Muzaffarpur in Bihar may have been hogging headlines for the death of the kids due to Acute Encephalitis Syndrome (AES), but experts point out that the disease has been endemic to the entire State with all the districts reporting the cases that are fatal to kids.
Following the analysis of total 4,400 cases of AES reported between 2009 and 2014, with an average of 733 cases per year, a team of researchers in their study also noted that the AES cases start appearing in April and reach a peak in June and then decline.
"There is another peak of Japanese Encephalitis (JE) cases in October. The confirmed fatal rate (CFR) of AES and JE ranges from 5 per cent to 35 per cent in Bihar," said the researchers in their study 'Status and trend of acute encephalitis syndrome and Japanese encephalitis in Bihar, India' published in National Medical Journal of India in 2018. There were a total 1309 deaths during the period.
"The disease peaks were during the start and end of the Indian summer and monsoon months for AES and JE, respectively. Districts such as Patna, Jehanabad, Nawada, Gaya and East Champaran reported the maximum number of AES and JE cases with annual incidence rates of 4.7-25.0 and 0.546-1.78 per 100 000 population, respectively," said the study.
The experts have stressed on strengthening the reporting and surveillance mechanism in all the districts of the state. They also called for encouraging reluctant private practitioners in surveillance activities especially for cases of AES. Intense information, education and communication (IEC) activities must be started at the village level to increase participation from the community and to improve the long-term passive surveillance.
The team included Praveen Kumar and PP Sarthi from Centre for Environmental Sciences, Central University of South Bihar, Patna, PM Pisudde from ESIC Medical College, Sanat Nagar, Hyderabad, MP Sharma, State Programme Officer (Malaria), Chief Malaria Office, Patna and VR Keshri from Bihar Technical Support Programme, Care India, Patna.
Acute encephalitis syndrome (AES) is a multifactorial clinical condition, the most common cause being Japanese encephalitis (JE). JE is a vector-borne viral disease caused by the JE virus of group B arbovirus (Flavivirus) and is transmitted to humans by the Culicine mosquito.
JE affects the central nervous system (CNS), and can cause serious complications and death. The CFR is high and those who survive may suffer from neurological squeal such as convulsions, episodic headache, autonomic disturbance, abnormal behaviour, mood disorder, intellectual deficit, paresis, incoordination of movements, jerky limb movements, speech disorder, cranial nerve palsy, gaze palsy, Parkinsonian features, impaired hearing, etc.
An estimated 25 per cent of affected children die from the disease, and among those who survive, 30 per cent-40 per cent suffer from physical and mental impairment. Children suffer the highest attack rate due to lack of cumulative immunity from natural infections, said the study.