The Curious Case of Encephalitis in Muzaffarpur
| Mallika Chugh - 28 Jun 2019

By Mallika Chugh

New Delhi, June 28, 2019: The death toll of the encephalitis victims in Muzaffarpur has topped to 152. While the nation mourns the loss of precious lives of young children in region, the government is  sitting clueless unable to veil it's utter failure in controlling the epidemic.   

On June 3, when the Bihar health minister, Mangal Pandey was leaving for attending a conference on gender equality, to be held at Vancouver in Canada, little did he know that acute encephalitis syndrome (AES) was not only breaking out in the State, it had also claimed the lives its first two victims.On June 8, by the time he returned AES was already anepidemic. Thereafter the state witnessed little respite from the disease in spite of visits by Union health minister Harsh Vardhanand Bihar chief minister Nitish Kumar.

The disease is not new to the state, every year it starts with the onset of summers and peaks just before monsoon. Basically it coincides with the litchi (fruit) harvesting season. Ever since the 1990s, the state has recorded number of child deaths, attributable to the disease, with most of the victims being less than 10 years of age. These children belonged exclusively from poor families.

This year too, the most badly affected areas included the same 222 blocks in 12 districts, especially in Muzaffarpur, Vaishali, Sheohar and East Champaran. Like the previous years, the patients were admitted for high fever. They were shivering and their hands were twisted by spasms, while their eyes struggled to focus. Most of the children reached the hospital when they were in no condition to speak or open eyes. Light, sound or touch only added to their agony. Doctors attributed the symptoms to severe glucose deficiency that aggravates because of heat and humidity.

So far since the last few decades the doctors had been treating the patients when the disease occurred with the onset of summer months however, later with the advent of winters they forgot about it. The cycle had been going on year after year. It is only now that the disease acquired the magnitude of an epidemic that the entire government machinery was jolted out of its slumber. Chief Secretary Deepak Kumar said no clear cause of deaths could be ascertained. Therefore the worst part was that since the exact cause of the disease was not ascertained, doctors only tried to treat the symptoms and not the disease.

Way back in 2012-2013, a team headed by virologist Dr. T. Jacob John had linked the disease to undernourished children. He had confirmed that a toxin found in litchi fruit was responsible for causing hypoglycemic encephalopathy. In 2017, an India-U.S. team also validated that the toxin called methylene cyclopropyl glycine (MCPG), was responsible.

The report said that sinceearly in the morning, blood sugar levels normally dip,undernourished children who skip a sleep meal before going to sleep are at riskto develop hypo glycaemia, especially the one who had Litchi. Normally, when glycogen reserve is not sufficient, the body converts the fatty acid (non-carbohydrate energy source) into glucose but in the presence of the litchi toxin, the conversion of fatty acid into glucose is stopped midway leading to hypo glycaemia. John believed that the symptoms did not indicate encephalitis but encephalopathy, which can be easily treated. DrArun Shah, a well-known pediatric who was also part of Johns team validated his point of view.

Dr Prabhat, however, begs to differ. He says there could be more to AES besides the hypothesis of just Litchi causing disease, since many children who have died did not consume litchis. A much deeper research can only reach to some conclusions. The culprit could be some unknown virus.

Meanwhile a PIL (Public Interest Litigation) was also filed blaming the government apathy for the deaths. Now the Supreme Court has sought a response from both central and Bihar government. It wants to know about the steps taken so far to prevent deaths of young children due to acute encephalitis Syndrome.If not the government actions, the advent of monsoon is sure to bring respite like every year.

However, back in Bihar as of now, suddenly the thick shady litchi groves do not look idyllic anymore the villages surrounding them have become death zones. Not a single child dares to pick up the fallen fruits. Even the sunshine looks grey and the air breathes heavy with the weight of the deaths of innocent kids.

Disclaimer: The opinions expressed in this article are the personal opinions of the author.

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