When it comes to encephalitis, the eyes of India have largely focused on Bihar’s Muzaffarpur district where more than 140 children are believed to have lost their lives to the condition. However, over the course of recent weeks, reports of potential outbreaks have poured in from other parts of Bihar – and from other states.
The Anugrah Narayan Magadh Medical College in tourist hotspot Gaya has reported six deaths due to what is expected to be acute encephalitis syndrome (AES). At the time of writing, 23 children have been admitted to the hospital and four are in critical condition. A definitive diagnosis of AES has yet to be confirmed, however.
Encephalitis outbreaks are not limited to Bihar. In addition to the 170 deaths being attributed to AES in the state, Minister of State for Health Ashwini Choubey has identified additional outbreaks in Assam, Jharkhand, Maharashtra, Manipur, Odisha, Uttar Pradesh, and West Bengal. These states have reported 63 deaths due to AES, Choubey stated.
The death toll from AES is likely to be much higher than the figures supplied by Choubey, given he cited National Vector Borne Disease Control Programme (NVBDCP) data from the beginning of the month. In the example of Assam, Choubey said 25 deaths had been reported. However, at the time of writing, the state has reported 234 AES cases from across 26 districts in the state, with 57 fatalities. It is being billed as the most vulnerable state in India to outbreaks of the disease.
ASSAM officials are responding with ‘fogging’, spreading insecticides within 100 metres of areas where JE cases are detected to kill off populations of the culex mosquito responsible for spreading the Japanese encephalitis virus (JEV). Steps are also being taken to ensure JE patients can avail treatment free of costs in government hospitals, with transportation to facilities for those in difficult-to-reach areas also being secured. Doctors’ leave has been cancelled in the state as the state still grapples with the outbreak.
Telangana is also reporting encephalitis cases, albeit to a lesser extent than what has been witnessed in Assam and Bihar. Health authorities have currently reported 21 cases this year. This is compared to twenty that were reported last year and eleven that were reported the year before. In response, officials are conducting a drive to expand coverage of the JEV vaccine to prevent cases. JEV vaccine coverage varies from eleven to 63 percent between districts.
Recent years have witnessed multiple instances of encephalitis outbreaks. Aside from the suspected outbreak in Muzaffarpur this year (with encephalitis being disputed by some as the cause of the deaths), Uttar Pradesh’s Gorakhpur witnessed in 2017 the deaths of scores of encephalitis-afflicted children due to shortages of medical oxygen.
A recurring trend identified in large-scale outbreaks of encephalitis seems to be inadequate healthcare infrastructure. The Bihar state government, in particular, is being castigated for what the National Human Rights Commission described as “deficiencies and inadequacies in the healthcare system”. The Supreme Court has ordered a report on the state of “medical facilities, nutrition, sanitation and hygiene conditions” in Bihar, shortly after the state was ranked in the bottom tier of states regarding performance on health indicators.
The Centre has pledged to the Supreme Court in recent days to establish a paediatric intensive care unit (ICU) in Muzaffarpur. As noted by Health Issues India, however, “wider improvements are needed for Bihar’s public health system to become fit for purpose.” The same is true at the national level – an imperative it is incumbent upon the state and central governments to realise.
Strengthening public health infrastructure is the need of the hour in a country beset by substandard healthcare that is responsible for 1.6 million deaths every year. States’ vigilance against potential encephalitis outbreaks in the wake of the Muzaffarpur tragedy is no doubt a positive sign. To avert such tragedies in the future, however, a sustained and robust effort is needed to create a public health system capable of delivering on the promise of “Health for All.”