Syndrome mystery in viral fight - Jargon clouds hunt for cause, fever toll rises to 110 in north Bengal

Civic workers spray mosquito larvicidal oil and bleaching powder at Haiderpara in Siliguri on Wednesday.
 Picture by Kundan Yolmo

TT, July 23: Union health minister Harsh Vardhan today offered Bengal emergency consultations on the encephalitis outbreak in the state, but experts cautioned that India’s public health system has spent over five years fighting a mystery disease blindly and was poorly equipped to save lives.

Harsh Vardhan, in a letter to Bengal chief minister Mamata Banerjee, wrote that he would recommend “intensive and extensive” consultations between state and central officials on steps to be taken on an emergency basis and permanent measures to avoid future outbreaks.

Today, four persons died in North Bengal Medical College and Hospital, taking the death toll in north Bengal to 110. Japanese Encephalitis could be established in one of the four deaths. The rest have been categorised as deaths from Acute Encephalitis Syndrome (AES).

“This AES is an unhelpful terminology — it represents a basket of possibilities,” said Thekekkara Jacob John, a senior virologist formerly with the Christian Medical College, Vellore, who was invited by the Bihar government last year to investigate AES in the state and has recommended that the term should be abandoned.

Experts have come up with varied reasons for AES but no one has been able to pinpoint what are the causes for what is labelled as AES.

The symptoms associated with Acute Encephalitis Syndrome, or inflammation of sections of the brain, can happen because of a number of conditions — viral infections such as JE, or infections caused by enteroviruses, or bacterial infections, or typhoid.

The precise cause of the disease is important to prevent future outbreaks, public health experts said.

“We’re missing the elephant in the room — whatever be the cause, the high mortality is unacceptable,” said Manish Kakkar, a clinical microbiologist and faculty member at the Public Health Foundation of India, New Delhi.

“Saving lives in encephalitis involves quick and efficient management of the brain inflammation and seizures,” Kakkar, who has studied how AES is managed in Uttar Pradesh and Bihar, told The Telegraph.

In north Bengal, the first stock-taking administrative meeting on the disease was held in Siliguri today, a pointer to how slow the administration has been in reacting to the outbreak.

District magistrate Puneet Yadav today said “the awareness drive across the district to apprise people about the viral disease would be intensified”. Simultaneously, fogging machines, used to spray the mosquito larvicidal oil, would be used in the Siliguri Municipal Corporation wards and also in neighbouring areas to prevent infection through mosquitoes.

Field observations by a Public Health Foundation of India team over the past year suggest that many patients are diagnosed late and have difficulty being admitted to hospitals. Late admission to hospitals is something doctors in North Bengal Medical College and Hospital (NBMCH) have also cited as a reason for the rapidly climbing death count.

Kakkar said doctors and paediatricians who manage encephalitis also do not always follow standard treatment protocol.

According to Amerendranath Sarkar, the NBMCH superintendent, around 25 children have been admitted with acute encephalitis syndrome in the past month and five have tested positive for JE.

“So far, eight children have died, of whom seven had acute encephalitis syndrome and one had tested positive for Japanese Encephalitis. Most of the patients affected by Japanese Encephalitis are adults. At present, 42 patients are admitted at the hospital with symptoms of encephalitis and 10 of them are children,” Sarkar said.

He said most of the patients were from Jalpaiguri and Alipurduar districts — Dhupguri, Mainaguri, Falakata and some from the Dooars.

From Cooch Behar, patients have come from Mathabhanga, Sitalkuchi and Ghoksadanga. The cases from North Dinajpur are from Islampur, Chopra and Ramganj.