Gorakhpur losing encephalitis battle

Lucknow: The tragic deaths of more than 60 children in Gorakhpur this month is a painful reminder of Uttar Pradesh’s (UP) unsuccessful battle against deadly encephalitis that has killed more than 25,000 children since the disease was first reported in the state in 1977.

 Almost four decades later, encephalitis still remains the state’s biggest child killer — with or without oxygen. Hundreds of children lose their lives to the deadly virus every year.

According to official records, more than 25,000 children have died due to encephalitis in the past four decades. The figures could be higher since a large number of cases do not even reach the hospitals and go unrecorded.

The alarm bells, however, began ringing in 2005 when 1,344 of children died in Uttar Pradesh.

In 2007, a vaccination programme was launched with drugs imported from China but it failed. The drive had no impact because the cold chain of the vaccine was broken at several places rendering it ineffective, according to medical experts.

BRD Medical College hospital in Gorakhpur, where over five dozen children have died this month due to the disease, is the only hospital in a 300 sq km region with facilities to treat encephalitis and similar infectious diseases.

The encephalitis virus affects children mainly in eastern UP, parts of Bihar and Nepal and patients from all these places converge on the BRD Medical College (BRDMC) that is the biggest medical facility in the region.

Gorakhpur has been the main treatment centre of Japanese encephalitis (JE) and acute encephalitis syndrome (AES) in the region.

Both kinds of encephalitis are viral infections that hit a patient's brain, lead to coma and cause death. At times, survivors are left with serious disabilities - mental and physical.

Both JE and AES are caused by mosquito bites of Culex vishnui and Culex tritaeniorhynchus. Filth is home to these species of mosquitoes and the monsoon season proves to be ideal breeding season.

In April this year, much before the onset of monsoon, the Yogi Adityanath government had declared 20 districts of eastern UP as “encephalitis sensitive”.

“Ironically, this year, encephalitis struck earlier than expected and we had 128 patients in BRD Medical College in April itself. The state government had planned a massive immunization drive and even a training programme for doctors at the primary health centre level,” said a doctor in college who did not wish to be named.

The doctor said that the main problem with encephalitis patients is that they come to a government medical centre when it is already too late.

“When the first symptoms appear, the children are treated by local doctors, even quacks, Since the initial symptoms are like that of flu-mild fever, pain in muscles and fatigue — the parents do not take it seriously. It is only when the child reaches a stage where he or she is likely to slip into coma that the patient is brought to BRDMC,” he said. “Since a majority of the patients belong to low income groups, they also face nutritional problems and have low immunity levels which reduces chances of recovery,” the doctor explained.

Around 70 per cent of the children who die due to encephalitis are malnourished. As per Fourth National Family Health survey, 35 per cent children in this region were underweight, he said.

It is common for the BRD hospital to report about 10 deaths every day due toencephalitis in the monsoon season when the virus is most active. Even the parents of the afflicted children are aware that chances of recovery remain slim due to the advanced stage of the disease.

“Eastern UP is marked by backwardness and illiteracy. People are not aware of the importance of hygiene and this makes children more susceptible to virus attacks. We have patients coming from Gonda, Kushinagar, Deoria, Maharajganj, Basti, Terai regions, Nepal and adjoining districts of Bihar such as Buxar and Siwan.

These are the districts where cleanliness and sanitation have been a major problem. In fact, in the Swachh Bharat Survey 2017, Gonda was declared the dirtiest district,” said Dr G.K. Shahi, a private medical practitioner in Gorakhpur. Dr Shahi said the large number of patients can’t opt for private nursing homes due to high cost of treatment and land at the BRD hospital.

Chief minister Yogi Adityanath, who is also the MP from Gorakhpur, has been raising the issue in Lok Sabha since 1998 but the situation doesn't seem to have changed much. He even demanded that the disease should be categorised as an epidemic. Ever since he took over as the CM, he has been regularly visiting the BRDMC and keeping in touch with the doctors.

Milind Gore, a scientist from the National Institute of Virology, Pune, has said vast lands in the region remain waterlogged and there is also open defecation, which encourages breeding of killer mosquitoes.  Ex-BRDMC principal Dr K.P. Kushwaha spoke of the need for encephalitis management centres and volunteers at the village level to create awareness.