Prelims cum Mains Social Issues

In one month, 28 children die of suspected encephalitis in Bihar’s Muzaffarpur district

The News

  • In what seems to be yet another epidemic outbreak, a number of districts in Bihar are witnessing a surge in the number of Acute Encephalitis Syndrome (AES) cases.

Context

  • Districts in North Bihar including Muzaffarpur, Vaishali, Sitamarhi, Samastipur, Sheohar, East and West Champaran are witnessing upsurge in the Acute Encephalitis Syndrome cases.
  • According to official estimates, more than 48 cases have been reported since January 2019. However, the number of actual cases are said to much higher.

 

In focus: Acute Encephalitis Syndrome outbreak in India

About AES

  • Introduction
    • Acute Encephalitis Syndrome is a spectrum of diseases classified based on similar clinical syndromes.
    • It is primarily a neurological condition characterized by sudden onset of fever and altered consciousness.
  • Symptoms
    • Symptoms include fever, abdominal pain, repeated vomiting, lethargy, seizures, loss of consciousness and even death.
    • Hypoglycemia is a common feature observed in more than 50% of the cases.
    • The fatality rate is extremely high. (10-35%)
  • Vulnerable group
    • Children in the age group 6 months – 15 years.
    • Majority of the cases occur in the age group within 10 years.
    • This is due to lack of cumulative immunity due to natural infection
  • Causes
    • The etiology of disease is still unknown.
    • It can be caused by different viruses, bacteria, fungus, parasites, spirochetes, toxins etc.
    • It is known to occur between March and June due to high temperature (42 degree C) and more than average humidity which are ideal conditions for the outbreak.
  • Depending on the nature of causes it can be divided into 2 groups – JE-causing AES and Non-JE AES.

 

JE-causing AES

Japanese Encephalitis Virus causes 11-15% of the acute encephalitis cases.

  • About Japanese Encephalitis
    • A mosquito borne viral disease.
    • It is a zoonotic disease.
    • Pigs and birds are the natural hosts.
    • It affects humans and horses.
    • The virus is transmitted by Culex Mosquitoes. (same in case of West Nile Fever)

 

Non-JE causes

  • Enterovirus (RNA virus)
  • These cases are reported in Gorakhpur in UP and Muzzafarpur in Bihar.
  • The enterovirus travels along the course of the River Sarayu (tributary of Gandak) from Gorakhpur to Muzzafarpur.
  • Toxins
  • A study in 2015 established a relationship between consumption of litchi and AES.
  • Exposure to a toxin in litchi (hypoglycin A and methylene cyclopropylglycine (MCPG).
  • Scrub typhus
  • A bacterial disease has been identified as a leading cause in a number of AES outbreaks in India.
  • Other causes
  • Measles
  • Fungal disease
  • Protozoan disease

 

Incidence in India

  • About 80% of the cases occur in Assam, Bihar, Karnataka, Tamil Nadu and Uttar Pradesh.
  • The worst AES outbreaks coincide with the Japanese Encephalitis outbreaks in 1973 (WB), 1978 (UP), Gorakhpur (UP) in 2005.
  • North Bihar has witnessed recurrent outbreaks in 2011, 2012, 2014, 2016, 2017 and 2019.
  • UP and Bihar has witnessed more than 44000 cases and 6000 deaths between 2008 and 2014 making it a public health challenge in India.

 

 

Strategy to arrest AES outbreaks

  • India has AES guidelines focusing on
  • Preventive
  • Management
  • Rehabilitation

Prevention

  • Vaccination
    • Since Japanese Encephalitis causes 15% of the AES cases, JE vaccination drive was introduce in 2006 following the 2005-outbreak.
    • In 2014 JE vaccine was included under the National immunization programme.
  • Improved sanitation
  • Improved nutrition
  • Water Traps
    • Construction of water traps in the course of Sarayu River to prevent spread of pathogens from Gorakhpur in UP to Muzzaffarpur in Bihar.
  • Awareness programme

Management of the symptoms

  • Administering dextrose to control hypoglycemia.
  • Anti-biotics, fever-management etc

 

 

Challenges

  • The major challenge is inability to identify a single cayse (aetiology)
  • In most of the cases the inability to isolate an infectious aetiological agent is the fundamental challenge to effective prevention and management.
  • Lack of research on aetiology, transmission, risk factors and environmental exposures makes the disease surveillance poor.
  • Poor levels of sanitation, nutrition, public health facilities etc aggravate the already high Case Fatality Rate of 10-35%.

 

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