Bihar Encephalitis Deaths

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Context: A high-level team of specialists constituted by the Centre to review the surge in acute encephalitis syndrome (AES) cases in Bihar, locally called( Chamki Bukhar)and to identify factor behind the nearly 200 deaths, making it the first major AES outbreak in the state since 2014. And the report reveals that heatwave is the major reason.

Relevance: GS- 3 Issues relating to the development and management of Social Sector/Services relating to Health.

GS-3 Science and Technology- developments and their applications and effects in everyday life.

 

In this respect, it becomes essential to know about Acute Encephalitis Syndrome (AES)

VECTOR
  • Transmitted to humans through bites from infected mosquitoes of the Culex species (mainly Culex tritaeniorhynchus).
  • Humans, once infected, do not develop sufficient viraemia to infect feeding mosquitoes.
  • The virus exists in a transmission cycle between mosquitoes, pigs and/or water birds (enzootic cycle)
CAUSE
  • Caused by several different viruses, bacteria, fungus, parasites, spirochetes, chemical/ toxins etc.
TARGET 
  • 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.
  • Least JE infections in infants (0-1 year)
SYMPTOMS
  • Acute onset of fever and
  • The clinical neurological manifestation includes mental confusion, disorientation, delirium, or coma.
  • Apart from viral encephalitis, severe form of leptospirosis and toxoplasmosis can cause AES
CURE 
  • Increase access to safe drinking water and proper sanitation facilities.
  • Improve the nutritional status of children at risk of JE/AES.
  • Vaccination
PREVENTION
  • Reducing the vector (mosquito) density.
  • Educate and improve the hygiene of people living in the JE endemic zones.
  • Providing proper nutrition to the AES-affected population as most of the affected people belong to the lower economic strata of the society.
  • JE vectors are exophillic and endophagic in nature. The risk of transmission increases when the human dwellings and animal sheds particularly piggeries are situated very close to each other. Piggeries may be kept away (4-5 km) from human dwellings. 

 

Related finding of high-level team of specialists :

  • Heatwave is the prime reason for the outbreak : the affected districts had temperatures of over 40 degrees for several days at a stretch. 
  • Mostly affected children are from the below poverty line family: as low level of nutrition and playing in the open area has acted as a stimulus to the high number of suffering from acute encephalitis syndrome (AES).
  • Girl child is more in number than boy child: This disease becomes deadly when children are affected by malnutrition under 5 and according to the National Family Health Survey-4, Bihar Factsheet is very looming. Out of the 168 children who died in Bihar's first major AES outbreak since 2014, 104 are girl child and they are more prone to malnutrition.
  • Many Primary Health Centre do not equip with dealing the situation and referred the patient to the big hospital which causes more burden on the pocket poor people, lead to the missing early hour treatment and hence it was also one of the reasons that affected the most.
  • Due to the Election campaign, many governments related task was not undertaken on time like a mass awareness campaign and necessary information to deal with the situation.
  • Changing food habit is also responsible for malnutrition earlier in the lean period people used to fish from the pond, but where are the ponds now,  and lacuna in the mid-day meal scheme.

Way Forward:

  • Awareness Campaign should not be for a limited period, it should be a long-drawn process, as new techniques and method are not known to the general public, so government should proactively involved with the people, NGO, and Asha Workers.
  • PHC should be properly maintained and equipped to deal with outbreaks.
  • Targeted age group to be identified and standard of procedure to be followed.

 



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