Ronan Kelly
Retired 2020
Re: India Encephalitis 2013; 842 fatalities
Re: India Encephalitis 2013; 842 fatalities
Second installment of the Indian Express' Encephalitis investigation - go read it all here; http://www.indianexpress.com/news/c...issolving-faith-an-enduring-mystery/1172834/0
Children deaths in Gorakhpur: A dissolving faith, an enduring mystery
Pritha Chatterjee : Gorakhpur, Mon Sep 23 2013, 08:32 hrs
In Gorakhpur, small successes in understanding ? and conquering ? the killer disease of children are undercut by a wily virus and administrative bottlenecks
On August 18, five-year-old Vishal spent the evening playing with friends in Vanjhai village in Gorakhpur district's Bhathat block. He came home irritable, with a slight fever. His mother and grandmother gave him a little milk and sent him to bed. They were not worried, because Vishal, like most children in the village, was "protected". What's ailing the Bihar's children?
Three years ago, Vishal had been given two shots, separated by four months, of "jhatki teeka", or the Japanese Encephalitis (JE) vaccine.
...
So, when Vishal woke up the next morning with a jhatki ? convulsions with a yellowish frothing at the mouth, fists clenched and eyes shut tight, seemingly unable to hear his mother's cries ? the family went to the local fakir, hoping he would rid the boy of the spirits they believed had attacked him.
...
The boy was admitted to the Nehru Hospital in BRD Medical College, where he died the next day.
...
In Nehru Hospital, two or three children share a bed and overworked doctors struggle to attend to cries that break out almost every minute from all parts of the epidemic ward. In the adjoining ICU, two skinny children are on ventilator support, multiple IV lines in their small bodies, with cardiac monitors beeping every now and then as a fresh emergency hits their vitals.
Since January 1 this year, over 1,000 children have been admitted to the hospital and 258 have died, with the same classic symptoms ? high fever, convulsions, altered sensorium, rigidity in the limbs and nausea ? now associated with Acute Encephalitis Syndrome (AES). Only 61 of these children were found to be JE positive.
...
Of 1,000 samples of cerebrospinal fluid (CSF) collected from children admitted between April and December last year to Gorakhpur's BRD Medical College, 100 isolates for organisms called Entero Viruses (EV) ? specifically the human EV 89 and EV 76 types ? have been identified by the National Institute of Virology (NIV) field station in Gorakhpur. A 10 per cent positivity is considered a huge success for CSF samples. These viruses spread through contaminated water, and can cause symptoms similar to JE, and are covered under the umbrella of diseases that constitute AES. The JE virus, which causes similar symptoms and is also included under the category of AES diseases, has a completely different route of transmission: it is hosted in pigs, water birds and other livestock, and is carried to humans by mosquitoes.
...
From 2008-11, while rectal swab samples showed a 15- 44 per cent positivity for EVs, CSF samples from the same patients showed positivity rates of between 1.8 per cent and 2.3 per cent.
...
This year, six per cent of cases are JE positive, and about 10-15 per cent EV ? which leaves the vast majority of cases still undiagnosed. "We are trying to identify the causative agents in all samples, but there are other factors that need to be considered. The causative agent is the most active in the CSF samples only within the first 2-3 days of onset. A majority of children are coming to us late, and hence we are losing out on identifying the pathogens there," said Dr K P Kushwaha, principal and head of the department of paediatrics at BRD Medical College.
...
Despite an over-90 per cent coverage of vaccination, a few JE cases have persisted, mostly in children who have been vaccinated for the disease.
...
There are many who say the problem could also be attributed to wasted vials of the vaccine, and false records of vaccination, considering the strict approach of the authorities. In the single case of JE death in Gorakhpur, where the deceased girl's family refused vaccination this year, the auxillary nursing midwife of the area, who was responsible for immunization, has been suspended.
"The vaccine comes in packs of five vials. Each vial costs about Rs 1,500-2,000, and is viable only for two hours after the whole pack is opened. So our health workers are advised to open the packs only when 4-5 children are present, to ensure there is no wastage. But a lot of times our health workers can't manage this, and the vaccines are wasted. False records are inevitable in some cases like these, to escape administrative action," said a medical officer monitoring the immunization efforts.
...
Water tables are high in the Terai region where the worst affected districts are located. Local surveys show between four lakh and five lakh locally dug handpumps, known as khechu pumps, which are hardly 30-40 feet deep. Almost no one uses the standard government handpumps which go 100 feet under the surface.
"Drinking water here comes from the first strata of the soil, which can be highly contaminated and is not considered potable," said the chief executive engineer of Gorakhpur Nagar Nigam.
...
http://www.indianexpress.com/news/c...issolving-faith-an-enduring-mystery/1172834/0
Re: India Encephalitis 2013; 842 fatalities
Second installment of the Indian Express' Encephalitis investigation - go read it all here; http://www.indianexpress.com/news/c...issolving-faith-an-enduring-mystery/1172834/0
Children deaths in Gorakhpur: A dissolving faith, an enduring mystery
Pritha Chatterjee : Gorakhpur, Mon Sep 23 2013, 08:32 hrs
In Gorakhpur, small successes in understanding ? and conquering ? the killer disease of children are undercut by a wily virus and administrative bottlenecks
On August 18, five-year-old Vishal spent the evening playing with friends in Vanjhai village in Gorakhpur district's Bhathat block. He came home irritable, with a slight fever. His mother and grandmother gave him a little milk and sent him to bed. They were not worried, because Vishal, like most children in the village, was "protected". What's ailing the Bihar's children?
Three years ago, Vishal had been given two shots, separated by four months, of "jhatki teeka", or the Japanese Encephalitis (JE) vaccine.
...
So, when Vishal woke up the next morning with a jhatki ? convulsions with a yellowish frothing at the mouth, fists clenched and eyes shut tight, seemingly unable to hear his mother's cries ? the family went to the local fakir, hoping he would rid the boy of the spirits they believed had attacked him.
...
The boy was admitted to the Nehru Hospital in BRD Medical College, where he died the next day.
...
In Nehru Hospital, two or three children share a bed and overworked doctors struggle to attend to cries that break out almost every minute from all parts of the epidemic ward. In the adjoining ICU, two skinny children are on ventilator support, multiple IV lines in their small bodies, with cardiac monitors beeping every now and then as a fresh emergency hits their vitals.
Since January 1 this year, over 1,000 children have been admitted to the hospital and 258 have died, with the same classic symptoms ? high fever, convulsions, altered sensorium, rigidity in the limbs and nausea ? now associated with Acute Encephalitis Syndrome (AES). Only 61 of these children were found to be JE positive.
...
Of 1,000 samples of cerebrospinal fluid (CSF) collected from children admitted between April and December last year to Gorakhpur's BRD Medical College, 100 isolates for organisms called Entero Viruses (EV) ? specifically the human EV 89 and EV 76 types ? have been identified by the National Institute of Virology (NIV) field station in Gorakhpur. A 10 per cent positivity is considered a huge success for CSF samples. These viruses spread through contaminated water, and can cause symptoms similar to JE, and are covered under the umbrella of diseases that constitute AES. The JE virus, which causes similar symptoms and is also included under the category of AES diseases, has a completely different route of transmission: it is hosted in pigs, water birds and other livestock, and is carried to humans by mosquitoes.
...
From 2008-11, while rectal swab samples showed a 15- 44 per cent positivity for EVs, CSF samples from the same patients showed positivity rates of between 1.8 per cent and 2.3 per cent.
...
This year, six per cent of cases are JE positive, and about 10-15 per cent EV ? which leaves the vast majority of cases still undiagnosed. "We are trying to identify the causative agents in all samples, but there are other factors that need to be considered. The causative agent is the most active in the CSF samples only within the first 2-3 days of onset. A majority of children are coming to us late, and hence we are losing out on identifying the pathogens there," said Dr K P Kushwaha, principal and head of the department of paediatrics at BRD Medical College.
...
Despite an over-90 per cent coverage of vaccination, a few JE cases have persisted, mostly in children who have been vaccinated for the disease.
...
There are many who say the problem could also be attributed to wasted vials of the vaccine, and false records of vaccination, considering the strict approach of the authorities. In the single case of JE death in Gorakhpur, where the deceased girl's family refused vaccination this year, the auxillary nursing midwife of the area, who was responsible for immunization, has been suspended.
"The vaccine comes in packs of five vials. Each vial costs about Rs 1,500-2,000, and is viable only for two hours after the whole pack is opened. So our health workers are advised to open the packs only when 4-5 children are present, to ensure there is no wastage. But a lot of times our health workers can't manage this, and the vaccines are wasted. False records are inevitable in some cases like these, to escape administrative action," said a medical officer monitoring the immunization efforts.
...
Water tables are high in the Terai region where the worst affected districts are located. Local surveys show between four lakh and five lakh locally dug handpumps, known as khechu pumps, which are hardly 30-40 feet deep. Almost no one uses the standard government handpumps which go 100 feet under the surface.
"Drinking water here comes from the first strata of the soil, which can be highly contaminated and is not considered potable," said the chief executive engineer of Gorakhpur Nagar Nigam.
...
http://www.indianexpress.com/news/c...issolving-faith-an-enduring-mystery/1172834/0
