Context

In the midst of the fight against Covid-19, Bihar has been hit by another health crisis — Acute Encephalitis Syndrome (AES), locally known as ‘chamki bukhar’ — which inflames the brain cells and targets children in particular.

An epidemic of Acute Encephalitis Syndrome (AES) broke out in five north Bihar districts, last year as well with more than 176 children having died.

The Supreme Court last year sought a response from the Central and Bihar governments on the steps taken to prevent death of children due to the outbreak of acute encephalitis syndrome (AES) in Muzaffarpu(AES).

Locally known as Chamki Bukhar, at least 400 children have died in the last one decade due to AES in these districts.

What is AES?

• AES is a clinical condition most widely caused by infection with Japanese encephalitis virus (JEV) or other infectious and non-infectious causes.
• It is a group of clinically similar neurologic manifestation caused by several different viruses, bacteria, fungus, parasites, spirochetes, chemical/ toxins etc.

Symptoms of AES

Acute encephalitis syndrome (AES) is characterized by an acute onset of fever and clinical neurological manifestation that includes mental confusion, disorientation, delirium, or coma. Keeping in mind the wide range of causal agents and the rapid rate of neurological impairment due to pathogenesis, clinicians face the challenge of a small window period between diagnosis and treatment.

Who is at risk?

People in rural areas where the virus is common are at greater risk.It predominantly affects population below 15 years.There is seasonal and geographical variation in the causative organism.

JEV has its endemic zones running along the Gangetic plain including states of UP (east), Bihar, West Bengal and Assam, and parts of Tamil Nadu.

People with weakened immune system – for instance, who have HIV/AIDS, take immune-suppressing drugs – are at an increased risk of encephalitis.

A report published in the Lancet Journal in 2017 reported that toxins in unripe litchies were responsible for acute toxinohenic encephalopathy in Children.In India, AES outbreaks in north and eastern India have been linked to children eating unripe litchi fruit on empty stomachs. Unripe fruit contain the toxins hypoglycin A and methylenecyclopropylglycine (MCPG), which cause vomiting if ingested in large quantities.

These compounds found in litchi seeds cause a sudden drop in blood sugar, vomiting, altered mental states leading to lethargy, unconsciousness, coma and death. These toxins combined with malnutrition rampant in these areas,cause sudden high fever and seizures serious enough to require hospitalisation in young, severely malnourished children.

Another theory suggests that it is the failure to acclimatise in children in these areas to changing rainfall patterns an heat waves, that has contributed to the rise in the cases.

Treatment for Acute Encephalitis Syndrome 

• People suffering from encephalitis need to be treated urgently.
• Treatment may include antiviral medication, steroid injections among others to support the body, relieve the symptoms.
• Other treatment options are – bed rest, plenty of fluids, anti-inflammatory drugs to relieve the symptoms such as fever and headache.
• There is no cure for the disease. However, safe and effective vaccines are available to prevent encephalitis.

Prevention of Acute Encephalitis Syndrome

• Increase access to safe drinking water and proper sanitation facilities
• Improve nutritional status of children at risk of JE/AES
• Vector control :
  • The preventive measures are directed at reducing the mosquito density.
  • Personal protection against mosquito bites using insecticide treated mosquito nets.
  • Clothing reduces the risk of mosquito biting if the cloth is sufficiently thick or loosely fitting. Long sleeves and trousers with stockings may protect the arms and legs, the preferred sites for mosquito bites.
  • Household insecticidal products, namely mosquito coils, pyrethrum space spray and aerosols have been used extensively for personal protection against mosquitoes.
  • Repellents are a common means of personal protection against mosquitoes and other biting insects.
  • The reduction in mosquito breeding requires eco-management, as the role of insecticides is limited.
• Vaccination : As per Govt. of India guidelines, 2 doses of JE vaccine have been approved to be included in UIP to be given one along with measles at the age of 9 months and the second with DPT booster at the age of 16-24 months w.e.f. April, 2013.

Learning from the Case of Odisha(The Hindu)

Source-The Hindu