Central medical teams to strengthen management of AES cases in Bihar

Children with encephalitis symptoms being treated at a hospital in Muzaffarpur, Bihar. (Photo: IANS)
Children with encephalitis symptoms being treated at a hospital in Muzaffarpur, Bihar. (Photo: IANS)
Union Health Minister Harsh Vardhan today directed that five teams of senior paediatricians and paramedics be sent immediately to help manage the cases of Acute Encephalitis Syndrome (AES)/Japanese Encephalitis (JE) in Muzaffarpur district of Bihar.
The teams will strengthen the State government's efforts and measures in Muzaffarpur and other affected districts, an official press release said.
Ten paediatricians (including five senior consultants) and five para-medics from RML Hospital, Safdarjung and Lady Hardinge Medical College will be part of the five teams. “The teams will strengthen the clinical care to the existing patients in the hospitals and also strengthen surveillance of cases from the peripheral areas,” Harsh Vardhan stated.
“A high-level central team led by Lav Agarwal, Joint Secretary, Health, has been stationed in the area to monitor the operations for the past three days. Teams have also been constituted for socio-economic survey in these areas to identify and pinpoint causes linked with the economic status," he added.
Ten additional ambulances have been deployed in the most affected blocks of the districts for round-the-clock services. Also, 16 nodal officers (teams of senior doctors and an administrative officer) have been deployed at the primary health centres (PHCs) in the affected blocks.
To strengthen the health infrastructure and facilitate the transportation of patients to the health facilities, the State Government has also made a provision to reimburse the ambulance charges if the patients are shifted privately by the family to the hospitals.
IANS adds from Patna:
Children have been dying in Bihar's Muzaffarpur and neighbouring districts due to Acute Encephalitis Syndrome (AES) for over a fortnight, but doctors and health officials are still in the dark about the exact nature of the disease and precise cause of deaths.
The state and central governments are also clueless in the matter. As per official figures, 113 children have died due to AES in Muzaffarpur and neighbouring districts, so far. 
Bihar Health Department Principal Secretary Sanjay Kumar said here that of the total 113 deaths, 91 had died in the 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.
This year, 501 AES cases have been reported in the state till date.
Doctors and health officials have different views on the factors behind the AES epidemic and the cause of the 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 the consumption of lychees, malnourishment or due to environmental conditions such as high temperature and humidity," he said. 
"Several research projects 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 S. P. Singh said the reason behind the outbreak of the disease was yet to be confirmed. "We don't know it and it is being ascertained medically," Singh said.
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, multi-disciplinary 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 has still not been identified and for it a research facility should be developed in Muzaffarpur. He said the government will take support from Atlanta based Centre for Disease Control and WHO for research in order to ascertain the causative factor of the disease.
However, Hardeo Manjhi, a landless labourer from Muzaffarpur, whose 4-year-old son is being treated at SKMCH, said: "My son suddenly developed a high fever in the early hours last week, followed by convulsions, and he later turned unconscious, after which we brought him to hospital for treatment. His condition is showing little improvement."
Manjhi pointed out that most of the children first develop high fever, followed by symptoms like weakness and convulsion, and then lose consciousness.
Marla Devi, the mother of a 6-year-old child undergoing treatment for AES, said doctors treating her daughter informed her that she had lost consciousness due to brain swelling and high fever. "We have noticed only high fever and convulsion," she said. 
SKMCH's Paediatrics 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) due 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.

(Our News Desk can be contacted at

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