More than 100 children die in India in encephalitis outbreak

PATNA, India (AP) — More than 100 children have died in an encephalitis outbreak in India's eastern state of Bihar, authorities said Tuesday.

Bihar health secretary Sanjay Kumar said 106 children had died and more than 430 others between the ages of 4 and 10 were being treated at hospitals in Muzaffarpur district, 80 kilometers (50 miles) north of Patna, the state capital.

Despite the deaths, Kumar said the mortality rate among children from encephalitis, which can cause swelling of the brain, a burning fever and vomiting, had dropped to 26.5% from 34% a year ago.

Young children are particularly vulnerable to the disease.

Villagers crowded outside Sri Krishna Medical College Hospital in Muzaffarpur, where some of the sick children are being treated, to protest a visit by Bihar's chief minister, whom they accused of only coming to the area after the death toll passed 100. Left-wing political organizations also rallied in New Delhi, demanding that the Bihar government do more to prevent what has become an annual outbreak.

"This acute encephalitis syndrome has been recurring in Bihar and the government has not taken any steps. And who is dying? It is the children of the very poor," said Mariam Dhawale of the All India Democratic Women's Association.

Thousands of Indians suffer from encephalitis, malaria, typhoid and other mosquito-borne diseases each year during the summer monsoon season. </s> (CNN) Scores of parents and locals gathered outside a hospital in the eastern Indian state of Bihar on Tuesday to protest the death of more than 100 children over the past three weeks.

Health authorities have confirmed that at least 109 children have died in the city of Muzaffarpur due to inflammation or infection in the brain. The fatal diagnosis is acute encephalitis, a neurological disease caused by either a virus or environmental toxins connected to the lychee fruit.

Protestors were yelling for government officials, who have been trickling in to assess the situation, to leave the hospital premises.

Local media showed mothers sobbing, parents running alongside gurneys transporting their babies, and droves of parents entering the hospital premises with children in their arms, asking for help.

Official responses -- both medical and administrative -- have been weak and delayed, some politicians say. In just two hospitals in the region, more than 400 children complaining of fever, dizziness and delirium have been admitted since the start of the year.

Acute encephalitis syndrome has spread across a few districts in India, focused in pockets in the poorer states of Uttar Pradesh, Bihar and West Bengal, which also have some of the country's hottest summers.

In 2014, nearly 117 deaths were reported in Muzaffarpur. But the death toll had dipped over the past few years.

"This year, the number [of cases] has gone up a bit," said Sanjay Kumar, a senior state health official. "The heat wave has been too intense, and it has gone on for too long."

Indian health officials and experts have been unable to accurately point to the cause of certain types of acute encephalitis syndrome and whether, as in the case of the latest India outbreak, it is viral or caused by the consumption of a toxin.

Research papers and local officials point to the presence of lychee as a factor that may have significance in understanding the cause behind the outbreak. The fruit is widely grown in and around Muzaffarpur.

"The association between litchis (or lychees) and acute encephalitis remains unclear. As with other emerging viruses, we face a multifactorial problem that seems to have litchi (or lychee) fruit production and harvest as its focal point," the paper says.

Children may be at a higher risk of getting infected because of lower immunity, said Dr. Neelu Desai, a pediatric neurologist in Mumbai. "If it is virus or a toxin in something they are eating, we don't really know," she added.

The Indian Ministry of Health has deployed a "high-level disciplinary team to Muzaffarpur to support the state in epidemiology research," according to a news release, and has announced the establishment of a research center there.

"To establish the cause of the disease, there is urgent need for an interdisciplinary, high-quality research team. The research team shall work with the children suffering from [acute encephalitis or Japanese encephalitis], looking at various aspects including periodicity, cycle of disease, environmental factors and meteorological data, besides other factors," said Harsh Vardhan, India's minister of health and family welfare.

Bihar state officials have issued warnings for the past few years across the Muzaffarpur district, advising parents to ensure that children stay hydrated and do not go to sleep on an empty stomach.

Kumar said that the affected children "are from poor families, and they do not have sugar reserves, and they are also malnourished."

Bihar health authorities have confirmed that all children displayed signs of hypoglycemia -- low blood sugar -- before they died.

"The liver stores glycogen. When the sugar level goes down, the liver releases extra sugar to balance it out, but if there is no extra sugar and there are only toxins, then they get released," Kumar said.

Officials have blamed the severe heat wave, which has lasted for more than 30 consecutive days, as the reason behind the rise in cases but aren't sure how heat plays a role in the spread of acute encephalitis syndrome.

Due to intense heat, the Bihar state government has ordered all government and private schools in the state to be shut until Monday. </s> An encephalitis outbreak has killed over 100 children in eastern India since June, officials say, with more than 430 others requiring hospitalization. The outbreak, striking children in India’s Bihar, has set off political protests outside a hospital where patients are being treated, with villagers claiming that the state’s chief minister ignored the issue until the death toll reached 100.

Thousands of people in India suffer from encephalitis, malaria, typhoid and other mosquito-borne diseases each year during the summer monsoon season, with children younger than 15 being the most vulnerable, according to the Associated Press. Left-wing political organizations have accused the Bihar government of not being proactive enough to prevent the illnesses.

"This acute encephalitis syndrome has been recurring in Bihar and the government has not taken any steps. And who is dying? It is the children of the very poor," said Mariam Dhawale of the All India Democratic Women's Association.

The mother of a 4-year-old girl hospitalized in the Muzzaffarpur Medical College’s intensive care unit said that no child recently admitted has survived or recovered from their illness.

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“In the last two days, no child from this hospital has recovered,” she told the BBC. “All of them have died. Did I painstakingly bring up this girl only to watch her die like this?”

Despite the high death toll, health officials said the mortality rate among children due to encephalitis had dropped from 34 percent to 26.5 percent over the last year. Doctors also suggest related illnesses may be contributing to the fatalities, including a large number of children allegedly dying from hypoglycemia.

“It’s difficult to say with certainty if children are dying due to encephalitis because there could be a number of reasons behind these deaths,” Dr. Mala Kaneria told the BBC. “It could also be due to malnutrition, insufficient levels of sugar and sodium or electrolyte imbalances.”

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Kaneria also said the practice of eating leeches on an empty stomach could have dire consequences, as they contain toxins that affect the body’s ability to produce glucose, which could cause major health issues for younger children.

The state has announced it will cover the cost of treatment for all patients affected.

The Associated Press contributed to this report. </s> The death toll of children due to suspected Acute Encephalitis Syndrome (AES) in Muzaffarpur area of Bihar on Friday went up to 77. Ten more deaths were reported on Saturday, taking the toll to 77. Most of the casualties are between the age group of 1-10.

Doctors claim that the deaths, due to Acute Encephalitis Syndrome (AES), are being caused due to excessive heat and humidity. Locally, this fever is being called ‘Chamki’.

Bihar CM Nitish Kumar has announced an ex-gratia of Rs 4 Lakh each to families of the children who died due to Acute Encephalitis Syndrome (AES) in Muzaffarpur. He has also given directions to health department, district administration and the doctors to take necessary measures to fight the disease.

The State government has announced that it will open a new 100-bed ward for children, and six additional ambulances would be deployed for the government-run Sri Krishna Medical College and Hospital (SKMCH).

Earlier on Wednesday, a four-member team of doctors, led by Dr. Arun Sinha, visited the SKMCH, where children with symptoms of AES have been admitted. The team then issued guidelines and suggestions to local medical experts and doctors.

Though the State government had previously said the cause of death of small children, mostly from poor families, was hypoglycemia, or low blood sugar levels, experts and private doctors in Muzaffarpur told The Hindu that “AES is a broader aspect of hypoglycemia”.

Meanwhile, sick children with symptoms of AES continue to be admitted into the two crammed Pediatric Intensive Care Units (PICU) at SKMCH.

A separate makeshift ward, too, is full with children suffering from AES symptoms.

A statement from district authorities said nine children at SKMCH and five in Kejriwal hospital were in critical condition.

“Doctors and nurses are doing round-the-clock duty to monitor the situation. Some of the children have also been discharged from the hospital, after getting well,” said

SKMCH Principal Dr. Sunil Kumar Shahi said, “We have an in-patient bed strength of only 610, whereas the number of patients admitted is around 876. But we are managing to provide treatment to all of them.”

Union Minister of State for Home Nityanand Rai on Saturday visited the Sri Krishna Medical College Hospital in Muzaffarpur and took stock of the situation. He also met the family members of the children who are undergoing treatment and assured of all central and state assistance.

“The entire state is in a state of shock over the death of innocent children. We are with the family members of the affected and ready to provide any kind of assistance”, Nityanand Rai said.

Experts are of the opinion that unless and until rainfall takes place, the situation will only aggravate in days to come.

Union Health Minister Harsh Vardhan will visit Bihar’s Muzaffarpur on Sunday to take stock of the situation there in view of rising cases of Acute Encephalitis Syndrome (AES) and Japanese Encephalitis (JE) there.

During his visit, the minister will interact with the multi-disciplinary teams deployed there and address a state-level review meeting.

Harsh Vardhan said that the health ministry is constantly monitoring the situation and supporting the state health authorities in managing the AES/JE cases. </s> MOSCOW (UrduPoint News / Sputnik - 16th June, 2019) The number of children, who died as a result of acute encephalitis syndrome (AES) in Indian Bihar state, has risen to 83, local media reported on Sunday.

Previous reports said that at least 50 children had died.

According to The Times of India, heatwave and high humidity have become the main causes of the AES outbreak.

Health experts expect the situation to aggravate further until rainfall takes place.

Over 100 children are currently undergoing treatment at local hospitals.

The temperature in Bihar exceeds 40 degrees Celsius (104 degrees Fahrenheit), which is some 5 degrees above normal. According to the Patna Meteorological Center, the heatwave will continue in a number of districts of Bihar until Tuesday. </s> The death toll from the Acute Encephalitis Syndrome outbreak in Bihar has risen to 100, with the disease killing 83 children at the Sri Krishna Medical College in Muzzafurpur alone. A further 17 died at the city's Kejriwal Hospital.

At least 290 more children remain admitted to the Intensive Care Unit (ICU) of the Sri Krishna Medical College. Dr SK Sahi, who is the medical superintendent at Sri Krishna Medical College, told NDTV that only the monsoon could bring respite from the disease.

Union Health Minister Harsh Vardhan, who was a doctor before he entered politics, visited Muzaffarpur yesterday to take stock of the situation. After his review, the minister said he has talked to "every concerned individual about this issue".

"Despite all problems and considering the seriousness of this disease, I appreciate the efforts put in by the doctors to ensure efficient treatment to everyone," he added.

Chief Minister Nitish Kumar had earlier expressed grief over the deaths and announced "an ex gratia payment of Rs. 4 lakh to the next of the kin of those who have died". The Chief Minister also said there is a lack of awareness on how to tackle this disease.

Acute Encephalitis Syndrome is a viral disease that causes mild flu-like symptoms such as high fever, convulsions and headaches. The state health department has cited hypoglycemia, a condition caused by very low level of blood sugar, as one of the main reasons for the deaths.

Bihar health officials have also been struggling with a heatwave that killed over 40 people on Saturday. Most of those deaths were reported from Aurangabad, Gaya and Nawada, with 27 dying in Aurangabad alone.

Dr Surendra Prasad Singh, a doctor at one of Aurangabad's state-run hospital, said number of deaths in the district is likely to rise.

Union Health Minister Harsh Vardhan called the deaths in Gaya "unfortunate" and advised people against leaving their homes during peak hours

The country is witnessing its worst heatwave this year with four cities in north India on a record high. Delhi, Churu in Rajasthan and Banda and Allahabad in Uttar Pradesh have witnessed temperatures of 48 degrees Celsius and above.

A heat wave is declared when temperature remains at 45 degrees Celsius and above for two days running. It gets a "severe" tag when mercury touches 47 degrees. </s> Acute Encephalitis Syndrome (AES) is group of symptoms that indicate an inflammatory condition of the central nervous system. It can be brought about by any number of virus, bacteria or even fungi - the actual reason has been elusive so far. Symptoms of Acute Encephalitis Syndrome can vary, depending on the part of the brain affected. The main symptoms include headache, fever, confusion and seizures.

This has killed more than 100 children this month in Muzzaffarpur and its surrounding districts in Bihar. According to the state health department, one of the main reasons of these deaths is hypoglycemia, a condition caused by low blood sugar levels.

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We spoke to Dr Sonia Lal Gupta, Senior Neurologist, Metro Hospitals, who stressed that malnourishment made children susceptible to Acute Encephalitis Syndrome.

"This condition is more common in areas like Muzzaffarpur and Bihar because the fruit lychee grows in abundance in the state at this time of the year. A study found that when malnourished children ate raw lychees and didn't have a proper meal after eating it, they suffered from Acute Encephalitis Syndrome. At night, the blood sugar in these children were found to fall drastically due to lack of food. This made many children go into coma right away. Some of them also experienced confusion and seizures. These symptoms were then diagnosed as Acute Encephalitis Eyndrome," explains Dr Sonia.

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According to a study published in International Journal of Medical and Health Research (download study here), methylene cyclopropyl glycine (MCPG) in unripe lychees can cause a sudden drop in blood sugar levels. MCPG can also cause vomiting, if it is ingested in huge quantities. This poisonous compound can also cause unconsciousness, death and coma, the study states. The toxins can cause high fevers and seizures in severely malnourished children.

Dr Sonia says that if children who are not malnourished consumed unripe lychees, they will not develop Acute Encephalitis Syndrome. "The study linked the disease more specifically with malnourishment. This has been found as a trend. When healthy children ate lychees, nothing happened," she adds. So it is posited that it is not the lychees but malnourishment that can be blamed for AES.

"To prevent acute encephalitis, it is important that children eat proper meals to avoid any rapid fall in the blood sugar levels", says Dr Sonia.

Regarding the treatment for encephalitis, it is important to know the causative factor which could be bacterial or viral. Viral encephalitis is the more common form. Supportive treatment is then provided accordingly.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information. </s> Thirty children, including 17 newborns, have died in the last 48 hours after oxygen supply to the children’s department in Baba Raghav Das Medical College and Hospital in Uttar Pradesh’s Gorakhpur district was disrupted, ANI reported on Friday. The authorities had to use gas cylinders as a replacement in the ward.

Earlier, reports had attributed the deaths to encephalitis, a condition which causes high fever and brain inflammation. However, a statement released by the hospital later showed only five of the 30 deaths were of children suffering from the acute encephalitis syndrome. Seventeen deaths were reported from the neo-natal ICU.

Twenty three children died on Thursday night, while seven lost their lives on Friday after oxygen supply to the hospital was disrupted at 7.30 pm on Thursday. “On August 10, at 7.30 pm, the pressure in the liquid oxygen started falling,” the hospital said in a statement. “Fifty-two oxygen cylinders kept in reserve were used as a replacement. Fifty cylinders were sourced from IGL Faizabad that arrived at 1.30 pm on August 11 in ward No 100. These were immediately connected by the central pipeline operator.”

“On August 11, at 8.30 am, again cylinders came from IGL Faizabad, and were used,” the statement said. “At 1.30 pm, 22 cylinders came from Modi Pharma Gorakhpur. At 4.30 pm, 36 cylinders came from Modi Pharma that were used. Hundred cylinders were sent to Modi Pharma for refill.”

The hospital added that they were hoping that the 100 cylinders would come back by 11 pm on Friday.

The oxygen supply was allegedly stopped after the hospital failed to clear the suppliers’ bill of Rs 67 lakh, the Hindustan Times had reported. “The supply of liquid oxygen was disrupted yesterday day due to pending payments. We had requested the suppliers not to disrupt supply,” District Magistrate Rajeev Rautela had said.

However, Uttar Pradesh’s Medical Education Minister Ashutosh Tondon said, “no deaths were caused due to lack of oxygen supply”, according to ANI. He said seven people died on Friday, out of which three deaths were reported from the neo-natal ICU. “Two others died due to acute encephalitis syndrome and two due to non-AES today [Friday],” he said. Tondon said the district magistrate has ordered a magisterial inquiry into the incident. “The report will be out in the next 24 hours,” he said. </s> More than 100 children die in India in encephalitis outbreak

PATNA, India (AP) — An encephalitis outbreak has killed more than 100 children in India's eastern state of Bihar.

Authorities say 106 children have died and 437 others between the ages of 4 and 10 are being treated in hospitals in Muzaffarpur district, 80 kilometers (50 miles) north of Patna, the state capital.

Villagers crowded outside Sri Krishna Medical College Hospital in Muzaffarpur to protest that Bihar's chief minister had only visited after the death toll passed 100. Left-wing political organizations also rallied in New Delhi.

Thousands of Indians suffer from encephalitis, malaria, typhoid and other mosquito-borne diseases each year during the summer monsoon season.

Medical experts say India's central and state governments remain unprepared for what is now an annual cycle of disease and death.
The death toll of Indian children who have died due to an acute encephalitis syndrome outbreak reaches 100.