H5N1

DRC Ebola: Placed in custody, Oly Ilunga promises to defend himself with 'the most extreme energy for his honor'

Via Actualite.cd: DRC: Placed in custody, Oly Ilunga promises to defend himself with "the most extreme energy for his honor". The Google translation:

Placed in custody on Saturday, September 14, the former health minister, Oly Ilunga, promises "to defend himself with the utmost energy for his honor," his lawyers said. Arrested in Kinshasa around 11 am, he is accused by the judicial police the alleged embezzlement of a sum of about 4.3 million US dollars made available to the Ministry of Health by the public treasury for the fight against my disease Ebola virus.

According to his lawyers, "the US $ 2.4 million placed at the disposal of the Minister's office in 11 months through the authorized public accountant, the accounting documents that are in the file sufficiently attest that this sum was exclusively used for the purpose of combating EBOLA virus disease. He therefore firmly reaffirms his innocence in this affair and promises to defend himself with the utmost energy for his honor."  

According to them, "at this stage more than US $ 1.9 million of this sum has been disbursed in one month after the resignation of Dr ILUNGA so that he can not answer at all".  

According to the Police, the former minister will have to be referred Monday, September 16 to the Prosecutor General Near the Court of Cassation.

Death toll from acute encephalitis in east Indian town rises to 129 children

Via Thompson Reuters: Death toll from acute encephalitis in east Indian town rises to 129 children. 

NEW DELHI, June 23 (Reuters) - At least 129 children have now died of Acute Encephalitis Syndrome (AES) in the town of Muzaffarpur in the eastern Indian state of Bihar since an outbreak earlier this month, a medical official said on Sunday. 

The death toll from AES, a fever that affects the central nervous system, has risen from 97 reported last Monday and medical and government officials are facing mounting criticism for struggling to contain the crisis in the town of nearly 350,000 people. 

AES, known as 'brain fever' is caused by any one of a number of viruses. Symptoms include high fever, vomiting and, in severe cases, seizures, paralysis and coma. Infants and elderly people are particularly vulnerable.  

"I received my last update in the afternoon and according to the latest report that I have, 129 children have died so far," Shailesh Prasad Singh, the top state medical official in Muzaffarpur told Reuters by phone. The town lies about 80 km (50 miles) from Patna, the state capital. 

The precise causes of AES are not known, though a majority of medical professionals say it is linked to a ferocious heat-wave. 

Some studies have blamed toxins in lychees, a fruit grown in abundance in orchards around Muzaffarpur. But many families told Reuters last week that their children had not eaten them in recent weeks. 

Singh said a team of experts, including doctors, paramedics and other government officials were working "round the clock" to contain the spread of AES, which killed more than 350 children in a previous outbreak in Bihar in 2014.  

Doctors from other parts of the country had been dispatched to Muzaffarpur to help staff at the Sri Krishna Medical College Hospital which had to evict a group of sick inmates from a ward to accommodate the surge in AES patients. Most of the children who died were being treated at the hospital.  

Nearly half of all children in Muzaffarpur are underweight, and a similar number are stunted, making them vulnerable to AES, which grips the town almost every year when summer temperatures surge. 

As the death toll mounts, both the Bihar and the federal governments have come under criticism for their inability to save children, and doctors and government officials have faced angry protests. 

On Sunday, the Bihar government suspended a doctor in Muzaffarpur for dereliction of duties, news agency ANI, a Reuters affiliate, said. 

India's Federal Health and Family Welfare Minister Harsh Vardhan, who is himself a doctor, said last week that health officials have finalised plans for construction of a 100-bed paediatric intensive care unit in Muzaffarpur, but gave no timeframe for when it would be built.

India: More on acute encephalitis syndrome in Muzaffarpur

Via The Washington Post: A mysterious sickness has killed nearly 100 children in India. Could litchi fruit be the cause? Excerpt:

NEW DELHI — The children go to sleep as best they can in the sweltering heat. Early in the morning, the fever spikes and the seizures begin. 

Nearly 100 children have died this month in India from an illness that impairs the functioning of the brain and sends the level of glucose in the blood plummeting.  

The deaths have occurred in and around the city of Muzaffarpur in the northern state of Bihar, one of the poorest regions in India. The illness strikes the area each summer, but in recent years the death toll has been less than 20.  

This year, at least 97 children have died, most of them under the age of 7, said Alok Ranjan Ghosh, a senior government official in Muzaffarpur. About 100 more remain in hospitals. The deaths represent the worst toll since 2014, according to figures provided by a state health official. 

Doctors describe the illness as acute encephalitis syndrome, or AES, which is characterized by the rapid onset of fever combined with disorientation and seizures.  

The syndrome has myriad causes, including viruses spread by mosquitoes and human contact, bacterial infections, parasites and toxins.   

In the Muzaffarpur case, officials say the precise cause of the outbreak remains unclear. Elsewhere in India, a mosquito-borne virus called Japanese encephalitis sometimes played a leading role in outbreaks of AES. But in Muzaffarpur, the virus appears absent in the vast majority of the cases, said Sanjay Kumar, principal secretary at the Bihar state ministry of health.  

The illness has been observed in the area since 1995, Kumar said, flaring up during the Indian summer when temperatures soar and subsiding with the arrival of the rains and somewhat cooler weather. Children are arriving at hospitals with critically low blood-sugar levels, he said.  

Sunil Kumar Shahi, the superintendent of Sri Krishna Medical College and Hospital in Muzaffarpur, where most of the children are being treated, said that all of the patients with the illness were under the age of 9.   

“You can imagine my mental condition. The situation is horrible,” he said, before rushing off to treat more children. “Think of the parents whose kids are admitted.”  

Gopal Shankar Sahni, the head of the pediatrics department at the same hospital, said its halls were crowded with distressed and crying parents. “They ask us to treat their kids, but we ask them to believe in God,” he said.  

A recent study conducted by India’s National Center for Disease Control in conjunction with the Centers for Disease Control and Prevention in the United States pointed to a different possible cause for the illness. The area around Muzaffarpur is a major litchi-growing region, and the study found that toxins occurring naturally in the fruit were a plausible source of the illness, especially when children failed to eat an evening meal the day before becoming sick. 

The outbreaks of this “acute unexplained neurological illness . . . begin in mid-May and peak in June, coinciding with the month-long litchi harvesting season,” the researchers noted, adding that most of the affected children come from poor and rural families.   

They posited that the illness might only occur with a combination of factors, for instance when a poorly nourished child eats a large number of litchis and then misses an evening meal. They also pointed to the limitations on local hospitals in providing critical care to such patients, which likely contributes to the death toll. 

At least 31 children in India killed by toxin in lychees

Via The Guardian: At least 31 children in India killed by toxin in lychees. Excerpt:

At least 31 children have died in northern India in the past 10 days from a brain disease believed to be linked to a toxic substance found in lychee fruit, health officials have said. 

The deaths were reported by two hospitals in Muzaffarpur in Bihar state, famed for it lush lychee orchards, officials said. 

The children all showed symptoms of acute encephalitis syndrome (AES), senior health official Ashok Kumar Singh said, adding most had suffered a sudden loss of glucose in their blood. 

At least 40 other children complaining of similar symptoms were being treated at intensive care units. 

“We are trying our best to save them,” said S P Singh, the chief medical officer of Sri Krishna medical college and hospital.

The outbreaks of the disease have happened annually during summer months in Muzaffarpur and neighbouring districts since 1995, typically coinciding with the lychee season. 

“The health department has already issued an advisory for people to take care of their children during the hot summer when day temperature is above 40 degrees,” Ashok Kumar Singh said.

Encephalitis: Faulty vaccination, late diagnosis, 'fudged data' - demons haunt Gorakhpur

Via The Print: Faulty vaccination, late diagnosis, 'fudged data' - demons haunt Gorakhpur. Excerpt:

Gorakhpur: Kishan was relaxed. His two-year-old son, Luv Kush, was protected against encephalitis, a serial killer in the region of eastern Uttar Pradesh to which they belong, because he had been given the teeka at a vaccination camp in Bhawaniganj. 

But just a month later, the child started having seizures, along with high grade fever. Sometimes, he would get aggressive; the very next moment, he would start crying, complaining about being attacked by ghosts.  

Diagnosed with acute encephalitis (AE), the child died of shock in August 2017 after spending three nights admitted at the BRD Medical College.  

“I went to the local hospital for a vaccine as I did not want my child to die of this horrible disease. I had seen too many deaths in the neighbourhood. But the doctors at the hospital did not tell me that I had to return for another injection; after one injection, I was convinced that it was done,” Kishan said. 

“What use are these injections?” he lamented.  

Is immunisation not working? 

The case of Kishan and his son is not isolated – children across Uttar Pradesh have been dying of encephalitis despite being vaccinated. The state government claims 90 per cent of children have been covered under vaccination programmes, but the number of suspected and confirmed cases reported at hospitals in Gorakhpur alone has remained pretty much constant over the last few years. 

In 2016, 426 children died of suspected or confirmed encephalitis at the Acute Encephalitis Syndrome (AES) ward of the BRD Medical College alone, while in 2017, the number was 379.  

In almost 20 per cent of these cases, the children had already received vaccinations, a doctor at the medical college said. 

Explaining these deaths, Dr Rakesh Saxena, spokesperson for BRD Medical College, said no vaccine assures 100 per cent protection, but only controls susceptibility. “Vaccines do not mean 100 per cent protection. It is because of the vaccines that not many patients are now diagnosed with encephalitis. These deaths mostly occur due to other reasons, including malnutrition, attacks by other viruses, and kidney failures,” he said.  

But on the other hand, health experts blame the government for not holding immunisation camps with trained workers. 

Fudged numbers? 

From 2006 to 2010, mass immunisation campaigns were carried out for children up to 15 years of age. But a study done by doctors at the BRD Medical College in 2016 showed that only 2 per cent of children were actually vaccinated.  

“These numbers are more on paper than a fact. In many cases, they give just one injection and do not care to give the booster dose, which defeats the purpose of vaccination,” alleged Dr Kafeel Khan, former nodal officer of the AES ward.  

“The volunteers fudge numbers, and we come to know of it only when the kids are admitted to the hospital with symptoms of encephalitis despite vaccinations. In most cases, we see that the people who hold camps do not reach out to villagers to convince them to get immunised. What is the purpose of this exercise when a proper dose is not even given to the kids? How do they expect them to work?” he alleged. 

Experts said these vaccines are effective only for two hours after the pack is opened. Each pack contains five vials, each of which costs between Rs 1,000[US$14.88] to Rs 1,500. 

Health officers at the camp are advised to not open the pack unless there are six to seven children present for vaccination. However, this is often ignored, and most vaccines lose their potency. But they are still injected, leaving the children susceptible, it is alleged.

India: UNICEF praises Uttar Pradesh campaign against Japanese encephalitis

Via The Financial Express: 'Big shout out to Uttar Pradesh government', UNICEF lauds CM Adityanath's DASTAK campaign against Japanese Encephalitis. Excerpt:

In a big achievement for the Yogi Adityanath, the United Nations Children Emergency Fund (UNICEF) India has lauded his government in Uttar Pradesh for successfully immunising all children of the state against Japanese Encephalitis and Acute Encephalitis Syndrome. UNICEF took to Twitter to praise the UP government. 

“A big shout out to #UttarPradesh for immunizing every child in the state against Japanese Encephalitis and Acute Encephalitis Syndrome under the #Dastak campaign! ??#VaccinesWork for #DimagiBukharSeJung,” UNICEF tweeted.   

Chief minister Yogi Adityanath had launched ‘Dastak campaign’ in the 38 affected districts of Uttar Pradesh. DASTAK campaign is part of the comprehensive Social and Behaviour Change Communication (SBCC) strategy embraced by state government to beat encephalitis. 

As part of the campaign, the whole state machinery with help of UNICEF went door to door in 38 JES (Japanese Encephalitis) and AE (Acute Encephalitis syndrome) affected districts, mostly falling in the Tarai region of the state which contributes to about 60% of total AES cases all over the country. State departments including health, rural development, primary education work together to spread awareness about the disease through mass media, initiate sanitation drive and ensure timely vaccination. 

On April 2, Chief Minister Yogi Adityanath had flagged off a programme in Pipraich to eradicate Japanese Encephalitis. The programme, which included vaccination drive against Encephalitis and cleanliness drive, concluded on April 16. 

Yogi Adityanath had said that Eastern Uttar Pradesh and 38 districts are majorly affected from Encephalitis, and hence the government will conduct vaccination drive against Japanese Encephalitis, and cleanliness drive and provision of pure water for prevention from acute encephalitis syndrome.  

Under the programme, adequate medical care was ensured, along with imparting training to paramedical staff and paediatrics. Yogi Adityanath had then said that the programme will be successful in eradicating Encephalitis from the state, and especially the 38 districts.

India: Gorakhpur doctors want encephalitis in school curriculum

Via The Indian Express: Gorakhpur docs want encephalitis in school curriculum.

A group of doctors in the chief minister’s hometown of Gorakhpur has demanded the inclusion of encephalitis and its preventive measures in primary and secondary school curriculum. 

In August, Gorakhpur’s B R D Medical College hospital was in the news after many children died due to different medical reasons, including acute encephalitis syndrome (AES). 

“We began this campaign because AES has 30 per cent death rate, which is higher than any other disease in the region, especially eastern Uttar Pradesh. While dengue and other diseases have found place in the curriculum, it is high time that encephalitis and its preventive measures were also included,” said Dr R N Singh, the Gorakhpur-based social activist and a doctor who has been raising the issue of preventive measures for encephalitis in the past as well. 

“AES can be prevented through basic measures like personal hygiene, keeping hair and hands clean, drinking clean water, keeping piggeries out of residential areas, among others,” he said. “These are more of a social issues rather than the medical ones and require participation from public.” 

Dr Singh said he had written to the chief minister’s office on the matter and also submitted a request on the “Jan Sunvayi” portal.

My daughter was not a number, cries a father of the forgotten Gorakhpur tragedy

Thanks to Ronan Kelly for sending the link to this Huffington Post report: My Daughter Was Not A Number, Cries A Father Of The Forgotten Gorakhpur Tragedy. Excerpt:

GORAKHPUR, Uttar Pradesh — Rihana Khatoon turned to her husband and said she loved the name Jasmine for their daughter. Mohammad Zahid preferred Khushi, the name he gave her when she was born.  

"He's just being stubborn," his wife said, "I thought Jasmine would be a lovely name for school." 

"I'm not being stubborn," Mohammad replied. "Khushi is the name that describes her best. It means joy."  

In the few minutes they had bickered on a warm and humid morning last week, the young couple spoke of their five-year-old daughter as if she were still alive. But it wasn't long before their eyes were heavy once again with the horror and grief they have carried since losing her on 11 August. 

It was the second day of the oxygen crisis that had erupted at the Baba Raghav Das Medical College in Gorakhpur in Uttar Pradesh. 

There are two images stuck in Rihana's head from that day. The first is of her husband using an Ambu bag to manually pump oxygen into their daughter's lungs. 

The second is of the unused diapers she had left on the hospital bed. 

Staring at the floor, she said, "When I asked a nurse to change her diaper, she said, 'What's the point? Your daughter is going to die anyway.' I told her, 'Please don't say that.' My daughter died soaked in her own urine."

As her voice trailed off, Mohammad waited a few minutes before saying, "I expect her to come around the corner, look into my pocket and say, 'Papa, where is my Five Star chocolate.' I always had one for her. She was my doll. When I went to work, she would wave at me until I turned the corner." 

The government hospital in Chief Minister Yogi Adityanath's constituency allegedly ran out of liquid oxygen on 10 and 11 August because hospital officials had delayed paying the supplier dues amounting to ₹70 lakh for over five months. At least 30 children died in 48 hours.  

Devastated parents narrated how they were given Ambu bags to manually pump oxygen into their ailing children for several hours. But even before any manner of investigation was under way, the CM had ruled out lack of oxygen as a possible cause of death in any single case, sealing the chances of an impartial future probe, at least by a state agency.  

Mohammad and Rihana were told that their daughter had encephalitis, an inflammation of the brain caused by several viruses, bacteria and parasites, which is a deadly killer in the marginalised communities of eastern UP. But they believe that it was the oxygen shortage that killed her. 

The first response of the state government was to cite death toll numbers from the previous years to prove that 30 deaths at the medical college were hardly unusual. While Health Minister Siddharth Nath Singh said it was normal for August to see a high number of fatalities in the encephalitis-prone region, Adityanath had blamed the deaths on the lack of cleanliness. 

The insensitivity cuts deep.  

"My daughter was not a number. If all they have to say is that it is normal for children to die in August, then what chance do the children of the poor have?" asked Mohammad. "Would they have dared say such a thing if the child of a minister or rich man had died? Would they want to hear something like that if it was their own children?"

Over 60 children die in a hospital in north India

Via The Lancet: Over 60 children die in a hospital in north India. Excerpt:

Although investigations are still ongoing to assess the chain of responsibility, the Gorakhpur tragedy exposes the malaise of India's health system. Dinesh C Sharma reports. 

About 60 critically ill children have died in the neonatal and encephalitis wards of the Baba Raghav Das (BRD) Medical College Hospital in Gorakhpur, Uttar Pradesh (UP), India, between Aug 10–11. The deaths were allegedly due to disruption in oxygen supply stopped by the supplier over unpaid bills. 

The medical education department of the UP Government has suspended Rajiv Mishra, the BRD Medical College Hospital's Principal, but denies that deaths occurred due to disruption in oxygen supply. Mishra and other officials of the hospital have been charged for negligence and corruption. Enquiries instituted by the central Ministry of Health and the UP Government, the contents of which are yet to be made public, have found that the deaths occurred due to illness, including sepsis and Japanese encephalitis. 

Amnesty International India has raised “serious discrepancies” in the findings of the investigations. A criminal complaint was also filed against the oxygen supplier. A fact-finding team deputed by the Indian Medical Association (IMA) found that “oxygen supply was interrupted for a short time on the night of August 10, as the liquid oxygen supplier had not been paid dues for the past six months”. 

In light of this, the IMA has concluded that it was a case of administrative negligence and not medical negligence. Clinical autopsies, which could reveal whether the deaths were linked to lack of oxygen, have not been conducted. 

A failing system  

“These tragic deaths…reflect on the state of India's public health system, and are an urgent wake up call to evaluate the functioning of public health facilities everywhere in the country”, said Asmita Basu, Programmes Director of Amnesty International India. 

Critically-ill children are often refered to the BRD Medical College Hospital which is in a region endemic for acute encephalitis syndrome and Japanese encephalitis. The government-run facility often experiences a high burden of patients. Poonam Muttreja, Executive Director of the Population Foundation of India, New Delhi, told The Lancet that this can be traced back to the tendency of “private hospitals, in spite of having comparatively better facilities, not [taking] responsibility of children at acute stage, since they fear loss of reputation in case deaths occur, and refer these children to government tertiary care centres”.  

“When sick children from poor families are admitted to an overcrowded hospital, requisite critical care is not assured in constancy or quality”, K Srinath Reddy, President of the Public Health Foundation of India, New Delhi, told The Lancet. “On top of this chronic problem of suboptimal care, an interruption of oxygen supply may have reversed recovery and hastened death in some children.” 

“Since these children were very sick to begin with, it is difficult to assign oxygen shortage as the precipitating cause of death but a contributory role cannot be ruled out”, he added.

Can India stop its children from dying?

The New York Times takes note of encephalitis in Gorakhpur and much else: Can India Stop Its Children From Dying? Excerpt:

Bengaluru, India — Two children younger than 5 die every minute in India. Even by India’s easy acceptance of child mortality, the death of 70 children within five days at a hospital in the northern city of Gorakhpur was hard to accept. 

A majority of the children who died had been struck by Japanese encephalitis, a mosquito-borne, potentially fatal viral brain infection that periodically ravages the Indian state of Uttar Pradesh. But the immediate reason for at least half the deaths appeared to be the cessation of piped oxygen into the intensive care ward. Japanese encephalitis has no known cure, and as it progresses, patients require oxygen to survive. 

Despite 11 reminders over six months, the Uttar Pradesh government did not pay the company that supplied oxygen to the Baba Raghav Das Medical College hospital. The company acknowledged it had threatened to stop supplies but denied it had actually done so. The state administration, with its own role in question, vaguely promised “stringent action against the guilty.” 

In a country chronically short of medical facilities, the Baba Raghav Das hospital is the largest and most important referral hospital in a poor, populous region, serving a population of more than 50 million in hundreds of nearby towns and villages. Stunned parents — carpenters, construction workers, security guards, homemakers and others from poor families — streamed out of the hospital with the bodies of their dead children.  

Many said the police had removed them from the hospital after their children died. Some who sought autopsies were told to bring masks and gloves for coroners, suggesting the breadth and depth of the state’s health care crisis.

Gorakhpur, a city of nearly 700,000, is home to Yogi Adityanath, a controversial monk and Hindu nationalist politician who was chosen by Prime Minister Narendra Modi to be chief minister of this, India’s most populous state, in March. Mr. Adityanath, who has a penchant for hate speech against Muslims and faces accusations of rioting and attempted murder, has politically dominated Gorakhpur and the adjacent region and represented it in the Indian parliament from 1998 to 2014.  

Although disregard for human life is common in India, the images of dead children from the Gorakhpur hospital were followed by intense criticism. “This is not just a tragedy, it is a massacre,” Kailash Satyarthi, an Indian Nobel laureate, tweeted.

Indian politicians are expected to look after their home constituencies, but Mr. Adityanath defended his record and dismissed allegations that his government was criminally negligent at worst and incompetent at best. One reason for the deaths, he said, is that “we do not lead a clean and hygienic life.”

Several leaders from India’s ruling Bharatiya Janata Party played down the tragedy. Amit Shah, the powerful B.J.P. president and Mr. Modi’s confidante, said, “In such a big country, many incidents happen; this isn’t the first time an incident like this has happened.” 

Irrespective of the local government’s political ideologies, Gorakhpur and Uttar Pradesh have repeatedly witnessed mass death from disease, grim reminders of the state of its public-health system. The Baba Raghav Das hospital’s records reveal that 3,000 children have died within its walls since 2012.