When how many children died in Malkangiri of Japanese Encephalitis (JE)/ Acute Encephalitis Syndrome (AES) or now labelled Acute Hepatomyo Encephalopthy syndrome (AHE) is the burning question, the State Health Department seems to be in complete confusion leaving the people at Malkangiri crestfallen with climbing fatalities.
While State Health Department has put the death toll figure at around 122 till date, the Union Health and Family Welfare Ministry’s regional office here pegs mortalities at around 140 (of which 137 deaths recorded till November last and around 3 in December). The detailed data shows that JE related deaths were around 36-39 and rest owing to AES.
Significantly, when the death toll still keeps ticking, the State Government seems wriggling out of the mess with the alibi that Cassia occidentalis consumption is cause of deaths in Malkangiri courtesy the discovery by State appointed expert team led by Dr Jacob John.
However, a very senior scientist in the Regional Medical Research Centre (an arm of ICMR) disputes the claim. Reason: The State Health Department and also the Centre put the deaths under JE/AES; whereas Cassia-toxin induced death would be called Acute Hepatomyo Encephalopthy syndrome (AHE). In AHE, the key sign is vomiting and liver dysfunction followed by late onset of mild fever. AHE is very fatal because it results in hypoglycaemia condition (means very low blood sugar affecting central nervous system) and leads to patient’s death in 24-48 hrs, provided the glucose level is not restored immediately.
Why did the State Health Department choose Dr JacobIJ It is Jacob who after studying encephalitis deaths in UP and Bihar (2003 - 2013) concluded the deaths there to Cassia - toxins or litchi-toxin induced deaths. However, the rider here is study by Dr Jacob is not based on histopathlogical examinations to find out microscopically any fatty acid degeneration in liver parenchyma cells, RMRC scientist informed and added that it was only a hypothesis based on toxin nature of Cassia and views of some families.
Interesting in Odisha too is the conclusion of Dr Jacob in Malkangiri is not based on any clinical study. The team shared its conclusion based on symptoms of some patients, availability of Cassia and accessibility of it to tribals in a Press interaction here.
While the Central team, that included RMRC scientists, post its visit observed it to a JE outbreak affecting mostly the malnourished children in the district and asked the State to study further for the cause of AES, the State appointed expert team led by Jacob diagnosed the deaths as AHE. Without pathological study of liver, skeletal muscles and brain, the team concluded it to AHE and the Odisha Government went into the mode of business as usual when an entire districts’ progeny is at risk.
Another contention to this AHE theory is how it peaked in post monsoon in Malkangiri this year, and why no such cases have come to fore before in earlier years.