H5N1

Uttar Pradesh: NCDC in Firozabad to probe ‘viral’ deaths, WHO says ‘dengue haemorrhagic fever’

Via the Times of India: UP: NCDC in Firozabad to probe ‘viral’ deaths, WHO says ‘dengue haemorrhagic fever’. Excerpt:

AGRA/NOIDA: A five-member team of the National Centre for Disease Control (NCDC) sent by the Union health ministry is in Firozabad to investigate deaths of children after prolonged fever, dropping platelets, severe dehydration and bleeding of gums. 

The Firozabad DM and UP DG (health) said dengue haemorrhagic fever could be the cause while the UP medical education principal secretary said these are cases of dengue, leptospirosis and scrub typhus.  

With six more cases, the death toll in Firozabad, the epicentre of the viral disease, touched 71. Of them, 52 were children, local sources said. “The WHO has suggested dengue haemorrhagic fever (DHF) could be causing deaths,” Firozabad DM Chandra Vijay Singh told TOI.  

UP DG (health) Dr Ved Vrat Singh said, “The Centre has asked the NCDC team to investigate deaths due to viral fever and dengue-like symptoms in Firozabad. The team will also study the nature of vector-borne diseases spreading there.” He added, “Local authorities have been alerted about the spread of dengue haemorrhagic fever. It is a severe form of the disease.”

During a visit by UP chief secretary Rajendra Kumar Tiwari to Noida, officials said some samples had been tested. “We can say for sure that there are known causes and there is no mystery. We had sent samples to KGMU (King George’s Medical University), Lucknow that have confirmed dengue in several cases. It was a small outbreak of dengue and leptospirosis,” Alok Kumar, principal secretary of UP medical education, told TOI. Officials said 185 samples had been tested by the Indian Council for Medical Research (ICMR), of which 73 were positive for dengue, 47 for leptospirosis, 28 for scrub typhus and one for Japanese encephalitis.

At a meeting in Lucknow, CM Yogi Adityanath had asked Kumar to position himself in Firozabad and monitor the situation. Senior IAS officer Sudhir M Bobde has been appointed nodal officer for Firozabad district. Sources in Firozabad told TOI that an estimated 5,000 people in the district are bedridden with fever, at home and in hospitals.

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.

History of mosquitoborne diseases in the United States and implications for new pathogens

Via EID: Ahead of Print -History of Mosquitoborne Diseases in the United States and Implications for New Pathogens. The abstract:

The introduction and spread of West Nile virus and the recent introduction of chikungunya and Zika viruses into the Americas have raised concern about the potential for various tropical pathogens to become established in North America. A historical analysis of yellow fever and malaria incidences in the United States suggests that it is not merely a temperate climate that keeps these pathogens from becoming established. 

Instead, socioeconomic changes are the most likely explanation for why these pathogens essentially disappeared from the United States yet remain a problem in tropical areas. In contrast to these anthroponotic pathogens that require humans in their transmission cycle, zoonotic pathogens are only slightly affected by socioeconomic factors, which is why West Nile virus became established in North America. 

In light of increasing globalization, we need to be concerned about the introduction of pathogens such as Rift Valley fever, Japanese encephalitis, and Venezuelan equine encephalitis viruses.

India: Four infants die after taking Japanese encephalitis vaccine in Palamu

Via the Hindustan Times: Four infants die after taking Japanese encephalitis vaccine in Palamu. Excerpt:

Four infants have died since Saturday after being vaccinated for Japanese encephalitis and measles in Jharkhand’s Palamu district, one of the state’s most backward districts. Three of the victims died within eight hours of the vaccination on Saturday while five others are undergoing treatment at a government hospital.  

Nine children were administered vaccines at the local government health sub centre in Loinga village under the Patan community health centre in Palamu on Saturday.  

The district administration has ordered a high level probe into the deaths and a team from Ranchi was sent to find out the reason for the casualties in the village, almost 200 km northwest of the capital Ranchi.  

Villagers alleged within six to eight hours after vaccination, the children fell seriously ill with high fever and bouts of vomiting while their eyes turned yellow. Their condition deteriorated so quickly that three of them died before anything could be done.  

Family members along with villagers blocked traffic for more than three hours near the village, 25 km from Daltonganj on Sunday.  

The irate villagers also briefly held the village auxiliary nurse midwife (ANM) Draupadi Pandey hostage , accusing her of being responsible for the tragedy. 

Three of the victims aged between one year to 18 months were identified as Ujjwal Kumar, son of Upendra Kumar; Sanju Kumari, daughter of Santosh Yadav and Aryan Kumar, son of Dhirendra Bhuiyan. 

The fourth child two-year-old Ayush Kumar died Sunday afternoon at Daltonganj Sadar Hospital. Another infant Prabhat Kumar was referred to RIMS, Ranchi for better treatment. 

Palamu deputy commissioner (DC) Ameet Kumar acknowledged the tragedy and assured the villagers of action against the guilty. “Nine children were vaccinated in the village yesterday. It was a routine vaccination for measles and other diseases. Three children have died while six others are admitted at Sadar Hospital. They are responding well to the treatment,” he said.

14 million Myanmar children to get nation-wide vaccination against Japanese encephalitis

Via Xinhua: 14 mln Myanmar children to get nation-wide vaccination against Japanese encephalitis.

About 14 million Myanmar children, aged from nine months to 15 years old, will soon to be vaccinated against Japanese encephalitis across the nation starting from Nov. 15, official Global New Light of Myanmar reported Sunday. 

Under the management of the Ministry of Health and Sports, the vaccination programs will be conducted into two different themes, school-based vaccination program which will be conducted from Nov. 15 to Nov. 23 and people-based vaccination program from Dec. 11 to Dec. 18, respectively. 

The school-based vaccination program will be conducted in designated local and international schools at different education levels as well as monastic education. 

Meanwhile, the people-based vaccination program will be conducted in hospitals, regional health centers and designated private homes. 

The authorities are also exerting efforts to reach every child in the country with vaccines under the program, especially in difficult-to-reach villages and border areas. 

Japanese Encephalitis virus is maintained in a cycle involving mosquitoes and vertebrate hosts, mainly pigs and wading birds. Humans can be infected when bitten by an infected mosquito. 

Some infected patients will develop neurological symptoms including tremors, seizures (especially among children), as well as mental status changes and movement disorders. 

Japanese Encephalitis can be fatal in 20 to 30 per cent of cases and most of survivors continue to have neurologic, cognitive or psychiatric symptoms.

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.

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.

India: Encephalitis still kills one in three children in Gorakhpur hospital

Via Hindustan Times: Encephalitis still kills one in three children in Gorakhpur hospital. Excerpt:

Uttar Pradesh chief minister Yogi Adityanath has ordered criminal action against hospital staff and the gas firm for 30 child deaths between August 9 and August 11. However, 15-18 children continue to die every day at the 950-bed Gorakhpur’s Baba Raghav Das (BRD) Medical College and Hospital. 

One third of these deaths are due to encephalitis.  

Japanese Encephalitis (JE) and the deadlier Acute Encephalitis Syndrome (AES) became the national buzzwords after 30 children died between August 9 and 11 in BRD Medical College, Gorakhpur’s largest government hospital, amid allegations that a private company contracted to supply oxygen cylinders cut supply over a payment dispute. 

A total of 97 of the 1,527 child deaths between July 1 and August 14 were from the mosquito-borne Japanese Encephalitis and AES, which is caused by other toxins, viruses and bacteria, among others. 

JE and AES deaths continue to account for roughly two-thirds of child deaths from all causes. 

Encephalitis is the swelling in the brain that leads to sudden high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and, finally, death. 

From January 1 till August 22, the hospital recorded 625 AES admissions, of which 158 children died. More than 30% of the cases and deaths were reported during July and till mid August.  

Of the 2,729 child deaths from all causes in 2016, close to 45% (1,218) occurred when monsoon peaks between July and October. 

On August 14, 24 deaths occurred within a single day, when there were no disruptions of any kind. 

“On an average, there are between 10 and 20 deaths each day at this time of the year. AES has got very high mortality rate of around 30% and since this is a referral hospital, all the infants admitted in the neonatal wards are brought in when they are critical,” said a senior administrative official, requesting anonymity.

Uttar Pradesh: Ritual of announcements fails to check encephalitis deaths

Via the Hindustan Times: Uttar Pradesh: Ritual of announcements fails to check deaths. Excerpt:

Announcement of projects and schemes has become a ritual for successive governments even as children have kept falling prey to Japanese Encephalitis (JE) and Acute Encephalitis Syndrome (AES) in Gorakhpur and the adjoining districts for four decades. 

The death of over 30 children in 48 hours last week shows that the BRD Medical College hospital still lacks basic infrastructure despite announcements that the central and state governments have made from time to time about providing better facilities. 

Adding to the list, union health minister JP Nadda on Sunday declared that central government had sanctioned Rs 85 crore [US$13.256 million] for establishment of the National Virology Research Centre in Gorakhpur.  

In 2004, the then Union health minister Anbumani Ramadoss visited Gorakhpur and announced establishment of a research centre and a separate block for treatment of encephalitis patients. The research centre is yet to see the light of the day. 

When the Bahujan Samaj Party (BSP) was voted to power in 2007, the then chief minister Mayawati announced the BRD Medical College would be upgraded to a centre of excellence for treatment of encephalitis patients. But the project failed to take off. 

The then union health minister Ghulam Nabi Azad visited Gorakhpur in 2011 and announced establishment of a super-specialty hospital, rehabilitation centre and para medical staff training centre in the district. The project remained limited to paper.  

After the SP formed the government in 2012, the then chief minister Akhilesh Yadav visited Gorakhpur in October and announced establishment of a 500-bed hospital for the encephalitis patients. Though five years have gone by, construction of the hospital is yet to be completed. 

Dr KP Kushwaha, former principal of BRD Medical College, told HT,“In 1978, a report by the Indian Council for Medical Research said the mysterious virus that was killing children in Gorakhpur and its adjoining districts was Japanese Encephalitis (JE). But it took the central and state governments over two decades to realise that hundreds of children were dying due to lack of proper health facilities.”  

In 2004, the then chief minister Mulayam Singh Yadav released Rs 93 lakh [US$145,000] for establishment of oxygen pipeline in wards and purchase of ventilators at BRD Medical College. In 2005, the central government decided to launch a vaccination drive in districts infested with JE virus. But no concrete measures were taken to improve facilities for patients, he said.  

Kushwaha said the Allahabad high court in 2006 directed the state government to increase the number of beds for encephalitis patients in wards, set up intensive care units, a rehabilitation centre and research centre.  

In 2007, the state government set up two wards. In 2009 a unit of National Institute of Virology (NIV), Pune was set up in BRD Medical College to conduct research on patients. 

In 2011, the high court again directed the state government to set up an expert committee and improve facilities for encephalitis patients. The state government released Rs 11 crore [US$1.75 million] for upgradation of 100 bed encephalitis wards, he said.  

Kushwaha called for establishment of a separate authority for the treatment of the encephalitis as was the case in Thailand, Taiwan and Singapore that have successfully controlled the outbreak of the disease. 

Rather than working in an ad-hoc manner, the state government should set up sustainable infrastructure for the working of the authority, he said.