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Syndrome mystery in viral fight

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 toll 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 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.

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, said.

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.

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

The Indian Council of Medical Research’s National Institute of Virology, Pune, has been investigating the AES cases in eastern Uttar Pradesh and Bihar for over three years, and has said they represent infections caused by enteroviruses — viruses ingested through contaminated water.

John and Mukul Das, a scientist at the Indian Institute of Toxicology Research, Lucknow, have proposed a hypothesis that toxic substance in lychee seeds is contributing to the encephalitis observed in Muzaffarpur, Bihar.

“The connnection with lychees is only a hypothesis, it needs to be tested,” John said.