Context

Bihar has recorded more than 100 deaths of children, since January due to the spread of Acute Encephalities Syndrome.

About

 Acute Encephalitis Syndrome (AES)

• AES affects central nervous system, mostly in children and young adults.
• It starts with high fever, then hampers neurological functions causing mental disorientation, seizure, confusion, delirium, and coma.
• The disease outbreak is usually reported during monsoons (June-October). But the incidence is also reported during April-June in Bihar.

Causes of AES

• It can be caused by virus, bacteria, fungi, and a range of agents.
• Japanese encephalitis (JE) virus is the most common cause of AES in India.
• The syndrome is also caused by scrub typhus, dengue, mumps, measles, Nipah and Zika virus.
• In several cases though the cause of AES remains clinically unidentified.
• The toxin, presented naturally in the litchi, responsible for the deaths is Hypoglycin A.

Spread

• AES Spreads through contaminated surfaces. Viruses enter through contaminated water. Once infected the patient can infect more individuals through their secretions and saliva.
• In Bihar, it has been reported that the victims might have ingested toxins from the affected litchi fruit.

Key Observations

• Most of the affected people belong to the lower economic strata of the society.
• Pigs are the primary host for JE viruses.
• Vero cell-derived purified inactivated JE vaccine-JENVAC, was the first vaccine in India that received manufacturing and marketing approvals from the Drug Controller General of India

Why are children at risk?

Mortality rates in kids have been traced to be the highest amongst all those affected. The reason for this is the lack of nourishment. The Under-nourished children lack sufficient glucose reserve in the form of glycogen and the production of glucose from non-carbohydrate source is blocked midway leading to low blood sugar level. This sharp fall in blood glucose level causes severe brain malfunction.

It is found that children who ate litchi during the day and went to bed on an empty stomach are at grave risk.

Status of AES in India

• According to National Vector Borne Diseases Control Programme (NVBDCP), 10,485 AES cases were diagnosed in 2018 with 632 deaths across 17 states.
• India records fatality rate at 6 per cent in AES, but the fatality rises to 25 per cent amongst children.
• Bihar, Assam, Jharkhand, Uttar Pradesh, Manipur, Meghalaya, Tamil Nadu, Karnataka, and Tripura are worst affected.
• Over the years, the scenario of AES in India has improved significantly in terms of research and health care facilities. Albeit the development of vaccine against JEV and minocycline under the clinical trials, AES cases in India has not restricted itself to the JE aetiology.

Solution

• 5% Dextrose infusion, in case of general low blood sugar level, and 10% dextrose infusion in case of acute low blood sugar level within few hours of illness onset will enable rapid recovery from the disease.