Acute Encephalitis Syndrome Response - 2019

In June 2019, the cyclic return of Acute Encephalitis Syndrome (AES) or Chamki fever to one of India’s poorest and malnourished states, Bihar, lead to hospitalisation of 309 children in Muzaffarpur. Encephalitis is a viral disease, which causes mild flu-like symptoms such as high fever, convulsions and headaches and has been claiming lives in the district for the past few weeks. Health Department's Principal Secretary Sanjay Kumar had earlier said the disease has affected 222 blocks of 12 districts especially Muzaffarpur, Vaishali, Sheohar and East Champaran. The popular terms like ‘Litchi Havoc’, Chamki Bhukar’, ‘Killer Encephalitis’, ‘Deadly Litchi Toxin’ that are being used to report the epidemic in Bihar point to the dismal methods of investigating a disease in India.

For years, it only served the purpose of headlines. Although over hundred children have already been cured and discharged from Sri Krishna Medical College and Hospital (SKMCH), the death of 130 children at the hospital after a gap of four years necessitates a four-part enquiry into the investigation of the outbreak: identification, causation, confusion and malnutrition. Malnutrition is one of the main cause of Disease. The “time-lapse factor” or the time taken to reach a Primary Health Centres (PHC), and at times the availability of treatment in them, also is an issue to the poor. Children suffering from fever and convulsion early in the morning are brought to health centres after 6-8 hours. Some children are safe because they reach on time, while the rest attempt to make it to a nearest government hospital, thus reducing the chance of survival.

What is Encephalitis: Symptoms, causes, treatment of the 'Chamki' fever

The death toll due to Acute Encephalitis Syndrome (AES) has reached 130 in Muzaffarpur and the adjoining districts in Bihar. Most of the casualties are between the age group of 1-10. Union Health Minister Harsh Vardhan has advocated setting up of a research institute to identify the reason behind the outbreak of the epidemic, colloquially known as 'chamki bukhar' (chamki = seizure). As per the reports, AES has taken around 12 districts of the state in its grip which includes Muzaffarpur, Vaishali and East Champaran. However, Muzaffarpur has been declared as the worst hit zone.

Acute encephalitis syndrome (AES) is a serious public health problem in India. It is characterized as acute-onset of fever and a change in mental status (mental confusion, disorientation, delirium, or coma) and/or new onset of seizures in a person of any age at any time of the year. The disease most commonly affects children and young adults and can lead to considerable morbidity and mortality. The AES cases in Muzaffarpur, Bihar and adjoining litchi producing districts have been observed mostly during April to June particularly in children who are undernourished with a history of visiting litchi orchards.

1. Viruses are the main causative agents in AES cases, although other sources such as bacteria, fungus, parasites, spirochetes, chemicals, toxins, and noninfectious agents have also been reported over the past few decades.
2. Japanese encephalitis virus (JEV) is the major cause of AES in India (ranging from 5-35 percent). Nipah virus, Zika virus are also found as causative agents for AES.
3. Herpes simplex virus, Influenza A virus, West Nile virus, Chandipura virus, mumps, measles, dengue, Parvovirus B4, enteroviruses, Epstein-Barr virus and scrub typhus, S pneumoniae are the other causes of AES in sporadic and outbreak form in India.

• High fever, Headache, Sensitivity to light, Stiff neck and back, Vomiting, Confusion. In severe cases, seizures, paralysis and coma

• Children suffering from Encephalitis should be kept in the Intensive Care unit or ICU to avoid any major mishap.
• It can be treated by anti-inflammatory drugs, such as Acetaminophen, Ibuprofen and Naproxen Sodium to reduce headaches and temperature.
• Most cases of encephalitis get resolved in a few days. In case of a severe condition, it may take a few weeks.

DFY Response

Doctors For You team has started its response at Muzaffarpur and need your urgent support to run the services for next 2 weeks minimum.

We urgently need

• Medicines
  • I/V fluids
  • Glucometre and strips, Suction machine
  • Oxygen delivery system
  • I/V anti convulsant like phenetoin sod.
  • Ambubag , ET tubes (pediatric)
  • Catheters
  • IV Mannitol,
  • Inj. Paracetamol
  • Pulse, respiratory rate, temperature and B.P. monitoring system
  • Water - bottles and cans
  • Nutrition for infants and young children
  • Dry Ration
  • ORS