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> 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. </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> Image copyright Getty Images Image caption Hundreds of children have been admitted to hospital since the start of June

More than 100 children have now died in an outbreak of suspected encephalitis in India's Bihar state, officials say.

At least 200 patients, many of whom are below the age of 10, are still being treated at two hospitals.

State officials have said that many victims had died due to hypoglycaemia, or low blood sugar.

Thousands of children have died of encephalitis in Bihar and neighbouring Uttar Pradesh since the first case was detected in the late 1970s.

The state has announced that it will bear the cost of treatment for all those affected.

The Indian government has said that it will "extend all possible support" to the state and affected families.

The outbreak since the beginning of June has seen the most number of deaths in the city of Muzaffarpur.

The disease usually occurs during the monsoon season and children are the worst affected.

Until 2005, doctors say that the the majority of deaths were caused by Japanese encephalitis, a mosquito-borne virus.

But in the past decade or so, children have been dying of other forms of viral encephalitis and the exact cause of which is unclear.

The disease causes headaches and vomiting and can lead to coma, brain dysfunction, seizure and inflammation of the heart and kidney.

Doctors say children between the age of six months and 15 years are the worst affected and a fifth of the children who survive have to live with neurological weaknesses.

"It is 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 BBC Hindi's Priyanka Dubey.

"It could also be due to malnutrition, insufficient levels of sugar and sodium or electrolyte imbalances."

Dr Kaneria added that some of these deaths could also be caused by eating lychees on an empty stomach.

Lychees contain toxins that inhibit the body's ability to produce glucose, which could affect young children whose blood sugar levels were already low because they were not eating dinner.

'All I know is that my child was fine a day ago'

BBC Hindi's Priyanka Dubey in Muzaffarpur

The thin glass door of the paediatric intensive care unit in the Shri Krishna Medical College cannot contain the sound of cries coming from inside.

Babia Devi was snivelling and crying as her five-year-old daughter, Munni, lay beside her in a corner inside the special ward.

Her mother, whose face is tear-stained, is convinced that her young daughter will not make it out of this hospital alive.

"The doctors have confirmed that Munni will not live. But I don't know what happened to the Munni I knew - who was healthy and playful," she tells me.

Neither she nor the doctors know what happened - they are unsure if Munni is a victim of encephalitis.

"All I know is that she was perfectly fine a day ago," she says.

They rushed to the hospital from their village on Saturday after Munni awoke with burning fever.

"There has been no improvement in her condition. She hasn't opened her eyes since we got to the hospital."

At another hospital in Muzzaffarpur, the mood is just as sombre.

Four-year-old Tamanna Khatoon lay on a bed inside the intensive care unit at Muzzaffarpur Medical College.

Her mother, Ruby Khatoon, is sobbing outside the room.

"In the last two days, no child from this hospital has recovered. All of them have died," she says.

"Did I painstakingly bring up this girl only to watch her die like this?"

In 2012, at least 390 people, mostly children, died in an outbreak of viral encephalitis in neighbouring Uttar Pradesh. More than 2,000 patients were admitted to hospital.

And in 2011, more than 460 people in northern India, mostly young children, died in one of the country's worst outbreaks of encephalitis.

In 2005, a virulent outbreak of Japanese encephalitis in Gorakhpur in Uttar Pradesh killed 1,000 people, mostly children. This was the worst outbreak since 1978. </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> 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> More than 100 children in the Indian state of Bihar -- home to some of the country's worst health indicators - have now been killed by a brain virus potentially linked to lychees, officials said.

[PATNA, India] More than 100 children in the Indian state of Bihar -- home to some of the country's worst health indicators - have now been killed by a brain virus potentially linked to lychees, officials said.

The northern state, one of India's poorest and home to almost 100 million people, is also in the throes of a major heat wave that is the country's second-longest on record and has so far claimed 78 lives.

Bihar has been struggling with an outbreak of Acute Encephalitis Syndrome (AES) since the start of June.

Eighty-five children have now died in the state's biggest government-run hospital - the Sri Krishna Medical College and Hospital (SKMCH), in the city of Muzaffarpur - and 18 others at a private facility, according to municipal officials cited by the Press Trust of India.

Most of the victims had suffered a sudden loss of glucose in their blood, health official Ashok Kumar Singh told AFP.

Such outbreaks have happened annually during summer months in the same districts since 1995, typically coinciding with the lychee season.

Several years ago, US researchers had said the brain disease could be linked to a toxic substance found in the fruit.

They also said more study was needed to uncover the cause of the illness, which leads to seizures, altered mental state and death in more than a third of cases.

TV channels showed distraught parents sitting next to their children, several of whom were cramped on one bed.

A doctor told a local TV channel that the SKMCH was ill-equipped to handle the rush of patients, most of whom were wheeled in semi-conscious.

Known locally as Chamki Bukhar, the disease claimed a record 150 lives in 2014.

Outbreaks of neurological illness have also been observed in lychee-growing regions of Bangladesh and Vietnam.

Meanwhile, the state has been experiencing temperatures around 45 deg C for several days, and authorities have imposed curfew-like restrictions.

Severe heat there has killed 78 people - most of them aged above 50 - across three districts since Saturday afternoon, local official Sandeep Kumar told AFP.

More than 130 others were undergoing emergency treatment for heatstroke in various hospitals.

Authorities in Gaya district - which has borne the brunt of the heat wave - invoked an Indian law to prohibit residents from going outdoors for non-essential work.

The district magistrate also banned construction work and any outdoor programme between 11.00am and 4.00pm.

Heatstroke is usually caused by prolonged exposure to sun or from physical exertion in high temperatures.

Daytime temperatures across large parts of India have hovered above 40 deg C for the past 32 days, just one short of a record 33-day period in 1988.

Temperatures touched 50.3 deg C in the town of Churu in the northern desert state of Rajasthan recently, just below India's record of 51 deg C.

Heatstroke has left more than 36 people dead in southern India in recent weeks. Large parts of India are also reeling from drought, with annual monsoon rains late in coming. </s> NEW DELHI — Thirty children have died at a public hospital in India over the past two days, with government critics blaming a shortage of oxygen for the surge after a supplier of liquid oxygen cut off deliveries because of unpaid bills.

Government officials were scurrying to explain what happened, admitting that the state-run hospital owed more than $50,000 to a supplier of liquid oxygen and that oxygen supplies had been “disrupted.”

“There was some payment issue to the oxygen supplier, and there was a shortage of liquid oxygen,” said Anil Kumar, the commissioner of Gorakhpur. But, he added, “those deaths were not due to lack of oxygen.”

Other officials said the hospital had a backup oxygen supply, though they did not explain why so many children had died in such a short time span. Since Monday, a total of 60 children have died at the hospital, many from acute encephalitis and others in the neonatal unit.

The hospital, Baba Raghav Das Medical College, is in Gorakhpur, a city several hundred miles east of New Delhi, India’s capital. It is the rainy season in India, a time when officials say it is not unusual for as many as 10 children to die there every day from Japanese encephalitis, a mosquito-born disease.
The death toll of Indian children who have died due to an acute encephalitis syndrome outbreak reaches 100.