H5N1

India: Six children with encephalitis in Bihar

Via News19.com, a Bihari news source, a May 21 report: Deadly brain fever makes a comeback in Muzaffarpur, 6 kids test positive.

As the climate takes a turn again, the deadly brain fever (Acute Encephalitis Syndrome) has started taking small kids in its clutches. The disease is prevalent since the past many years in Muzaffarpur and other parts of Bihar. 

The disease has taken one life till yet. Sheela, a four-year-old kid succumbed to AES in Muzaffarpur on Wednesday. 

According to reports, 6 kids have been found positive for this disease till now in the state. 4 among them have been sent home after being properly treated. 

The medical department of the state has started awareness campaign in the villages from where the kids have been tested positive.

India: Encephalitis claims first victim in Bihar this year

Via Zeenews, bad news: Encephalitis claims first victim in Bihar this year.

Patna: A child has died due to the deadly mosquito-borne disease Acute Encephalitis Syndrome (AES) in Bihar's Muzaffarpur district - the first in the state this year, an official said on Saturday. 

"So far one child has died at the Sri Krishna Medical College and Hospital due to AES in the district," said Muzaffarpur civil surgeon Gayan Bhusan. 

According to him, three children have been admitted in the hospital with AES symptoms. 

The AES is a severe case of encephalitis characterised by inflammation of the brain. Mosquitoes transmit the infection causing high fever among children. 

"Every year, encephalitis hits Muzaffarpur and other neighbouring districts in May or June. But this year it seems to have hit a little early," a health department official here said. 

In the last few years, hundreds of children have died due to this disease, mainly in Muzaffarpur and Gaya districts.

India: Acute encephalitis syndrome in Bihar

Via NewKerala.com: Acute Encephalitis Syndrome: Paralyzing fear in Bihar. Excerpt:

Officials have been preparing [for Ebola] for months, installing screening systems at international airports and preparing quarantine sites in major cities. The commitment towards public health is indeed commendable. 

On the other hand, such commitment is clearly missing when it comes to fighting the deadly Acute Encephalitis Syndrome (AES) that has, for the last two decades, been wreaking havoc in several districts of the eastern Indian State of Bihar, like Muzaffarpur, East Champaran, Sitamarhi, Shivhar, Samastipur, Vaishali, and Begusarai. 

In 1995, Kothiya Village in Kanti Block of Muzaffarpur District in Bihar came into the headlines when over 125 children died undiagnosed in Kaanti and Minapur blocks. Jaleshwari Devi's ten-year old daughter was the first victim of this epidemic. In the last twenty years, several hundred mothers have lost their children to this disease now familiar to the residents of various villages in Muzaffarpur as Acute Encephalitis Syndrome (AES). 

This epidemic attains a peak every year in May-June in almost 236 villages of Muzaffarpur, killing innocent children; it disappears in the monsoons, only to surface again the following year. In 1996, almost 1000 children suffered from AES, of which 350 lost their lives. In 2012, once again almost 184 children died an untimely death. In 2014, almost 800 children suffered from AES, with nearly 150 dead. Despite several researchers trying to solve the mystery behind it, the reasons still remain unknown. 

Last year, samples were said to be sent for testing to California but no progress has been reported so far. A vaccination campaign was also run in the affected areas but the last visit of the former Union Health Minister Dr. Harsh Vardhan to Kothiya village unveiled a different reality - he said that 92 percent children have not been vaccinated against this disease. Then on 22-23 June, a special vaccination campaign was organized and 43,269 children were vaccinated. 

Jeetan Ram Manjhi, the first chief minister to visit this area after 1996, was reportedly infuriated to see the pathetic condition of health infrastructure in these areas, and demanded to know what role the Health Departments had been playing. There is no neurologist; hospitals lack MRI testing facilities; there is no proper arrangement for ambulances to take the referred cases to city hospitals. Dasai Paswan could not get an ambulance to bring home the body of his 10 year old son who lay on the ground for hours. Tragically, this disease is affecting only poor children - the ones struggling against malnutrition and poverty. 

The malnutrition eradication programmes being run by UNICEF and the State Government have also failed to produce effective results. As per the former Union minister and a doctor by profession, Dr. CP Thakur, "Malnutrition is the most common factor amongst Encephalitis patients, besides poor vaccination and poor standards of living."

Acute encephalitis syndrome outbreaks in India – an ongoing puzzle

This is an article I've been waiting years for. Via the University of New South Wales School of Public Health and Community Medicine, an article by Ronan Kelly of FluTrackers: Acute Encephalitis Syndrome Outbreaks in India – an ongoing puzzle.Excerpt:

Between Jan 1, 2008 and Aug 27, 2014; 44,097 cases and 5,728 deaths were reported due to AES in India. This figure represents a significant increase in the recent annual number of reported cases even as the CFR has dropped to around 13%. An average of 8,139 cases per year have been reported for 2011-2013 an increase of 220% over the period 2003-2007.(8,9) This is likely an underestimate. 

Government statistics do not generally include cases that never make it to hospital, and AES outbreaks predominantly affect rural communities with poor access to healthcare who are less likely to be notified as AES cases. Much of the recent increase is accounted for by a surge in reported cases in Assam (cases tripled in 2011 and stayed at that level ever since) and West Bengal (cases jumped sevenfold in 2011 and doubled again since then). 

Nationally, since 2008, only 6,825 (15.5%) patients tested positive for JE. In many cases, the causative agent remains elusive.  

The State of Uttar Pradesh has experienced periodic AES outbreaks since 1978, but following a major outbreak in 2006, the annual case load has exceeded 3,000 patients, three times the level prior to that year.(10) The State has accounted for almost half (over 20,000) of cases and 3,560 deaths since 2008. Only 8.1% of the cases have been confirmed for JE and the State has annually hosted a variety of investigative teams. 

In recent years, various enteroviruses such as EV-76, EV-89 as well as coxsackievirus B5 and echovirus 19 have been found associated with AES cases.(11,12)  It has been suggested that shallow wells pumping up contaminated drinking water are a major problem. 

However, making any conclusions about what is causing AES outbreaks in Uttar Pradesh is hampered by poor patient record systems. A study from Kushinagar in 2011-2012 found that record keeping, test results and vaccination history were so poor that “inferences about the epidemiology and etiology of AES could not be made”.(13) 

One of the conclusions that can be drawn from the various studies in Uttar Pradesh is that the cause of AES outbreaks can vary from location to location. This is also true for the country at large. For example while outbreaks in Assam have consistently tested >35% positive for JE since 2008, Chandipura Virus has been implicated in outbreaks in Gujarat. West Nile Virus (WNV), as in Kerala in 2011, may also be playing a part.(14) 

But some outbreaks remain a mystery. One intriguing outbreak has drawn much attention. The State of Bihar has seen periodic outbreaks for over twenty years. Recent recurrent outbreaks centered on Muzaffarpur appear unusual. One such outbreak of unknown aetiology occurred in 2012. Rather than peaking in September as is usual for JE, on this occasion the peak happened in June. None of the 334 patients tested positive for JE and at least 118 (35.3%) of them died.(15) 

This year (2014), the outbreak lasted through June and early July and resulted in around 200 deaths. None tested positive for JE, Chandipura, Nipah or WNV. The victims were mostly children, mostly poor, mostly malnourished. 

The outbreak coincided with the litchi (lychee) picking season. One hypothesis is that a toxin in unripe litchis leads to hypoglycaemic syndrome in under nourished children causing symptoms that are being diagnosed as AES. (16) Others suggest that the outbreak is really a form of encephalopathy brought about by heatstroke. (17) In parallel with Uttar Pradesh, most cases got their drinking water from shallow hand pumps, but I am not aware of any enteroviruses being identified.(18) 

Investigations over the past two years have resulted in local treatment recommendations such as rapid assessment for and correction of hypoglycaemia. Preliminary study suggests that this may have reduced the mortality rate in Muzaffarpur this year down to 26%.

India: West Bengal's encephalitis death toll climbs to 254

Via Firstpost.com: West Bengal's encephalitis death toll climbs to 254. Excerpt:

Kolkata: The encephalitis outbreak in West Bengal this year has so far claimed 254 lives, an official said Tuesday claiming that the situation is now "under control". 

According to B.R. Satpathi, director of state health services, 254 Acute Encephalitis Syndrome (AES) deaths have been reported since January. Of these, 45 deaths were due to Japanese Encephalitis (JE). 

JE is a subset of AES caused by the mosquito-borne virus. Representational image. Agencies. 

The number of deaths this year due to AES in north Bengal is 169. 

Three suspected cases have been reported in the past two days. 

"The situation is under control now," Satpathi told IANS. 

Encephalitis is a disease that results in inflammation of the brain, affecting the patient's central nervous system. It can be caused due to bacterial or viral infections of the brain, injection of toxic substances or increased complications of an infectious disease.

India: Five more deaths in 24 hours take West Bengal encephalitis toll to 133

Via The Indian Express: Five more deaths in 24 hours takes encephalitis toll to 133. Excerpt:

The death of a two-year-old baby from Acute Encephalitis Syndrome in NRS medical college and hospital on Wednesday has set off the panic alarm as the disease, which is wreaking havoc in north Bengal over the past few weeks, now seems to be inching closer to the state capital. 

Pratik Roy, a two-year-old from Bansdroni area in south Kolkata, was admitted to M R Bangur hospital, from where he was shifted to NRS medical college and hospital. 

Pitbaran Chakraborty, Superintendent of the hospital said: “The baby was clinically detected with AES by doctors of M R Bangur hospital. However, we are yet to confirm whether he died of Japanese Encephalitis.” 

Significantly, the deceased kid’s father Pranab Roy is also admitted to SSKM hospital with high fever and convulsions, said a member of the family. 

Meanwhile, the death toll due to Encephalitis climbed to 133 with five more deaths reported from north Bengal on Wednesday, sources in the state health department said. Director, health services, Dr B Sathpathy said the disease has so far claimed 84 lives in North Bengal Medical College and Hospital. The remaining deaths have appeared in other districts of north Bengal. 

Health officials also confirmed that four deaths, whose cause was not known earlier, had been caused by AES. 

Among the five deaths reported in last 24 hours, two patients were from Jalpaiguri and worked in tea gardens. The rest were from Siliguri. 

North Bengal Medical College and Hospital is currently flooded with Encephalitis cases. According to sources in the health department, the healing hub has the capacity to accommodate around 600 beds, while at present at least 1200 patients detected with AES are admitted there. Acute crisis of infrastructure and staff crunch have made the crisis more severe.

India: 305 encephalitis deaths in Assam

Via The New Indian Express, a PTI report: 305 Encephalitis Deaths in Assam; CM Asks to Check the Disease.

Chief Minister Tarun Gogoi today directed the Health department to take all possible measures to check the spread of Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE), which have jointly claimed 305 lives in Assam this year. 

The Chief Minister directed the Health Minister, Chief Secretary and Health department officials to take all necessary measures for speedy control of Encephalitis and provide necessary medical treatment to the people affected with vector-borne disease, officials said. 

Gogoi also directed Principal Health Secretary to provide medicines and vaccinations against the disease and procure the necessary amount of medicines from outside the state. 

The vector-borne AES has claimed 212 lives while Japanese Encephalitis 93 in Assam this year, a senior Health Department official said. 

The total number of people suffering from AES was 1,286, including 488 by JE, Joint Director Health Services-Malaria Dr B K Barua told PTI. 

After the doubtful patients tested positive through the Elisa Test, they were declared as AES affected, he said. Meanwhile, fogging was on in the vulnerable areas of the 24 of the 27 districts of the state affected by the killer disease, health department officials said. 

The worst hit districts in Lower Assam were Sonitpur, Barpeta, Nalbari, Darrang, Kamrup (Rural) and Kamrup (Metro), while in the Upper Assam Tinsukia, North Lakhimpur, Jorhat, Dibrugarh, Dhemaji and Golaghat, they said. 

Meanwhile, a case of suspected encephalitis was reported from the state capital, Kolkata. 

A four-year-old child was admitted in a very serious condition at the Calcutta National Medical College during the day and he died within a few hours. 

"Clinically it seems to be a case of encephalitis as of now. But we cannot confirm this till full investigation is done," hospital's superintendent Prof Pit Baran Chakraborty told PTI.

India: Encephalitis toll 117, govt cracks down on piggeries

Via The Indian Express: Encephalitis toll 117, govt cracks down on piggeries. Excerpt:

With six more deaths reported in the last 24 hours in North Bengal, the toll in encephalitis outbreak reached 117 Saturday. Minister of state for health Chandrima Bhattacharya claimed the “situation is under control” now even as the state government has begun a drive to close down unhygienic piggeries. 

Bhattacharya reached north Bengal Saturday on the directions of Chief Minister Mamata Banerjee to assess the severity of the crisis and supervise hospitals in districts dealing with encephalitis cases. 

The Chief Minister Friday suspended three chief medical officers of health for their alleged delay in response to the encephalitis outbreak. 

Bhattacharya Saturday also held a meeting with North Bengal Development Minister Gautam Deb and senior health officials. 

She later said, “The situation is under control now. We have directed health officials to keep the blood test centres open 24 hours. We are also trying to distribute medicated mosquito nets in the affected areas.” 

She added the government would request the Centre to set up two encephalitis treatment centres in Coochbehar and Jalpaiguri. 

Meanwhile, the state health department Friday identified 500 piggeries in Jalpaiguri and Darjeeling districts that would be closed down by the state animal husbandry department. 

Swapan Debnath, minister of state for animal husbandry, said, “We have so far identified 500 piggeries that are spreading the virus. We are shutting down these piggeries. We are buying livestock from the owners on government rates. Only those pigs which are carrying the virus would be purchased and would be treated in government farms. Once the crisis will be over, we will return those pigs to its owners free of cost.” 

The drive to close down “unhygienic” piggeries would continue.

It's not clear how they know not only that pigs spread encephalitis, but which specific pigs. Are they testing all the animals in 500 pig farms?

India: North Bengal encephalitis toll 111, CM suspends three health officials

Via The Indian Express: Encephalitis toll 111, CM suspends 3 health officials.

As the toll in cases related to encephalitis in north Bengal rose to 111 with three more deaths reported Friday, Chief Minister Mamata Banerjee suspended three senior health officials citing “dereliction of duty” on their part. 

She said the government was kept in dark about the actual situation in north Bengal, which is why there has been a delay in measures to control the disease.

“The health department did not inform us in advance. We have acted fast after we received reports of deaths due to encephalitis. We are doing our best despite shortage of staff. We have suspended district health officials. The state government has cancelled the leaves of all health officials working in the region,” the Chief Minister said. 

Those suspended Friday are Chief Medical Officers of Darjeeling and Jalpaiguri districts and the superintendent of North Bengal Medical College and Hospital (NBMCH). 

Mamata has further directed Minister of State for Health Chandrima Bhattacharya to visit hospitals in north Bengal and assess the situation. She has also ordered Director of Medical Education Sushanta Ranjan Banerjee to camp in north Bengal for the next 72 hours. 

The Chief Minister, who also holds health portfolio, said she will leave for north Bengal today along with the director of medical education. Mamata also announced immediate drive to monitor unhygienic pig farms responsible for breeding mosquitoes that cause the disease. 

Sources in the health department said investigation to determine encephalitis infection could not be conducted earlier at NBMCH — a revelation that made Mamata angry. 

Director, State Health Services, Dr B Satpathy said, “We are procuring kits for conducting tests for Japanese Encephalitis from Pune. In the  last 24 hours, we have lost three patients while two deaths were reported from NBMCH and one death has been reported from Coochbehar.” 

Government procures Japanese Encephalitis kits from National Institute of Virology in Pune. One test kit costs Rs 15,000 [US$250] from which 96 samples can be tested. The test is expensive, however, at present, the NBMCH is conducting tests free, said a health official. 

India: In Jalpaiguri, little government help for encephalitis zones

Via NDTV: In Jalpaiguri, Negligible Government Help for Villagers in Encephalitis Zones. Excerpt:

Jalpaiguri:  An outbreak of Japanese encephalitis and suspected encephalitis in North Bengal has claimed over 100 lives in seven districts, with the majority deaths coming in the last fortnight. The government has said it has stepped up measures to control the spread of the disease. 

 But settlements like the Haricharan Bihta village in North Bengal's Jalpaiguri district are examples of how the government's measures to tackle encephalitis may not be working. A lot of these people for instance prefer going to private doctors as they say government doctors are mostly unavailable at primary health care centres. 

 14-year-old Farooq Hussain has high fever for the last 10 days that has not gone away. His grandfather Fazlur Rehman died of Encephalitis just a few days ago and yet Farooq and the elders at the village say they prefer taking affected people here to private clinics. 

 "The doctors at government facilities are mostly absent. They are never around," Farooq said. 

While a lot of this may also have to do with ignorance and a distrust of the government system, villagers also point out that nothing has been done in the area to spread awareness. No one here, for instance, has heard of the government's latest initiative called fever clinics, proposed to be set up in encephalitis affected areas across North Bengal. 

As many as 15 people in just this village had symptoms of encephalitis when we visited. 

At the healthcare centre closest to the village, and the entire Binaguri panchayat , there are no doctors, and is currently manned by a single nurse under the National Rural Healthcare mission, who mostly takes care of pregnancies, and was on duty when we visited.  

Swarnali Dasgupta, the auxillary nurse in charge, tells us, "If people come here with symptoms of encephalitis, we give medicines for three days. If that doesn't work we do a blood test and refer people to a bigger hospital."  

On this subject, Deutsche Welle has a good background article on India's encephalitis outbreak: the key facts.