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India Encephalitis 2014 - 1,808 fatalities

Re: India Encephalitis 2014 - 289 fatalities

Re: India Encephalitis 2014 - 289 fatalities

Gorakhpur gearing up for encephalitis season, and not a moment too soon given recent rains & waterlogging - Ro


Uttar Pradesh

JE - AES doctor trained to treat
Publish Date: Sunday, Jun 22,2014 12:47:36 AM | Updated Date: Sunday, Jun 22,2014 12:47:05 AM

News reporter, Gorakhpur:
Health centers for treatment of encephalitis two-day training doctors. The identification of these disease, patients precautions to be taken during transport and health centers were given information about the treatment protocol. Doctors are trained respective areas Encephalitis Treatment Center by visiting the doctor, give hope and ANM training.
Additional CMO as well as doctors, district malaria officers were aware of it. Training Uttar Pradesh government, in collaboration with the National Health Mission and international organizations were given path. It was attended by doctors from the health center every other districts. He also mentioned that with the identification of disease a patient is referred by ambulance during the - what precautions should be taken. Speeding ambulance to the hospital, horn player, for instance, to avoid shocks. The patient should be protected from strong light. When the patient's fever was also about to be blindfolded. Encephalitis health centers were also informed about the treatment protocol.
http://www.jagran.com/uttar-pradesh/gorakhpur-city-11415862.html

Encephalitis awareness campaign from today
Publish Date: Sunday, Jun 22,2014 12:46:35 AM | Updated Date: Sunday, Jun 22,2014 12:46:03 AM

News reporter, Gorakhpur:
Encephalitis in the district for prevention awareness walk from June 27 to 23. Pipraic dissemination activities conducted between the beginning of the development section of the village Goplapur June 23 at 9 am in the Ministry of Health, Government of India and Chairman of the task force set up by the state joint secretary Satyabrata Sahu said.
Chief Development Officer Prashant Kumar before the start of the campaign on 22 June 8.30 pm Regional Sports Stadium, the stadium will rally to call for public awareness of the student union square, court bus station, Ambedkar square, while Shastri Nagar intersection Collectorate office complex will be finished.
Avoid mosquitoes and contaminated drinking water: CMO
Japanese encephalitis is transmitted by mosquitoes and Ais contaminated drinking water. In this disease, sudden high fever, stiff neck fainting, shaking quite common symptom. Symptoms occur, the patient should be taken to the nearest government hospital. Patient to hospital should be put right or left side. When the patient has high fever strip of water or wipe with damp cloth should carcass. In the unconscious patient's mouth and no substance Do not wake him or her Hilayen.
Today will be Joint Secretary Drinking Water
Joint Secretary will Gorakhpur pm on June 22 and June 23 at 11 AM encephalitis prevention of disease in relation to the preparation for the meeting will be in the auditorium GDA. 4 pm, will leave for New Delhi to Gorakhpur.
http://www.jagran.com/uttar-pradesh/gorakhpur-city-11415858.html

Steeped in water, roads, homes and hard to get
Publish Date: Sunday, Jun 22,2014 12:57:58 AM | Updated Date: Sunday, Jun 22,2014 12:57:03 AM

22_06_2014-21ktn12-c-2.webp

Steeped in water, roads, homes and hard to get
Sitting turn a blind eye to the responsible representatives of the people suffering - pain is nothing.
Dozens of people in neighborhoods in the city occurred during the last days of the day of moderately heavy rain Jljmav facing. No officer, representative Rustmpur free Pcpedwa Ram Nagar Colony Square and go and take a look at Gorakhnath area. Of course, even after sitting on a four-wheeler get discouraged and will return half way.
Cilmapur Rustmpur Azad Chowk, Brvlia The route is completely damaged. Move - move from Gdde and the rain gutter filled with water. During the excavation of drains after rain turned the soil has been transformed into a swamp. Come - are people being trapped in the vehicle. Sewer construction has not been completed and now the road is yet to be made. While Saket Nagar here bagaha Bir Baba route connecting road and drain completely broken. On the way place - the place is Jljmav.
Shiv Nagar Colony made Jljmav silt in front of people's homes, in the morning with rain water drains into the mud houses. Marriage Betiahata House Road in the southern colony is huge Jljmav.
Meanwhile, north of the railway line north Humaunpur, Gorakhnath Pcpedwa Azad Nagar sector in four Mirjapur Jljmav hard to get because of the people's homes. Between dirty water coming through - to get people's skin. She said it Jljmav Sonkar showing the result of his feet.
http://www.jagran.com/uttar-pradesh/gorakhpur-city-11415949.html
 
Re: India Encephalitis 2014 - 289 fatalities

Re: India Encephalitis 2014 - 289 fatalities

I'm not sure of this source, the fatality figure quoted is higher than other media outlets. - Ro

Google translated.

Bihar
After the death of 195 innocent Mujfrfrpur Health Minister Dr. Harsha arrived on Saturday. ME
June 22, 2014 01:56 PM
How sensitive is the center of the Modi government. It is estimated that this could only be imposed after the death of 195 innocent Mujfrfrpur Union Health Minister Dr Harsha arrived on Saturday. The 9 children died in their presence. They had six children and three children die Skemsiac Kejriwal was in the hospital. Dr Harshvardhan said hospital malnutrition is not appropriate to add the disease. If this happens, the other area of ​​children are vulnerable to the disease. This is going to cause illness in children Ilektronaid Imbailens sodium, potassium deficiency disease is suspected children. He said that public awareness of the disease can be contained.
http://www.tatkalnews.com/news/39243-195-मासूमों-की-मौत-के-बाद-केन्.aspx
 
Re: India Encephalitis 2014 - 299 fatalities

Re: India Encephalitis 2014 - 299 fatalities

Jharkhand

Baby's death from meningitis in the rims
Publish Date: Monday, Jun 23,2014 10:18:01 PM | Updated Date: Monday, Jun 23,2014 10:18:11 PM


Baby's death from meningitis in the rims
Ranchi: The rims of the baby suffering from disease, meningitis Monday morning Miss facilitate a child (12 years) died. Uday Chandra Yadav resident of Giridih district Bengabad Budihya she was the daughter of Dako. On June 17 the rims of her infant disease, was admitted under the care of Dr. AK Chowdhury. Prior to June 20 death of 12-year-old Mira Kumari had become Inseflaitis Miningo. She was the daughter of PEG district Krra resident Vijay Oram.
The rims of the physicians reported that the children's department at the time of recruitment had been complaining of fever, malaria Miss accessible. If the blood test was later found in the report of TB meningitis. Miss tirelessly to protect doctors said was intelligible, but could not save her.
Uday Chandra Yadav told her father that she Dako Budihya state middle school student in the class VII. He was suffering from fever for the last 25 days. His Bengabad and treated in Giridih. After the deterioration of the physicians who referred him rims for better treatment. The treatment lasted for six days in a smooth rims, but he could not be saved.
----------------
Meningitis is one of the rims and child recruitment
The rims of the infant and child suffering from meningitis disease, on Monday Sandeep Kumar (14 years) were admitted for treatment. Purusottmpur resident of Panki police station area of ​​Palamau district, he is the son of Paras Nath Mahato. Sandeep Kumar is a student of Class 8 in Daltnganj DAV. Sandeep said that his father is suffering from a fever for the last eight days. With fever - as it is vomiting. Department of rims her baby syndrome have been admitted under the care of Dr. AK Sharma. Said pediatrician Dr. SS Sidana cuticle Meningitis is inflammation of the brain.
...
http://www.jagran.com/jharkhand/ranchi-11420564.html
 
Re: India Encephalitis 2014 - 301 fatalities

Re: India Encephalitis 2014 - 301 fatalities

You are here: Home ? National ? AES toll mounts as doctors search for vector
AES toll mounts as doctors search for vector

Abhay Kumar, Patna, June 23, 2014, DHNS:
AES, which continues to be a long-standing mysterious disease, has affected mainly north Bihar districts, claiming the lives of nearly 1,000 children since 2008. Some deaths have been reported from Gaya and Bhagalpur too. DH graphics for representation purpose
With six more children succumbing to acute encephalitis syndrome (AES) over the past 24 hours, the toll from the disease in Muzaffarpur has gone up to 156 this year.

Union Health Minister Dr Harsh Vardhan, who visited Muzaffarpur to take stock of the situation, suggested remedial measures, but added that one still cannot confirm that all the deaths had been due to AES.
...
Since the first case this year was reported on April 11, 242 children have been admitted to Sri Krishna Medical College and Hospital (SKMCH) at Muzaffarpur. ?Of them, 92 have been discharged, while 83 are undergoing treatment. The rest 67 have died,? said SKMCH superintendent Dr G K Thakur.
...
http://www.deccanherald.com/content/415530/aes-toll-mounts-doctors-search.html
 
Re: India Encephalitis 2014 - 301 fatalities

Re: India Encephalitis 2014 - 301 fatalities

Govt struggles with JE vaccination target

KHWAJA JAMAL IN MUZAFFARPUR

A child being vaccinated in Muzaffarpur on Monday. Picture by Lokesh Bihari
The health department is sweating it out to accomplish the target of immunising 92,200 children with Japanese encephalitis (JE) vaccines.

...
District immunisation officer Dineshwar Singh said the health department is burning the midnight oil to immunise 92,200 children.

Singh, however, added: ?A lot more is yet to be achieved. Not many immunisations were possible on the first day of the drive because of the inspection of the Union health minister. Because of the visit, most officials remained on their toes.?

Health officials are now involved in monitoring the drive and it would continue on June 24 as well because of lack of desired recovery.
...
Superintendent of Sri Krishna Medical College and Hospital G.K. Thakur said in the past 24 hours, seven new cases of AES have come to the health hub.

The number of total admissions related to AES reached 735. More than 130 children have died during the course of treatment, said a press note of the district public relations officer.
...
Four patients with AES have been admitted in Gaya?s Anugrah Narayan Medical College and Hospital since late Sunday evening.

ADDITIONAL REPORTING BY GAUTAM SARKAR IN BHAGALPUR AND ALOK KUMAR IN GAYA
http://www.telegraphindia.com:8080/1140624/jsp/bihar/story_18541378.jsp#.U6n2TvldXus
 
Re: India Encephalitis 2014 - 301 fatalities

Re: India Encephalitis 2014 - 301 fatalities

Published Date: 2014-06-25 05:57:33
Subject: PRO/AH/EDR> Japanese encephalitis & other - India (09): (BR) Reye-like synd. susp.
Archive Number: 20140625.2563561
JAPANESE ENCEPHALITIS AND OTHER - INDIA (09): (BIHAR), REYE-LIKE SYNDROME SUSPECTED
***********************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Tue 24 Jun 2014
From: TJ John <tjacobjohn@yahoo.co.in> [edited]


The annual recurring summer season (pre-monsoon rains) outbreaks of acute central nervous system disease in Muzaffarpur district of Bihar, during Litchi [lychee] harvesting season, is quite different from other outbreaks that occur in other parts of Bihar and elsewhere in India post-summer (during and after monsoon rains). This year [2014], the outbreak began in the 1st week of June 2014 and has affected a very large number of children.

Typically, a child is found either unconscious or with seizures early in the morning. The cerebrospinal fluid is clear without inflammatory cell response (less than 5 cells per cubic mm). "CSF gushes out," said one pediatrician, indicating brain edema. The moderator's observation of similarity with Reye syndrome is correct. Individually, each child fits with Reye syndrome diagnosis.

The special feature here are the large numbers of children getting Reye-like encephalopathy in a short period of time (2 months). It is this phenomenon of clustering that fooled people to think of an outbreak due to some infection, hence encephalitis, virus unknown, hence acute encephalitis syndrome (AES). That mistake continued until 2013 when I was invited by the Bihar government to assist. Once I saw cases and made the diagnosis, things have changed rapidly, but unlearning old lessons is difficult for many. There is only so much one individual can do, but I am grateful to the Bihar government for the invitation. In India, there is lack of clarity as to which government -- State or Federal -- is in charge of outbreaks. I am helping the Bihar State government, while the Federal government had been sending various teams during the past many years. Why they do not work with me in cooperation is not known.

I have strongly recommended that the term AES be abandoned, as it is useless and harmful. The Muzaffarpur disease is a form of acute hypoglycemic encephalopathy. I had personally taken classes to the pediatricians of both the hospitals in Muzaffarpur and all Medical Officers of Primary Health Centers (PHC) prior to this year's [2014] expected outbreak and requested them to do lumbar puncture on every child to make sure we do not miss an occasional meningitis or encephalitis. (Among children admitted to the "encephalitis ward," I saw some with bacterial meningitis that would have been clubbed with the outbreak cases).

Secondly every child's blood glucose level must be tested and every child given 10 percent dextrose even before blood glucose value is available. This year [2014] (I am just back from Muzaffarpur), I can confirm that the disease is undoubtedly hypoglycemic encephalopathy (with blood glucose levels below 40 in about half the children in whom testing was done), and lower than 80 in 80-85 percent. The lesson was to give 10 percent dextrose infusion as soon as possible after drawing blood for glucose measurement. Pediatricians who did these tell me that children given 10 percent dextrose within a short period of onset tend to recover within a few hours and are well to go home the next day.

The instruction from the government so far has been to transport children from villages to the tertiary care hospitals in the city. This results in delays of a few hours. A few days ago, one PHC Medical Officer saw a child at around 7:30 AM, within a half hour of onset, and after taking blood for glucose measurement, infused 10 percent dextrose. Within a half hour, the child sat up with open eyes to the delight of everyone. Blood sugar value was 30 mg [/dL]. So I am advising that PHCs should be made ready for treating these children, and only those who really need more tests or treatment need be referred out.

I have tried hard to obtain a few liver biopsies to look for microvesicular fat inclusion bodies but have failed. In the 2015 season, I hope I will succeed. I understand the difficulties the local pediatricians face. They work really hard, and some feel very upset about so many sick children being hospitalised and many dying. They do not get additional hands to deal with the workload. Then, other investigators come and tell them this is viral encephalitis and keep collecting CSF and serum samples for virology. The public is told that the cases are encephalitis; some even say Japanese encephalitis (and JE vaccination is demanded and is being provided); others still call this AES. Sane voices are crowded out by such cacophony. My hand extended to CDC has not been reciprocated.

What causes Muzaffarpur outbreaks of Reye syndrome (or hypoglycemic encephalopathy)? I know of 3 suggestions: One, heat encephalopathy. Certainly, the disease occurs in the height of summer, but the age distribution (all under 10 years) and the early morning onset are against heat disease. In Bangladesh, where litchi-associated encephalopathy has been reported, the suspicion was that organo-chlorine pesticides may be the cause. This line will be explored by my colleagues in Muzaffarpur. The 3rd possibility is litchi-seed-associated methylenecyclopropylglycine (MCPG), and this will also be investigated by my colleagues in future (Ref: John TJ, Das M. Current Science 2014; 106: 1184-1185).

Hope these details will clarify the Muzaffarpur situation.

--
T Jacob John
Christian Medical College
Vellore, Tamil Nadu, India
<tjacobjohn@yahoo.co.in>

[ProMED-mail thanks Dr. John for his comments. He suspects, as we did, that a Reye-like syndrome is the likely diagnosis in this outbreak in children in Muzaffarpur (see moderator ML's comments in ProMED-mail post Japanese encephalitis and other - India (08): (BR) 20140623.2558283).

In 1963, Reye and co-workers reported their clinical and pathological observations in 21 children with encephalopathy and fatty change in viscera (Reye RD, Morgan G, Baral J. Encephalopathy and fatty degeneration of the viscera. A Disease entity in childhood." Lancet 1963;2 (7311): 749-52. doi:10.1016/S0140-6736(63)90554-3. PMID 14055046). The illness usually begins as a non-specific febrile syndrome that is then followed by profuse vomiting, altered mental status, convulsions, coma, and death. Hypoglycemia (low blood sugar level) occurs in most cases, accompanied by elevation of blood transaminase and ammonia levels with an acute non-inflammatory encephalopathy, cerebral edema, increased intracranial pressure, and fatty degeneration in the liver and kidneys. The pathogenesis of Reye syndrome appears to involve mitochondrial injury.

Most cases of Reye syndrome were associated with use of aspirin during the illness. In the United States, Reye syndrome became a reportable disease in 1973, and the government began issuing warnings about the association between this syndrome and aspirin. A dramatic decrease in the use of aspirin among children then was followed by a marked decrease in incidence of Reye's syndrome. However, other drugs and mitochondrial toxins (e.g., insecticides) may also be associated with Reye-like syndrome. Several plant species contain substances that have hypoglycemic potential, e.g., the toxin hypoglycin A, which is present in unripened fruit of the ackee tree, can cause Jamaican vomiting sickness (Barceloux DG. Akee fruit and Jamaican vomiting sickness (Blighia sapida Koenig). Dis Mon. Jun 2009;55(6):318-26).

As mentioned by Dr. John, the current outbreak in Muzaffarpur has been attributed by some to consumption of litchi (AKA lychee) fruit (http://zeenews.india.com/news/healt...ausing-acute-encephalitis-syndrome_28452.html). Although this news article attributed the illness to a "litchi virus," lychee seeds have been found to contain a toxic substance alpha-(methylenecyclopropyl) glycine that can induce hypoglycemia in experimental animals (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1243468/?page=1). - Mod.ML]

[It is worth having a look at Dr. Lloyd Olson's comments (archive no. 20131011.1995836). He noted: "In the province of Udorn, northeastern Thailand, of 3000 children admitted to the provincial hospital during 1969, we observed at least 83 children with the clinical features of acute encephalopathy (Pediatrics 1971; 47: 707-16). 46 died, all within 72 hours of the onset of symptoms. The disease was characterized by the sudden onset of fever, vomiting, and headaches progressing to seizures and coma. Almost all children were less than 6 years of age, and the majority of cases occurred during the late rainy season (August to October). This area is also endemic for JEV, and without autopsy and laboratory data, it would have been easy to confuse this syndrome with acute infection."

Curiously, the Udorn encephalopathy outbreak ended by the 1980s and never returned, whereas the Bihar cases recur year after year. Dr. Olson also indicated that there was a possibility of aflatoxin involvement. Mod.ML added that contamination of food by aflatoxin has been postulated as another cause of Reye-like syndrome. In any event, given Olson's and Jacob John's assessments, Japanese encephalitis seems to be ruled out in these early season cases. - Mod.TY

Location map of Bihar state at
http://www.mapsofindia.com/maps/bihar/bihar.jpg. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/142.]
See Also
...
http://promedmail.org/direct.php?id=20140625.2563561

MUZAFFARPUR 4 hours ago
ETV Bihar/Jharkhand | Wed Jun 25, 2014 | 12:51 IST
Encephalitis horror continues, 1 more kid dies; death toll mounts to 162
http://www.news18.com/locali/bihar/...kid-dies-death-toll-mounts-to-162-523361.html
 
Re: India Encephalitis 2014 - 303 fatalities

Re: India Encephalitis 2014 - 303 fatalities

Two more children died from AES
Publish Date: Monday, Jun 23,2014 08:27:14 PM | Updated Date: Monday, Jun 23,2014 08:27:58 PM

Two more children died from AES
Muzaffarpur: Acute Encephalitis season by softening Sindrom (AES) is a respite to children suffering. On Monday, two children died of the disease. Skemsiac resulted in the deaths of two children. The ten children were recruited. Kejriwal eight Skemsiac and two were hospitalized. 41 patients are being treated in two hospitals. The death toll from the disease reached 169. Shama in Skemsiac daughter of Mustafa panorama of today Pcgchiya Ahiapur, goraul Vaishali Sanjeev Kumar Paswan's son Aman died.
http://www.jagran.com/bihar/muzaffarpur-11420150.html

Ais in the deaths of two children
Publish Date: Thursday, Jun 26,2014 01:05:37 AM | Updated Date: Thursday, Jun 26,2014 01:05:50 AM

News reporter,Gaya (the city) has Anugrah Narayan Magadh Medical College cum Hospital Ais disease deaths continues. On Wednesday, two more children die AES grown. Still in the hospital two children living and dying, while two children discharged from the hospital said.
Hospital Superintendent Dr. Sudhir Kumar Sinha said previously hospitalized Nawada 5-year-old Kanchan Kumari's death Tuesday late at night. While in critical condition Ais suffering from conch 6-year-old Kajal Kumari on Wednesday admitted it. But he survive for long could not. Wednesday evening mascara handedly broke. Mr Sinha said that two children were still Ilajrt amenities. While two other children from leave has been granted.
Here tell that by now the Aanmsiac the Ais Wednesday evening 7 children have died. Ais and JE suffering child before 12 June Aanmsiac admitted was. So far 11 children Ais and JE suffering have been found.
http://www.jagran.com/bihar/gaya-11426926.html
 
Re: India Encephalitis 2014 - 305 fatalities

Re: India Encephalitis 2014 - 305 fatalities

ETV BIHAR JHARKHAND @ETVBIHARJHARKHA ? 5m
Bihar - Death Toll with Encephalitis rose to 166 in Muzaffarpur

https://twitter.com/ETVBIHARJHARKHA

Encephalitis epidemic persists in Poorvanchal
TNN | Jun 27, 2014, 10.34 AM IST

GORAKHPUR: Despite huge claims made by state and central government of providing better medical treatment to encephalitis patients, the mortality rate due to the disease has doubled in the last three years.

As per BRD Medical College reports, in the year 2011, only 18% encephalitis patients died but this year it has risen to 36%. In 2012, the mortality rate was 20.93% whereas in 2013, 29.33%. The increase in the last three years raises question on the claims made by the government.

Though an epidemic ward equipped with modern facilities was built for encephalitis patients in the year 2008 and a lot of money was also spent for medicines and other resources but the percentage of death is rising which is a subject of deep concern.
...
http://timesofindia.indiatimes.com/...sists-in-Poorvanchal/articleshow/37303427.cms

Ro's note - Using data from http://www.scielo.br/pdf/bjid/v16n6/v16n6a11.pdf and http://nvbdcp.gov.in/Doc/je-aes-till-May14.pdf, the statewide Uttar Pradesh cfr for AES for the past 11 years is;
2004: 22.1
2005: 24.7
2006: 22.8
2007: 21.3
2008: 17.8
2009: 18.1
2010: 14.0
2011: 16.6
2012: 16.0
2013: 19.7
2014: 20.4 (to May 31st)
Ave 19.4%, med 19.7%.

Is it possible that BRD's cfr is so much higher simply because it is viewed as the "encephalitis hospital" where critical cases get transferred as a last resort?
 
Re: India Encephalitis 2014 - 307 fatalities

Re: India Encephalitis 2014 - 307 fatalities

Indian health ministry orders encephalitis vaccination in select districts after more than 500 deaths
vipin m. vashishtha, Pediatrician
Mangla Hospital & Research Center, Bijnor, Mangla Hospital & Research Center, Shakti Chowk, Bijnor, Uttar Pradesh, India

Synchronized, detailed investigations, not JE vaccination are need of the hour
27 June 2014

Apropos the news item (1), the response of the Indian health system to any outbreak of a brain disease seems stereotyped with a ?knee jerk-like? response. Any instance of AES (which is in itself is a misnomer), anywhere in the country, is seen as yet another instance of acute viral encephalitis, supposedly caused by JE virus, and yet another opportunity to order mass vaccination against it. The authorities think vaccination against JE is the panacea for all such outbreaks. Hardly any thought is spared to first confirm the exact etiology.
As a result, the move fails to contain the recurrent outbreaks that lead to deaths of hundreds of children every year in different parts of the country. The case of Bihar is very peculiar. Recurrent outbreaks are occurring in the Muzaffarpur and adjoin districts for last many years with a very distinct seasonality. All the available features like affection of uniformly poor, young rural children of a narrow age group, involvement of only malnourished kids, failure to identify an etiological agent including JE virus despite intensive investigations year after year, absence of JEV infection in vector mosquitoes, etc, point toward non-infectious pathology. Involvement of JE as a probable etiology behind these outbreaks is also ruled out by a recent entomo-virological study from Muzaffarpur (2). A few researchers have identified these outbreaks as heat stroke (3) and others have indicated possibility of methylenecyclopropyl-glycine (MCPG) as a toxin responsible for a hypoglycemic encephalopathy (4). All the available pointers lead toward a non-infectious, probably a toxin-mediated etiology where litchi-cultivation is to be blamed. It is not a mere coincidence that outbreaks with similar features are reported from yet another litchi producing region of the country Malda (5) and from other countries like Vietnam (6) and Bangladesh (7). Whether any biological toxin contained in the fruit itself or any pesticide employed in the cultivation or some other toxin involved need to be determined.

The move to merely order mass JE vaccination seems not only unwarranted but may also shift the attention from ascertaining the actual etiology of these outbreaks and later instituting measures to control them. In a similar instance in western Uttar Pradesh, India, where recurrent outbreaks of an unknown brain disease was responsible for the deaths of hundreds of young poor children year after year (8, 9), the GoI instituted massive campaigns of JE vaccination in many districts. But they failed to have any impact. Later, it was discovered consumption of a local weed, cassia occidentalis and a multisystem illness, ?acute hepatomyoencephalopathy syndrome (erroneously referred as to ?Saharanpur Encephalitis) was responsible for the recurring outbreaks, not viral encephalitis (10). And massive health education measures led to disappearance of the disease in just few years (11).

Currently, the outbreak investigation in India looks like five blind people describing an elephant. So, what India needs is a well coordinated, thorough systematic outbreak investigation approach with correct methodology to investigate all these recurring outbreaks of unknown etiology rather than clubbing them under one head of viral encephalitis and resorting to empiric preventive measures like mass JE vaccination programs. A thorough approach would entail first defining the clinical entity, histopathogical investigations including autopsies, if required, and detailed epidemiological and toxicological investigations in a coordinated manner.

References:

1- Travasso C. Indian health ministry orders encephalitis vaccination in select districts after more than 500 deaths. BMJ 2014;348:g4209
2- Samuel PP, Muniraj M, Thenmozhi V, Tyagi BK. Entomo-virological study of a suspected Japanese encephalitis outbreak in Muzaffarpur district, Bihar, India. Indian J Med Res 2013; 137: 991-992.
3- Sahni GS. The recurring epidemic of heat stroke in children in Muzaffarpur, Bihar, India. Ann Trop Med Public Health 2013;6:89-95.
4- John TJ, Das M. Acute encephalitis syndrome in children in Muzaffarpur: hypothesis of toxic origin. Current Science 2014; 106: 1184-1185.
5- Litchi virus kills 8 kids in Malda. Available from: http://timesofindia.indiatimes.com/city/kolkata/Litchi-virus-kills-8-kid...
6- Paireau J1, Tuan NH, Lefran?ois R, Buckwalter MR, Nghia ND, Hien NT, et al. Litchi-associated acute encephalitis in children, Northern Vietnam, 2004-2009. Emerg Infect Dis. 2012; 18:1817-1824.
7- Biswas SK. Outbreak of illness and deaths among children living near lychee orchards in northern Bangladesh. ICDDRB Health Sci Bull 2012; 10: 15?22.
8- Kumar S. Inadequate research facilities fail to tackle mystery disease BMJ 2003; 326 : 12.
9- Vashishtha VM, Nayak NC, John TJ, Kumar A. Recurrent annual outbreaks of a hepato-myo-encephalopathy syndrome in children in western Uttar Pradesh, India. Indian J Med Res 2007; 125 : 523-533.
10- Vashishtha VM, Kumar A, John TJ, Nayak NC. Cassia occidentalis poisoning causes fatal coma in children in western Uttar Pradesh. Indian Pediatr 2007; 44 : 522-525.
11- Panwar RS. Disappearance of a deadly disease acute hepatomyoencephalopathy syndrome from Saharanpur. Indian J Med Res. 2012;135:131-132.
http://www.bmj.com/content/348/bmj.g4209/rr/703565
 
Re: India Encephalitis 2014 - 307 fatalities

Re: India Encephalitis 2014 - 307 fatalities

ETV BIHAR JHARKHAND @ETVBIHARJHARKHA ? 4h
Bihar - One More Child died with Encephalitis at SKMCH, Muzaffarpur. Death toll reached 169
https://twitter.com/ETVBIHARJHARKHA

Mystery disease claims 176 lives in Bihar
The Statesman28 Jun 2014 |

statesman news service
Patna, 27 June
A mystery disease has broken out in an epidemic form in Bihar, claiming the lives of as many as 176 children in the past one month.
Initially, the disease was reported from northern Bihar?s Muzaffarpur district but now it has been spread to several other districts of Bihar, including Gaya in the south and Bhagalpur in the east.
What is peculiar is that health experts are still to identify the killer disease despite the fact that it has been an annual feature. While some claims it to be as suspected Encephalitis, others describe it as Acute Encephalitis Syndrome (AES). However, renowned expert Dr T Jacon John, retired head of clinical virology at CMC Vellore, who visited the affected area of Muzaffarpur last week, claimed the deaths were actually due to Acute Hypoglycaemic Encephalopathy which is a metabolic disease and can occur due to low blood sugar.
...
http://www.thestatesman.net/news/62227-mystery-disease-claims-176-lives-in-bihar.html
 
Re: India Encephalitis 2014 - 314 fatalities

Re: India Encephalitis 2014 - 314 fatalities

Reports from Atlanta, did not check virus AES
Publish Date: Saturday, Jun 28,2014 11:34:20 AM | Updated Date: Saturday, Jun 28,2014 11:34:52 AM

Reports from Atlanta, did not check virus AES
Muzaffarpur: The disease is fatal to children, acute encephalitis syndrome (AES) is not a virus. CS office team reached the first report of the CDC in Atlanta. Report that over the past seven years was examined virus. In the year under scrutiny 13 'Known Virus "was held. Blood of children from Muzaffarpur and its surrounding districts - were collecting water samples of urine and spine. If it did not detect any virus in check. The team from the U.S. neurosurgeon Dr. Jims Saviers been investigated in monitoring and sample collection. Civil surgeon Dr Jञanbhusn said the CDC in Atlanta and NCDC Delhi team is the first pathological investigation reports. The virus does not cause disease in children. This is the first report. However, many organizations are individually investigation is continuing. Still further, the report said. Until the exact cause of the disease is not known, until then will continue to research and study. Issued by the State Government before the diagnosis and treatment based on protocol. JE report, encephalitis, meningitis, Cikengunia, malaria, kala-azar and other diseases which may result from viruses, they are not.
http://www.jagran.com/bihar/muzaffarpur-11433438.html
 
Re: India Encephalitis 2014 - 314 fatalities

Re: India Encephalitis 2014 - 314 fatalities

Health Minister at Centre for Disease Control and Prevention, Atlanta
Seeks knowledge sharing agreement for fight against encephalitis, other diseases

Union Health Minister Dr. Harsh Vardhan yesterday held a four hour long meeting with top experts at the world famous Centre for Disease Control and Prevention (CDC) at Atlanta.

During the talks, the Health Minister highlighted the annual visitation of Japanese encephalitis and acute encephalitis syndrome (AES) which leads to heavy loss of life in Uttar Pradesh and Bihar.

The Minister, who is on an official tour of the US, said, “Though I have personally visited the affected areas of the two states recently and overseen an immunisation drive, I feel that CDC’s research assistance could go a long way in understanding the root causes (etiology) of AES which is still a mystery. So I made a request to Dr Tom Frieden, Director in this regard.

Dr Harsh Vardhan also discussed the possibility of CDC giving technical assistance for development of early warning, epidemic preparedness and response, development of field friendly rapid diagnostic kits and bilateral cooperation for development of Dengue vaccine.

The Minister visited the Emergency Operations Centre of CDC. Dr Steve Monroe, one of the senior functionaries, highlighted the emerging and zoonotic infectious diseases which are of grave concern before the world community.

During the talks, the problems faced by India in combating multi-drug resistant (MDR) TB were raised. The CDC’s scientists had identified the chief problems in India as being poor health coverage, inadequate data on the rising MDR cases and cases of hospital employees catching the infection.

There was much focus on tobacco control environmental and occupational medicine. The Minister and the CDC specialists exchanged views on programmes for diabetes, hypertension, ending the culture of physical inactivity and on the need for strengthening global health security.

Dr Harsh Vardhan requested Dr Frieden that CDC carries out an objective assessment of India’s TB control programme. The CDC director suggested that the Indian government strengthen the programme’s management at the national, state and district levels.

The Health Minister reiterated his intention of making health for all a social movement in India. Dr Frieden responded saying that the excellent social mobilisation network set up for the pulse polio mission in India should not be dismantled. Rather it should be used for strengthening the immunisation drives for achieving 100 percent immunisation coverage for all vaccine preventable diseases with special focus on measles elimination and rubella control for the near future.

The CDC delegation shared information with the visiting Indian minister on research progress into a variety of diseases. The future would see more collaboration between India and this premier institute.

The Health Minister announced that it had been decided that CDC would designate a doctor who would work for better coordination of the India projects of the organisation by acting as a communication bridge between the Director and India’s Health Minister.

******


MV
(Release ID :105942)
http://pib.nic.in/newsite/erelease.aspx?relid=105942

MUZAFFARPUR 4 hours ago
One more child dies of encephalitis, death toll mounts to 170
ETV Bihar/Jharkhand | Sat Jun 28, 2014 | 18:24 IST
http://www.news18.com/locali/bihar/...phalitis-death-toll-mounts-to-170-527287.html
 
Re: India Encephalitis 2014 - 315 fatalities

Re: India Encephalitis 2014 - 315 fatalities

Continued risk of Encephalitis 6/28/2014 11:20:46 PM
Muzaffarpur. Inseflaitis Acute Syndrome has become life-threatening to children - AES factor is not a virus. CS office on Friday, the first report of the CDC team arrived in Atlanta. It was reported that last year over seven virus was examined.


The team from the U.S. neurosurgeon Dr. 0 Jims Saviers been investigated in monitoring and sample collection. Civil Surgeon Dr 0 Jञanbhusn CDC Atlanta and NCDC Delhi said the investigation team from the first pathology report is received. Children, according to which the virus does not cause disease. This is the first report. Well many other organizations also individually investigation is ongoing. Come forward and report. While the exact cause of the disease is not known, then it will continue to research and study. Issued by the State Government before the diagnosis and treatment based on protocol. JE report, Inseflaitis, meningitis, Cikengunia, malaria, kala-azar and other diseases which are Wayrsse Sati, they are not.


Uttar Bihar Inseflaitis Acute Syndrome - AES is faster havoc once again. On Friday, killing five children. In this way the total number of children dying from the disease has risen to 181. Civil Surgeon Dr 0 Jञanbhusn reviewed the Skemsiac and Kejriwal arrived at the hospital. He's bitterness Seyh situation has arisen suddenly. Today, 11 new patients were admitted. Kejriwal 8 Skemsiac and three of these had been hospitalized. Currently, 40 patients are being treated in two hospitals.

- See more at: http://www.patrika.com/news/continued-risk-of-encephalitis/1014869#sthash.RCMF5ujn.dpuf
 
Re: India Encephalitis 2014 - 326 fatalities

Re: India Encephalitis 2014 - 326 fatalities

Uttar Pradesh

So far 76 deaths from encephalitis in Purwancl


Gorakhpur (Amit Roy) became Purwancl breaking havoc on the Masumo Encephalitis is not to stop the scourge of disease. The death toll from the disease is increasingly evident. Encephalitis usually stay at the peak of the rainy season begins before the start of this season has started to show its effects.
patient's Medical College January, has 276 yet Watchmens far dead's 76 patients 's. In the last three decades, the disease Purvanchal border areas of Bihar not only innocent, even thousands of calls stored in the cheek and the season began, the minister and the administrative authorities have launched attacks.

Today (Saturday) Principal Secretary Medical Education VS Medical College encephalitis ward observe Bhullar took stock of the situation and prevent the disease control measures discussed at the Medical College administration. He suffered from encephalitis sharply from 100 beds in the new ward shortage of man power will soon be overcome.

Bhullar said sharply mortality from this disease in order to prevent possible
* Efforts are being trained to meet the rural zones Carykartion hope so she went to the villages to educate people about the disease and its. Please provide information about the rescue. Masumo suffering from encephalitis to identify the nearest health center to take her for treatment.

http://www.bhaskarnewsonline.com/news2.aspx?id=105409#.U6_px_ldXus
 
Re: India Encephalitis 2014 - 327 fatalities

Re: India Encephalitis 2014 - 327 fatalities

US nod to sample test

KHWAJA JAMAL IN MUZAFFARPUR
The Union health minister has cleared the process of sending blood and cerebrospinal fluid samples of children affected by the mystery disease from Muzaffarpur and adjoining districts to US for research.

Two experts from Centre for Disease Control, Atlanta, US, James Xavier and John D. Thomas, had visited Muzaffarpur twice in May and June. They stayed for over a fortnight to oversee the treatment of suspected encephalitis-affected children and supervise collection of samples for laboratory investigation in Atlanta. The experts had left Muzaffarpur with the samples and stored them in the National Centre for Disease Control, New Delhi.
...
The inclement weather has brought a relief to the virus threat. ?In the past 24 hours, no new case was received at SKMCH or Kejriwal Maternity Clinic,? Thakur said.
http://www.telegraphindia.com:8080/1140630/jsp/bihar/story_18563613.jsp#.U7E02vldXus
 
Re: India Encephalitis 2014 - 327 fatalities

Re: India Encephalitis 2014 - 327 fatalities

Bihar - Gaya

Inseflaitis in the deaths of two children
Publish Date: Tuesday, Jul 01,2014 01:03:17 AM | Updated Date: Tuesday, Jul 01,2014 01:03:49 AM

Dialogue partners (the city) has Anugrah Narayan Magadh Medical College these days is constantly dying from the disease Inseflaitis and AES. Two children were killed on Sunday by Inseflaitis. Deceased was a resident of the district Kijrsray point Sliver mediatory 4 year old daughter is a virgin. The number of children dying has risen 8.
Co-Deputy Superintendent in charge of the hospital superintendent Dr Kameshwar Mandal said two children were admitted on Sunday. Both the children's condition was critical. Nawada Hisua Sunday evening and late night spot Kum Kum three-year-old baby has died. The number of children dying has risen 8. He is now a total of 17 children were admitted with AES and Inseflaitis disease. The 8 children have died. 3 It has been discharged after treatment. Without notice to the child to have his family with him. Infant ward of the hospital in ICU and five children are still being treated.
http://www.jagran.com/bihar/gaya-11440000.html
 
Re: India Encephalitis 2014 - 329 fatalities

Re: India Encephalitis 2014 - 329 fatalities

From idsp reports weeks 23 & 24

Malda
Acute Encephalitis Syndrome
69 cases 29 fatal 05/06/14 06/06/14
Under Surveillance
Cases of fever associated with diarrhea, vomiting and
convulsions reported from English bazar, GP Kaliachak-1,
II, III, District Malda. District & State RRT investigated the
outbreak. Active search for cases done. Cases treated
symptomatically. Majority of cases were malnourished and
dehydrated children between age group of 2-5 years. Entire
village is surrounded by litchi garden. Stool and throat swabs
were taken from 8 cases by School of Tropical Medicine. 4
CSF, 2 rectal swabs collected and sent to STM, Kolkotta.
ELISA test for Dengue, Chikungunya and JE was non
reactive. Litchi samples were collected for chemical
analysis. Pesticide Alpha Cyphermethrin was found above
Minimum Safe Limit in Litchi samples. Health education
done regarding hydration of children.
http://idsp.nic.in/idsp/IDSP/23rd_wk14.pdf

Malda
Acute Encephalitis Syndrome
69 cases 31 fatal 05/06/14 Under Surveillance
Cases of fever associated with diarrhea, vomiting and convulsions reported from
English bazaar, GP Kaliachak-1, II, III, District Malda. District & State RRT
investigated the outbreak. Active search for cases done. Cases treated
symptomatically. Majority of cases were malnourished and dehydrated children
between age group of 2-5 years. Entire village is surrounded by litchi garden. Stool
and throat swabs were taken from 8 cases by School of Tropical Medicine. 4 CSF,
2 rectal swabs collected and sent to STM, Kolkata. ELISA test for Dengue,
Chikungunya and JE was non reactive.10 serum samples sent to NIV, Pune for
testing of West Nile Virus, Chandipura virus and Japanese Encephalitis, tested
negative. Litchi samples were collected for chemical analysis. Pesticide Alpha
Cyphermethrin was found above Minimum Safe Limit in Litchi samples. Health
education done regarding hydration of children.
http://idsp.nic.in/idsp/IDSP/rcntobrk.pdf
 
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