From Gorakhpur to Muzaffarpur, a tale of rising death tolls and unprepared health systems

As the death toll of children dying from Acute Encephalitis Syndrome (AES) in Bihar’s Muzaffarpur crosses 100 in over two weeks, it brings back disconcerting memories from Gorakhpur, about two years ago.

Over 70 children had died in a matter of days at Uttar Pradesh’s Gorakhpur, a tragedy that raised questions involving the government hospital where it occurred, its doctors and the alleged short supply of oxygen cylinders.

Lack of preparedness

The two incidents are similar, as they reflect the State’s lack of preparedness to tackle seasonal encephalitis, say experts, urging health authorities to have standard operating procedures (SOP) that kick in before the worrisome months arrive.

And yet, Muzaffarpur’s outbreak is different, as it is not the classical infectious encephalitis that occurs in some States in the monsoon months, says V Ravi, Senior Professor and Head (Neurovirology), NIMHANS. Over the years, the mid-summer encephalitis outbreak in this region has been linked to a toxic ingredient in the lychee fruit coupled with low blood sugar in children.

AES may be caused by organisms (bacteria, virus), toxins etc and are treated/managed depending on the causative agent.

And though lychee has many good properties, problem arises when children have it on an empty stomach. “Children pick up fruits from the ground and bite the seed too that has the toxin. Schools are closed for summer, so children don’t get their midday meals. They end up going to sleep on an empty stomach. The toxin and low blood sugar are fatal for the child,” explains Ravi, who has about four decades of experience working on encephalitis cases and is presently wrapping up a five-year study on its prevalence in West Bengal, Uttar Pradesh and Assam. The study is funded by the United States Centres for Disease Control and Prevention. “It is dramatic, as the child slips into a coma and dies the next day,” he says.

When the lychee-link came to light, there was a campaign to alert parents. This resulted in no cases last year. However, communication failed this year, says Ravi. The authorities should have alerted parents in April on the lychee-linked encephalitis and told them to ensure their children had a meal before sleeping, he adds.

On the type of encephalitis that can be treated with doxycycline, he says, “It is gratifying to see a child close to death, get up and walk instead. It is most gratifying. But there is no paediatric syrup of this medicine.” He added that pharmaceutical companies don’t show interest as “encephalitis is the king of orphan diseases”.

Gagandeep Kang, Executive Director with the Translational Health Science and Technology Institute, underlines the need for an SOP in hospitals. There needs to be a good diagnostic setup to identify the cause and trained clinical staff to deliver quality care. Health administrators too need to have a preventive strategy, she added.

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