Cure May Come Soon

by Shibani Dasgupta

It has been plaguing the State since 1978 and continues to strike in the month of August and peak in September-October. Earlier it was believed that it is the Japanese Encephalitis but now the experts are having second opinion. In the midst of this debate there is hope that a cure will be found in the near future.

The Uttar Pradesh government and the Centre are in a major fix on the death of over 350 children in the eastern part of the state this year of suspected Japanese Encephalitis, but very recently it has been said by medical studies that JE may not be the cause of the tragic deaths.

More than 350 people, mostly children have succumbed to the dreaded encephalitis in Uttar Pradesh since August this year and the sheer number of casualties has once again exposed the state government's claims and also the limitations of the preventive measures.

According to reports from Lucknow, Gorakhpur, Kushinagar and Maharajganj districts of Gorakhpur divisions in eastern UP have borne the brunt of the fatal disease with the majority of the victims belonging to the villages in these districts. As many as 222 children have died in the pediatrics ward of Baba Raghav Das Medical College in Gorakhpur.

Considered one of the biggest health problems in India since 1978 when the disease was first noticed, encephalitis (Japanese Encephalitis) to begin with and now Entero-Viral Encephalitis, normally breaks out in August and reaches its peak in September-October before declining. It has been estimated that about 17,000 cases of encephalitis have been reported in the region since 1978.

According to the doctors at the BRD Medical College, an average of 20 to 40 cases of acute encephalitis syndrome were admitted daily till September this year but since then the number of fresh arrivals had declined to 16 or 17 cases per day. According to senior doctors in the pediatrics department at the hospital, a new dimension has been added to the health problem associated with the disease. Only about 15 percent cases were that of JE, the majority 85 percent victims carried non-JE virus called entero-virus, hence the name entero- viral- encephalitis.

Since the focus has shifted from JE to EVE, preventive measures too need a fresh look. Entero viruses enter the body through eye ailments and human excreta, as such fogging to eradicate the disease bearing mosquitoes is not the only solution to the problem. A massive state intervention is needed in the form of construction of water channels in villages, toilets and provision of safe drinking water, the doctors in Gorakhpur have strongly recommended.

Incidentally, vaccination is still considered the safest and best preventive measure and has to be adopted as a policy measure. The UP Legislative Council members taking interest in this outbreak point out that 67 lakh vaccines were administered in Gorakhpur division in 2006 but there has been no follow-up measure this year.

Pointing out that the disease was eradicated in other countries like China and Japan by administering vaccines to the children, the legislators say follow-up action keeping in mind the specific health needs of the region, has to be followed.

In yet another dimension to the ailment and its spread, a research study in the last four years has concluded viral encephalitis, may not after all be the culprit for the 350 or so deaths reported this year.

A four year study conducted in ten districts of Uttar Pradesh and two districts of Uttarakhand by a team of pediatricians, virologists and pathologists from UP, Tamil Nadu and Delhi - the findings of which were published in Indian Journal of Medical Research recently - concludes that the seasonal outbreak is not viral encephalitis but poisoning caused by the consumption of pods of a locally prevalent weed called kasondi or Cassia occidentalis.

It is understood that the study was submitted to both UP government as well as Central government, in September this year. The Central government has planned to send to UP a multi disciplinary team from the National Institute of Communicable Diseases (NICD) in Delhi to conduct an in-depth investigation into the findings of the study.

Experts from the National Institute of Virology in Pune are also being sent to investigate the killer virus. The Pune doctors at this stage are not willing to rule out the possibility of Japanese encephalitis. The NIV team would join scientists from NICD and Centre for Research and Medical Entomology Madurai.

The four year long research by a Bijnor based hospital's pediatrician team had established that the seasonal outbreak is hepato-myo-encephalogy caused by photo toxin that is a plant toxincausing an allergic reaction rather than encephalitis caused by a virus.

Media reports from Western UP say as the study moved on, a clear association was drawn between the consumption of Cassia occidentalis and the outbreak of the disease in the western region.

The plan grows luxuriantly in western UP with its flowering season in August-September and the seed -pod season in September-December, correlating to the seasonal disease outbreaks.

Till the doctors and researchers in different parts of the country pool together their knowledge, information efforts and brains, under privileged people will have to suffer in the coming years. But ultimately, man will defeat disease.