadly vector-borne disease which claims hundreds of lives in the state every year. According to a report by the Directorate of National Vector Borne Diseases Control Programme (NVBDCP), 26,686 cases of encephalitis were reported in Uttar Pradesh between 2010 and August 2017. Of this, 24,668 cases were of Acute Encephalitis Syndrome (AES) and 2,018 of Japanese Encephalitis (JE). Out of those reportedly suffering from AES, 4,093 died in the same period. On the other hand, there were 308 JE deaths registered in the state — 15 percent of the total people who suffered from JE between 2010-2017.
AES and JE – What’s the difference?
Acute Encephalitis Syndrome (AES) is an umbrella term for all symptoms which cause inflammatory brain diseases. They could be caused by bacteria, fungi or virus of different strains which are difficult to identify individually. As a result, the World Health Organisation (WHO) in 2006, coined the term AES to signify a group of diseases which seem similar to one another but are difficult to differentiate in the chaotic environment of an outbreak, a Fountain Ink report noted.
In India, the most common pathogen for encephalitis is the JE virus, which accounts for a quarter of the cases. As a result, doctors cannot pinpoint whether the AES is caused by the West Nile virus, dengue virus, Chandipura virus, chikungunya virus, or bacteria such as Streptococcus pnuemoniae, Orientia tsutsugamushi, Haemophilus influenza or fungi like Candida albicans. Illness caused by any of these pathogens triggers fever, an altered mental status causing the patient to behave abnormally and seizures.
Since there exist tests only to confirm JE, all other diseases whose cause cannot be precisely ascertained are relegated to being diagnosed as AES, which is as vague as it can get.
“For around 80 percent of the patients who come here, we can’t give a proper diagnosis,” Mahima Mittal, head of the department of paediatrics at the BRD Hospital, told Fountain Ink. This explains how the number of AES cases is significantly higher than JE in the statistics mentioned above.
In the same report, Ravi Vasanthapuram, a neurovirologist from NIMHANS, Bengaluru called AES a “dustbin diagnosis” for all encephalitis cases whose cause one cannot find. If you Google encephalitis in India, a majority of published research is about JE and hardly any about AES.
Major encephalitis outbreak is Uttar Pradesh
Uttar Pradesh carries the largest AES burden in India and has succumbed to repeated outbreaks. Nearly 6,000 children have died in Gorakhpur region since the virus was first detected in 1978. One of the major outbreaks of AES/JE major outbreaks was recorded in Gorakhpur between July and November 2005. The outbreak turned out to be one of the biggest epidemic in three decades. Out of the 5,700 cases, nearly 1,000 children died, BBC reported.
A team of researchers collected samples from 326 people who were admitted at the BRD hospital with encephalitis symptoms during that period. They found that rural populations between the age of three months to 15 years were most affected, while adults in the area were immune to it. It further noted that the patients’ clinical history showed that they experienced fever, headache, convulsions and vomiting leading to paralysis, coma and death eventually.
