Doctors claim that the deaths, due to Acute Encephalitis Syndrome (AES), are being caused due to excessive heat and humidity. Locally, this fever is being called ‘Chamki’.

Bihar CM Nitish Kumar has announced an ex-gratia of Rs 4 Lakh each to families of the children who died due to Acute Encephalitis Syndrome (AES) in Muzaffarpur. He has also given directions to health department, district administration and the doctors to take necessary measures to fight the disease.

The State government has announced that it will open a new 100-bed ward for children, and six additional ambulances would be deployed for the government-run Sri Krishna Medical College and Hospital (SKMCH).

Earlier on Wednesday, a four-member team of doctors, led by Dr. Arun Sinha, visited the SKMCH, where children with symptoms of AES have been admitted. The team then issued guidelines and suggestions to local medical experts and doctors.

Though the State government had previously said the cause of death of small children, mostly from poor families, was hypoglycemia, or low blood sugar levels, experts and private doctors in Muzaffarpur told The Hindu that “AES is a broader aspect of hypoglycemia”.

Meanwhile, sick children with symptoms of AES continue to be admitted into the two crammed Pediatric Intensive Care Units (PICU) at SKMCH.
A separate makeshift ward, too, is full with children suffering from AES symptoms.

A statement from district authorities said nine children at SKMCH and five in Kejriwal hospital were in critical condition.

“Doctors and nurses are doing round-the-clock duty to monitor the situation. Some of the children have also been discharged from the hospital, after getting well,” said

SKMCH Principal Dr. Sunil Kumar Shahi said, “We have an in-patient bed strength of only 610, whereas the number of patients admitted is around 876. But we are managing to provide treatment to all of them.”

Union Minister of State for Home Nityanand Rai on Saturday visited the Sri Krishna Medical College Hospital in Muzaffarpur and took stock of the situation. He also met the family members of the children who are undergoing treatment and assured of all central and state assistance.

“The entire state is in a state of shock over the death of innocent children. We are with the family members of the affected and ready to provide any kind of assistance”, Nityanand Rai said.

Experts are of the opinion that unless and until rainfall takes place, the situation will only aggravate in days to come.

Union Health Minister Harsh Vardhan will visit Bihar’s Muzaffarpur on Sunday to take stock of the situation there in view of rising cases of Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE) there.

During his visit, the minister will interact with the multi-disciplinary teams deployed there and address a state-level review meeting.

Harsh Vardhan said that the health ministry is constantly monitoring the situation and supporting the state health authorities in managing the AES/JE cases.

Courtesy: Counter Current

The post Scores of Children Die of Acute Encephalitis Syndrome in Bihar appeared first on SabrangIndia.

Five children put at Neonatal warmers at BRD Medical College in August 2017, the middle neonate has passed away (Photo – TwoCircles.net)
 

However, the reason behind Adityanath’s strange claim lies in the data released by the National Vector Borne Disease Control Programme (NVBDCP). In the data released earlier this month, NVBDCP miraculously reduced the number of deaths until the end of the August.
Until the end of July, NVBDCP reported that the total number of deaths because of Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE) were 124. Out of this, AES accounted for 118 deaths while JE was responsible for 6 deaths. But when data was released in September, which also included the total number of deaths until the end of August, the total number was strangely reduced to 113. Out of this number, 110 deaths were because of AES while only 3 deaths were said to have been due to JE.

NVBDCP September

NVBDCP has reported that until July 31, UP had 1,299 cases of AES out of which 118 lost their lives. The number of cases pertaining to JE was 75, out of which 6 patients lost their lives. But until August, NVBDCP reported, that UP had 1,545 cases of AES out of which 110 people lost their lives, and 3 patients died out of 90 cases of JE.

The data released by NVBDCP shows that the total deaths this year by August compared to the figures released in July. Even simple calculations prove that the authorities have been playing with the death data and it is possible that such manipulated numbers are the basis of the claims made by Yogi Adityanath and several other politicians.

NVBDCP Augut

In August, we released a detailed investigation explaining why and how Baba Raghav Das Medical College, Gorakhpur had stopped providing death figures to anyone in the state. We also reported that detailed death numbers—which were being issued every day until October last year—were handed out to one or two persons, including chief medical officer (CMO) Gorakhpur, in sealed envelopes.

If only the numbers from BRD Medical College would be taken into account, 89 children lost their lives because of encephalitis until the end of July. The number, revealed by our sources at the medical college, was confirmed by CMO Gorakhpur in a detailed meeting last month.
So if only at BRD Medical College 89 deaths were recorded due to encephalitis, there is very less possibility that the whole state would have seen only 118 deaths. What remains unanswered is how the total number of deaths actually decreased in August versus July, making the official report look dubious and faulty.

Gorakhpur has been fighting the outbreak of encephalitis for the past several years. After last year’s August tragedy in which a few dozen children lost their lives because of a critical shortage of oxygen, BRD Medical College has indeed learned some lessons.

The hospital has created a couple of big wards with an increase of around 200 beds. Ganesh Kumar, the Medical College Principal, who is upset with media because of “negative reporting”, claims that the hospital has managed the load so well that the staff is free most of the time. However, many doctors refuted this by saying that authorities still have to do many things to ensure life for children.

We also reported that BRD Medical College was actually not reporting the cases of Japanese Encephalitis to ensure that there would be lesser patients of encephalitis in the records.

In our prolonged reports and investigations, we have managed to produce the number of dead children only, but the death number released by NVBDCP comprise deaths occurred in every age group. So if the number of dead children is 89 at just BRD Medical College, how is the cumulative death number only around 110 for the state?

A senior paediatrician at Lucknow’s King George Medical College told TwoCircles.net, “The numbers are indeed misleading. If around 90 children died at Gorakhpur medical college only, how is it possible that only 28 deaths occurred in rest of the state?”

He further said, “It clearly shows that central government is suggesting the state authorities in Uttar Pradesh to basically lie about deaths of innocent children.”

When TwoCircles.net reached out for comments over the misleading numbers, this correspondent did not get any reply from regional centres and officers of NVBDCP.

Courtesy: Two Circles
 

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Photo Courtesy: Greeshma Aruna Rai

Firstly, 32 children have been confirmed to have died due to JE. This by itself is cause for concern and requires all the necessary action by the Odisha government. The government is only now waking up to training health professionals to carry out immunization. Why was there so much of a gap in response. It shows that the government has not responded in a timely fashion and is now getting out of a difficult situation by hiring experts who minimize the role of  JE and therefore the role of the government, which increasingly the burden of responsibility on the community. Safe and effective vaccines are available to prevent JE. WHO recommends that JE vaccination be integrated into national immunization schedules in all areas where JE disease is recognized as a public health issue. Why has the government of Odisha not done this even if, by their own estimates 32 children had died of JE.

Of those who survive JE infection, 20%–30% suffer permanent intellectual, behavioral or neurological problems such as paralysis, recurrent seizures or the inability to speak. This requires urgent action by the government even if there are one or two confirmed cases. Instead the government did nothing, allowed many more deaths to occur and then brought in an expert committee which then went on to make the community the violator rather than the government. This is like adding fuel to the fire.

The expert committee makes no mention of how they went about ruling out JE. Did they do IgM Elisa tests on all the children? If yes, what were the findings? And if no, it only points to how delayed government response has been.

Surveillance of the disease is mostly syndromic for acute encephalitis. Confirmatory laboratory testing is often conducted in dedicated sentinel sites, and efforts are undertaken to expand laboratory-based surveillance. Case-based surveillance is established in countries that effectively control JE through vaccination. Why was this not being done in this area??

Safe and effective JE vaccines are available to prevent disease. WHO recommends having strong JE prevention and control activities, including JE immunization in all regions where the disease is a recognized public health priority, along with strengthening surveillance and reporting mechanisms. Even if the number of JE-confirmed cases is low, vaccination should be considered where there is a suitable environment for JE virus transmission. There is little evidence to support a reduction in JE disease burden from interventions other than the vaccination of humans. Following this recommendation by the WHO the government has taken no steps to ensure spread of the disease.

Since Odisha has been shown to have a rising occurrence of JE, all children should be considered to have had JE unless it has been actively ruled out. The expert committee makes no mention of how they went about ruling out JE. Did they do IgM Elisa tests on all the children? If yes, what were the findings? And if no, it only points to how delayed government response has been.

When John claims that ‘we found toxin in the urine samples of a few tested children’,  it is hardly the statement of a researcher. How can few then go on to mean that the toxin itself caused the issue? And how can this be extrapolated to all the other children.
Those children about whom it is claimed to have died due to encephalopathy caused due to consumption of seeds of Bana Chakundi, it is unlikely that a community will have continued to eat a food that causes such high mortality. Local knowledge would have identified if deaths due to this seed was high.

All communities who eat this seed are likely to have traces of it in the urine. The only way of confirming is to rule out JE completely which the expert panel doesn’t seem to have done. The traces of anthraquinone in the urine could be a confounding or an aggravating factor.

JE could affect the normal metabolism of this plant Bana Chakundi or aggravate the possible side effects. This plant is being eaten throughout the year and probably by all families. Why are the deaths happening now?

5 urine samples out of 121 children (unofficially the figure stands at more than 300 hundred)  who died is hardly evidence
Dr. Jacob John says that the children have eaten the raw seeds and somehow makes that as the cause of the deaths. From finding the toxin in 5 children to making claims that bada chakunda seeds are behind most deaths amounts to misrepresentation and twisting of facts.

Encephalopathy due to any cause will have close similarity. So when the report says that the acute encephalopathy in Malkangiri has close similarity with encephalopathy found in western UP, this doesn’t make sense because encephalopathy would have many similar findings even if due to a variety of causes.

The expert committee is premature at best and with a vested interest of placing the locus of attention on the community than on the government which should have responded with much more urgency and seriousness. The committee has recommend further investigation into relative contribution of JE and encephalopathy along with other causes that might affect the CNS. Without having the baseline data, this expert committee cannot make an absolute statement that some cases were due to diet induced encephalopathy and not as a result of JE.

The maximum that the expert committee can say is that confirmed deaths due to JE are 36 and five of the children who died had the toxin in their  urine which could or could not have contributed to the encephalopathy. It is important that all children with symptoms are tested for JE and also the government takes cognizance of the 36 deaths and take immediate and adequate response to prevent further JE deaths. Here the expert team seems to be attempting to underplay the role of JE in the deaths and surmise that toxin found in the urine of5 children automatically means that all the other deaths are due to the plant. How is this scientific and evidence based?

His simple suggestion for managing this crisis is that children and their parents have to be advised not to consume raw Chakundi beans. Where is his evidence for this? To expect a community to break a long tradition, without adequate evidence and basis amounts to abuse of expert position. The government somehow then becomes the benevolent guardian who has to educate the community. Why is the expert team not pushing the government to prevent cases of JE when 32 deaths have been confirmed due to the virus?
Why has this expert group not made any comment on the state of disarray and dysfunction of the anganwadis in the area?  Have they made any attempts to find out if these children have been receiving adequate foods?

Just because 64 deaths were JE negative doesn’t automatically mean that they were due to the toxin.
On this, the tribal leader has questioned the effect of consumption of these seeds. According to him, “The tribals very well know about the roots and seeds they eat. This food habit of the tribals finds its way back to hundreds of years back. Each and every member of the family eatsChakundi seeds, then how come they were not infected for so many years?”

About saying that malnourishment could have compounded the diseases, John says that it has to be verified. This is again a flippant attitude because there is enough evidence that with poor nutrition children have a lesser ability to fight disease that they would normally be capable of fighting. Why has this expert group not made any comment on the state of disarray and dysfunction of the anganwadis in the area?  Have they made any attempts to find out if these children have been receiving adequate foods? So on the one hand the expert committee wants to wave a wand to take away traditional foods of people while on the other hand the do not even critique that the state has abdicated its responsibility by not providing healthy hot and culturally relevant food to the children as clearly prescribed by the ICDS guidelines.

I completely agree with the tribal MLAs statement that the expert opinion is misleading. I would also add that it may be driven by an agenda. This agenda could be to show that the government had no role in this problem and to minimize the criticisms that have been thrown on the government. In this effort, the expert committee has far overstepped their role of being objective and following due diligence and instead seem to be more focused on giving a report that removes the responsibility from the government.
It is also important to check the credentials of these expert committees and positions that they have taken earlier. The expert committee report has been lapped up by the government and media which is going out of the way to take away the onus of responsibility from the government.

Most JEV infections are mild (fever and headache) or without apparent symptoms, but approximately 1 in 250 infections results in severe clinical illness. Severe disease is characterized by rapid onset of high fever, headache, neck stiffness, disorientation, coma, seizures, spastic paralysis and ultimately death. The case-fatality rate can be as high as 30% among those with disease symptoms. Fever will not occur due to a plant based encephalopathy is it is not infectious. Without correlating with any other clinical signs and symptoms or history, the expert team cannot take one finding of toxin the urine of just five children and then go on to make sweeping statements that the major cause is the plant.

Dr. Sylvia Karpagam is a Public health doctor who works with marginalised communities.

Courtesy: India Resists
 

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