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Posted at: Jun 19, 2019, 6:46 PM; last updated: Jun 19, 2019, 7:55 PM (IST)

As AES deaths touch 113, health authorities puzzle over disease

SC to hear PIL on June 24
As AES deaths touch 113, health authorities puzzle over disease
Relatives of a child suffering from Acute Encephalitis Syndrome (AES) sit outside an intensive care unit as they wait to hear news of their condition at the government-run Sri Krishna Medical College and Hospital in Muzaffarpur district in the eastern state of Bihar on Wednesday. AFP photo

Tribune News Service
New Delhi, June 19
The increasing number of children’s deaths from brain fever in Bihar’s Muzaffarpur has left doctors puzzling over the nature of the ailment and led to a Public Interest Litigation in the Supreme Court for the Centre’s intervention. 
Some 113 children have already died from the latest outbreak of the disease. Bihar Health Department Principal Secretary Sanjay Kumar said here that of the total 113 deaths, 91 had died state-run Sri Krishna Medical College and Hospital (SKMCH), 16 in the private Kejriwal hospital both in Muzaffarpur, two in the Nalanda Medical College and Hospital in Patna, and 4 in other districts.
Some 501 cases of Acute Encephalitis Syndrome (AES) have been reported in the state so far this year. 
The ailment has caused a panicked scramble among health authorities. Doctors and health officials remain uncertain of the nature of the disease and the precise cause of deaths. This confusion has further complicated the process to combat or control the seasonal outbreak of AES, which has been recurring every year.
Bihar Chief Secretary Deepak Kumar has publicly admitted that even the government is unclear about what exactly was causing the AES outbreak, which has been recorded regularly in Muzaffarpur since 1995.
“We are still not aware if the disease is caused due to some virus, bacteria, toxin effect due to consumption of litchi, malnourishment or due to environmental conditions such as high temperature and humidity,” he said. 
“Several researches have been conducted, including by a team of experts from the Centers for Disease Control and Prevention, Atlanta (US), but the finding is inconclusive."
SKMCH Chief Medical Officer SP Singh said the reason behind the outbreak of the disease was yet to be confirmed. “We don’t know it and it was being ascertained medically”, Singh said.
Union Health Minister Harsh Vardhan, himself a doctor, who had visited Muzaffarpur three days ago and examined several children in SKMCH, said the deaths could have something to do with electrolyte imbalance and the metabolic system. 
He also did not rule out the possibility of AES due to viral infection or toxin effect, which could possibly be caused by the consumption of litchi, as well as high temperature and humidity.
Taking this into consideration, Harsh Vardhan stressed the need for research on AES and setting up of a state-of-the-art, multidisciplinary research unit in Muzaffarpur in collaboration with the Indian Council of Medical Research, the National Centre for Disease Control and AIIMS Patna.
He said  there should be research to identify the disease that still not identified and for it research facility should be develop in Muzaffarpur will take support from Atlanta based Centre for Disease Control and WHO for research in order to ascertain the causative factor of the disease.
Hardeo Manjhi, a landless labourer from Muzaffarpur, whose 4-year-old son is being treated at SKMCH, said: “My son suddenly developed high fever in the early hours last week, followed by convulsions and later turned unconscious, after which, we brought him to hospital for treatment. His condition is showing little improvement”.
Manjhi said that most of the children first develop high fever, followed by symptoms like weakness, convulsion, and then lose consciousness.
Marla Devi, mother of a 6-year-old child undergoing treatment for AES, said doctors treating her daughter informed that she had lost consciousness due to brain swelling and high fever. “We have noticed only high fever and convulsion”, she said. 
SKMCH’s Paediatric Department head Gopal Shankar Sahni said the AES outbreak happened during extreme summer.
“We have collected information that suggests that children’s body temperatures would shoot up followed by convulsion. They also suffer from hypoglycaemia (very low blood sugar) to shortage of sodium."
Rajiv Kumar of Kejriwal Hospital said it was common for children struck by AES to suffer from mental disorientation after the sudden onset of fever.
“In such a situation, we have been advising parents to bring their children to the nearest PHC or hospital without delay for treatment. Chances of survival increase with early arrival,” he said.
Most of the child victims of AES belong to poor and marginalised sections, including Dalits, Other Backward Classes (OBCs), Economically Backward Classes (EBCs) and Muslims.
“AES victims are mostly the malnourished children from underprivileged sections of society, they are from categories below the poverty line (BPL)”, said a district health official in Muzaffarpur.
After Chief Minister Nitish Kumar visited Muzaffarpur on Tuesday, the government has commissioned a survey in blocks and villages which reported high death toll to study  the socio-economic profiles of the affected families and their living conditions. A team of experts sent by the Central government has expressed dissatisfaction over the weak health infrastructure and poor hospital facilities.
Encephalitis is an inflammation of the brain, caused by any one of a number of viruses. Symptoms include high fever, vomiting and, in severe cases, seizures, paralysis and coma.
Petition in SC
The Supreme Court on Wednesday agreed to hear on June 24 a Public Interest Litigation that asks for the Centre’s intervention in the brain fever outbreak.
A Vacation Bench headed by Justice Deepak Gupta agreed to take up the issue on Monday after the petitioner’s counsel sought an urgent listing of the petition.
Filed by advocate Manohar Pratap, the PIL sought direction to the Centre to provide all necessary medical help and support for effective treatment of children suffering from the epidemic. The petitioner also demanded compensation of Rs 10 lakh to families of the children who died. 
Some 113 children have died, with both the Shri Krishna Medical College and Hospital and the privately-owned Kejriwal Hospital in Muzaffarpur reporting one casualty last night. 
Pratap claimed he was deeply pained and saddened by the deaths of the children, mostly of them under 10, in the last one week and the figures were rising day-by-day. 
“The deaths of children are a direct result of negligence and inaction on the part of the respective state governments of Bihar, Uttar Pradesh and Union of India in handling the epidemical situation which arises every year due to outbreak of AES also called Japanese encephalitis,” the plea alleged. 
It said that thousands of young children were losing their lives yearly from the disease but the governments (state and Centre) had done nothing to prevent its spread. 
“This year… the epicenter of the said disease is Muzaffarpur in Bihar where more than 126 children have lost their lives in past one week. Media reports shows that there is acute shortage of doctors, medical facilities, intensive care units and other medical equipments in the hospitals in nearby areas and children are dying in hospitals due to lack of required facilities,” the petition said. 
The petitioner wants the court to order the central government to send a panel of medical experts immediately to Muzaffarpur. 
The plea also sought direction to the Centre and the Bihar government for immediately arranging 500 stationary and 100 mobile intensive care units (ICU) with required medical professionals to deal with the patients from the remote areas and the emergency situation which occurred due to the AES outbreak. 
It demanded that Bihar government be directed to notify an extraordinary government order asking all the private medical institutions in the affected area to admit and provide treatment free of cost to the patients. 
The petitioner sought directions for all possible steps to stop the disease outbreak in the earlier epicenter, Gorakhpur in Uttar Pradesh, and to create awareness about the preventive steps and first aid which requires to be given to the patient in the case of AES. With IANS


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