India Encephalitis 2017: 1,228 fatalities

[Ronan Kelly]

Link to 2016 thread: https://flutrackers.com/forum/forum...4296-india-encephalitis-2016-1-353-fatalities

Assam

Japanese encephalitis vaccine drive to cover four more district

Gaurav Das | TNN | Updated: Jan 16, 2017, 11.21 AM IST


GUWAHATI: Four more districts of the state will be covered by the Japanese encephalitis (JE) vaccine campaign for adults (15-65 years) from the second week of February. The four districts - Morigaon, Nalbari, Bongaigaon and Cachar - are vulnerable to JE.
With this, a total of 18 districts in the state will be covered under the programme.
...
Till December 31, 2016, the state witnessed 92 JE deaths. It recorded the maximum number of deaths as compared to other endemic states like Odisha, Uttar Pradesh and West Bengal which saw 42, 73 and 30 deaths, respectively. In the same period, Assam also reported 427 JE and 1,713 AES cases.
http://timesofindia.indiatimes.com/...r-four-more-district/articleshow/56587338.cms

Comment: Assam also saw 187 AES deaths. It is likely that at least some of these were also JE. - Ro

 

[Ronan Kelly]

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[Ronan Kelly]

Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study

Aakash Shrivastava, PhD, Anil Kumar, MD, Jerry D Thomas, MD, Kayla F Laserson, ScD, Gyan Bhushan, MD, Melissa D Carter, PhD, Mala Chhabra, MD, Veena Mittal, MD, Shashi Khare, MD, James J Sejvar, MD, Mayank Dwivedi, MD, Samantha L Isenberg, PhD, Rudolph Johnson, PhD, James L Pirkle, MD, Jon D Sharer, PhD, Patricia L Hall, PhD, Rajesh Yadav, MBBS, Anoop Velayudhan, MBBS, Mohan Papanna, MD, Pankaj Singh, D Somashekar, MD, Arghya Pradhan, MBBS, Kapil Goel, MD, Rajesh Pandey, MBBS, Mohan Kumar, MBBS, Satish Kumar, MD, Amit Chakrabarti, MD, P Sivaperumal, PhD, A Ramesh Kumar, PhD, Joshua G Schier, MD, Arthur Chang, MD, Leigh Ann Graham, PhD, Thomas P Mathews, PhD, Darryl Johnson, PhD, Liza Valentin, PhD, Kathleen L Caldwell, PhD, Jeffery M Jarrett, MS, Leslie A Harden, MS, Gary R Takeoka, PhD, Suxiang Tong, PhD, Krista Queen, PhD, Clinton Paden, PhD, Anne Whitney, PhD, Dana L Haberling, MSPH, Ram Singh, PhD, Ravi Shankar Singh, MD, Kenneth C Earhart, MD, A C Dhariwal, MD, L S Chauhan, DPH, S Venkatesh, MD, Dr Padmini Srikantiah, MD'Correspondence information about the author Dr Padmini Srikantiah

Summary
Background
Outbreaks of unexplained illness frequently remain under-investigated. In India, outbreaks of an acute neurological illness with high mortality among children occur annually in Muzaffarpur, the country's largest litchi cultivation region. In 2014, we aimed to investigate the cause and risk factors for this illness.

Methods
In this hospital-based surveillance and nested age-matched case-control study, we did laboratory investigations to assess potential infectious and non-infectious causes of this acute neurological illness. Cases were children aged 15 years or younger who were admitted to two hospitals in Muzaffarpur with new-onset seizures or altered sensorium. Age-matched controls were residents of Muzaffarpur who were admitted to the same two hospitals for a non-neurologic illness within seven days of the date of admission of the case. Clinical specimens (blood, cerebrospinal fluid, and urine) and environmental specimens (litchis) were tested for evidence of infectious pathogens, pesticides, toxic metals, and other non-infectious causes, including presence of hypoglycin A or methylenecyclopropylglycine (MCPG), naturally-occurring fruit-based toxins that cause hypoglycaemia and metabolic derangement. Matched and unmatched (controlling for age) bivariate analyses were done and risk factors for illness were expressed as matched odds ratios and odds ratios (unmatched analyses).

Findings
Between May 26, and July 17, 2014, 390 patients meeting the case definition were admitted to the two referral hospitals in Muzaffarpur, of whom 122 (31%) died. On admission, 204 (62%) of 327 had blood glucose concentration of 70 mg/dL or less. 104 cases were compared with 104 age-matched hospital controls. Litchi consumption (matched odds ratio [mOR] 9?6 [95% CI 3?6 ? 24]) and absence of an evening meal (2?2 [1?2?4?3]) in the 24 h preceding illness onset were associated with illness. The absence of an evening meal significantly modified the effect of eating litchis on illness (odds ratio [OR] 7?8 [95% CI 3?3?18?8], without evening meal; OR 3?6 [1?1?11?1] with an evening meal). Tests for infectious agents and pesticides were negative. Metabolites of hypoglycin A, MCPG, or both were detected in 48 [66%] of 73 urine specimens from case-patients and none from 15 controls; 72 (90%) of 80 case-patient specimens had abnormal plasma acylcarnitine profiles, consistent with severe disruption of fatty acid metabolism. In 36 litchi arils tested from Muzaffarpur, hypoglycin A concentrations ranged from 12?4 μg/g to 152?0 μg/g and MCPG ranged from 44?9 μg/g to 220?0 μg/g.

Interpretation
Our investigation suggests an outbreak of acute encephalopathy in Muzaffarpur associated with both hypoglycin A and MCPG toxicity. To prevent illness and reduce mortality in the region, we recommended minimising litchi consumption, ensuring receipt of an evening meal and implementing rapid glucose correction for suspected illness. A comprehensive investigative approach in Muzaffarpur led to timely public health recommendations, underscoring the importance of using systematic methods in other unexplained illness outbreaks.

Funding
US Centers for Disease Control and Prevention.

Full paper available at; http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30035-9/abstract

 

[Ronan Kelly]

For background:

Interestingly the first publication of the litchi hypothesis came in 2014 from TJ John: Acute encephalitis syndrome in children in Muzaffarpur: hypothesis
of toxic origin CURRENT SCIENCE, VOL. 106, NO. 9, 10 MAY 2014 http://www.currentscience.ac.in/Volumes/106/09/1184.pdf
and Recurrent outbreaks of hypoglycaemic encephalopathy in Muzaffarpur, Bihar CURRENT SCIENCE, VOL. 107, NO. 4, 25 AUGUST 2014 http://admin.indiaenvironmentportal....phalopathy.pdf
and further developed in 2015 Litchi fruit contains methylene cyclopropyl-glycine CURRENT SCIENCE, VOL. 109, NO. 12, 25 DECEMBER 2015 http://www.currentscience.ac.in/Volumes/109/12/2195.pdf
But it seems that John & the CDC team were not working in cooperation with each other
Outbreaks of Hypoglycemic Encephalopathy in Muzaffarpur, India: Are These Caused by Toxins in Litchi Fruit? INDIAN PEDIATRICS VOLUME 53__MAY 15, 2016 http://www.indianpediatrics.net/may2016/399.pdf

Interview with Dr. John

Q:You were working with government and the other group of researchers was also working with government bodies. So how come the two groups never communicated?

A: In 2013, after I made the diagnosis of encephalopathy and categorically refuted encephalitis, I was very open with government officers and paediatric colleagues. So other group knew about my conclusions ? such as the SK Medical College faculty, doctors of the Kejariwal maternity and child hospital in Muzaffarpur, AIIMS professors in Patna and regional medical research centre personnel. NCDC officers had been coming repeatedly for a few or even several years to investigate; in fact, their earliest known investigation was in 1995. Some research reports were already in medical journals. The point is, there was no unified line of command or communication ? each group had some hypothesis and supporting arguments. CDC investigators had made a presentation in Patna in 2013, stating that the disease could be encephalitis or could be encephalopathy and that both lines will be investigated by them. In other words, we all knew what each group was doing and what they were reporting. When I spoke to the health secretary and the executive director of NRHM they clearly responded that this concept (encephalopathy and hypoglycin) was new to them. The idea that children should not be fasting overnight came from such discussions. The risk factors of undernutrition and ?possible prolonged fasting? were already identified as amenable to intervention. I had held press meets in Patna and Muzaffarpur in 2014. All details were shared and there were press reports; I did not keep any [secrets]. - See more at: http://www.governancenow.com/news/re....z7EJvPKa.dpuf

The lack of cooperation has led to a certain amount of controversy.
Publishing on hypoglycemic encephalopathy, borrowing information without giving credit: is Current Science invisible? CURRENT SCIENCE, VOL. 109, NO. 5, 10 SEPTEMBER 2015 http://www.currentscience.ac.in/Volumes/109/05/0843.pdf

'Litchi deaths' in Muzaffarpur are not mysterious and finding their cause is not a new discovery
Newspapers reporting the findings of a new study linking litchi toxins to child deaths have ignored previous work with strikingly similar findings

A new study connecting the consumption of the litchi fruit to the deaths of children in Bihar?s Muzaffarpur has received widespread attention in national and international media. The New York Times reported that the ?mystery of deadly outbreaks in India is solved? and the Times of India said that ?the mystery behind the outbreak of an unexplained neurological illness in Bihar?s Muzaffarpur, which had claimed nearly 100 lives each year till 2014, has been solved?.

The study that these and other newspapers are referring to was conducted by a collaboration of scientists from Centre for Disease Control in the United States and its Indian counterpart, the National Centre for Disease Control. Published in the journal The Lancet Global Health on January 30, the study claims to be the ?first comprehensive confirmation? that the recurring outbreak of acute encephalopathy ? a general description for disorders of the brain ? is associated with toxic compunds found in the litchi fruit.

Hypoglycin A and methylene cyclopropyl-glycine or MCPG are toxins in the litchi fruit, which the CDC and NCDC scientists said trigger low blood glucose levels in malnourished children who skipped evening meals leading to fatal outcomes.

What is conspicuous by its absence in the newspaper reports are references to the strikingly similar findings reported a year ago in the Indian journal Current Science by a team of Indian scientists led by T Jacob John, epidemiologist at the Christian Medical College in Vellore.
...
https://scroll.in/pulse/828389/litch...-new-discovery

 

[Emily]

https://www.telegraphindia.com/1170204/jsp/bihar/story_133849.jsp

[h=1]Litchi scientists scoff at study alarm[/h] [TABLE="border: 0, cellpadding: 4, cellspacing: 0"]
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[TR]
[TD="class: story, align: left"] Feb. 3: A national crop institution in Bihar has questioned suggestions by Indian and US government scientists that consumption of litchi on an empty stomach may have contributed to child deaths from encephalitis in Muzaffarpur among other sites.
Senior scientists at the National Research Centre on Litchi (NRCL), Muzaffarpur, have challenged the findings of the Indo-US study that corroborated three-year old suspicions that the sweet litchi fruit contains certain compounds that may cause blood sugar to fall to dangerously low levels.
They have described the Indo-US study as "academic" and said that it has relied on too small a sample of patients for general conclusions. They claimed the NRCL has also examined encephalitis deaths and not found any link to litchis.
..
A senior diabetes specialist not associated with the Indo-US study has described it as significant enough to justify a public health advisory.
"This is a solid study; young children and adults on treatment for diabetes with insulin or multiple drugs should take care when consuming litchi," said Anoop Misra, chairman of the Fortis diabetes centre in New Delhi, and director of the National Diabetes Obesity and Cholesterol Foundation.
Misra said the findings support recommendations that such vulnerable populations should avoid eating litchis on an empty stomach or after fasting. Consuming the fruit on a full stomach would compensate for the sugar-lowering risk of the toxins, he said...
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I still wonder why this became a problem over the past 5 years.

 

[Ronan Kelly]

Agreed! Why only recently? What changed?


Interesting older paper here about all the possible factors involved in the 2011 outbreak: Possible factors causing Acute Encephalitis Syndrome outbreak in Bihar, India https://www.ijcmas.com/vol-2-12/D.S.Dinesh, et al.pdf Also important to remember that surveillance and reporting is improving over time and we might just be noticing something that had also occurred periodically in the past. In addition, the litchi hypothesis is localized to the Muzaffarpur region. I remember in 2014 that AES outbreaks were also occurring in other areas such as Gaya, but with a number of those patients testing positive for JE

 

[Ronan Kelly]

Meanwhile - Encephalitis season is year round in Uttar Pradesh and West Bengal;

http://nvbdcp.gov.in/Doc/je-aes-cd-Jan17.pdf

 

[Ronan Kelly]

I guess if you ask, an answer is forthcoming! Bolding added- Ro

The enigma of litchi toxicity: an emerging health concern in southern Asia
Peter S SpencerEmail the author Peter S Spencer, Valerie S Palmer
Published: 30 January 2017
Open AccessArticle has an altmetric score of 74
DOI: http://dx.doi.org/10.1016/S2214-109X(17)30046-3


References
How is it possible that lychee, a deliciously sweet tropical fruit, could induce a fatal hypoglycemic encephalopathy in children? The answer is straightforward: the edible fruit (aril) of lychee or litchi (Litchi sinensis or Litchi chinensis), and other members of the Soapberry family (Sapindaceae), contains unusual amino acids that disrupt gluconeogenesis and β-oxidation of fatty acids. This is well established in relation to both litchi fruit and, more particularly, fruit of its cousin, the ackee plant (Blighia sapida), a member of the Sapindaceae originating in west Africa and transplanted in the 18th century to the Caribbean. Ingestion of immature ackee fruit has been known for decades in Jamaica to cause a toxic hypoglycaemic encephalopathy (Jamaican vomiting sickness) in children.1, 2 This knowledge has been slow to reach certain parts of Asia where the so-called mysterious litchi disease has been attributed to various causes (fruit colouring, heat stroke) in Bihar, India,3 to an unidentified pesticide in northwest Bangladesh4 and, after an exhaustive negative virological search, to a yet-to-be-discovered neurotropic virus in northeast Vietnam.5 However, the illness evolves far too quickly to be a viral disorder, with a median time of 20 h from health to death in Bangladeshi children.4
In The Lancet Global Health, Aakash Shrivastava and colleagues'6 study of Indian children with litchi-associated encephalopathy unequivocally pins the blame on the litchi fruit itself, as predicted by previous Indian investigators7 and by us.8 Like most, if not all, neurotoxic factors, the separation between chemical-induced health and illness depends on dosage and individual susceptibility, which in this case translates to the number of litchi fruit consumed and the concentration of hypoglycaemic amino acids, as well as the children's age and state of nourishment. Shrivastava and colleagues6 report that, akin to ackee, the unripe fruit of litchi has a higher concentration of hypoglycin A and its lower homologue, α-(methylenecyclopropyl)glycine; the reported absence of a significant difference between the two probably arises from the small number of fruit samples tested (n=6 per batch of ripe and unripe fruit). Unfortunately, the study did not compare litchi-associated cases with controls drawn from the community and, strangely, cases were compared with sick controls lacking neurological disease and no history in the previous 3 months of altered mental status or seizures, and admitted to a case-surveillance hospital less than 7 days from admission of the case.

That well-established data for Sapindaceae toxicity have long existed from clinical experience in Africa and the Caribbean is an important lesson for global health and neurotoxicology. A worldwide understanding of the adverse effects on the nervous system of both naturally occurring as well as synthetic chemicals will speed diagnosis and treatment of other mysterious epidemics of environmental brain disease. The Indian subcontinent is no stranger to the neurological effects of toxins in plants?eg, food dependency on the grass pea or cassava resulting in the spastic parapareses of lathyrism and cassavism, respectively.9, 10 Unlike these untreatable self-limiting neurological diseases, litchi and ackee encephalopathy can be arrested by restoring serum glucose concentrations. However, some children reportedly are left with cognitive deficits, muscle weakness, or movement disorder; the causes of which require investigation.

Why is seasonal litchi encephalopathy a relatively recent event in India, Bangladesh, and Vietnam? The most plausible explanation is the rapid expansion of commercial litchi production across Asia and beyond.11, 12 Indian production is second only to China's, from where Litchi sinensis originates and its potential toxic effects are noted in ancient literature. Today, several Asian countries export litchi and other Sapindaceae, including rambutan (Nephelium lappaceum) and longan (Dimocarpus longan) for consumption abroad. In the USA for instance, unlike the regulated importation of canned ackee fruit, which must be screened for hypoglycin content, there are no restrictions on other members of the Soapberry family, including litchi. Fortunately, the high cost of these imported fruits and the likelihood that would be eaten in small quantities by well-nourished consumers, suggests there is little reason for concern in the USA.

There is, however, cause for major concern that litchi-induced seasonal toxic hypoglycaemic encephalopathy will not only continue to be mistaken for a viral disorder, specifically Japanese B encephalitis, but also affect other regions of Asia where commercial litchi production is increasing and poorly nourished children have access to dropped, damaged, or immature fruit that cannot be sold. Areas of concern include northwestern Bangladesh, southern China, northern India, the Terai of Nepal's Central and Eastern Development regions, the Cordillera Autonomous Region of the Philippines, northern Thailand, and northeastern Vietnam.11, 12 Litchi cultivation is also increasing in southern Africa, Australia, and the Americas.12 Going forward, researchers need to work with the litchi industry to determine how levels of hypoglycaemic acids vary across cultivars, soil, climate, and harvest conditions. Guidance should be developed for the consumer, especially children but also adults who have a susceptible metabolic profile or who eat fruit after fasting. While resistance can be anticipated to the notion that litchi has potential toxicity, this might disappear when industry is informed of ongoing research to address the possible beneficial effects of litchi-derived glucose-lowering agents in the fight against metabolic syndrome and associated chronic health disorders. For good reason, perhaps, a song from Jamaica, where Blighia sapida is held as the national fruit and regularly eaten with saltfish, contains the words: ?an ackee a day keeps the doctor away?!

We declare no competing interests beyond research grant applications.

References
Tanaka, K, Kean, EA, and Johnson, B. Jamaican vomiting sickness. N Engl J Med. 1976; 295: 461?467
View in Article | Crossref | PubMed
US CDC. Toxic hypoglycemic syndrome. Morb Mort Wkly Rep. 1992; 41: 53?55
View in Article | PubMed
Sahni, GS. The recurring epidemic of heat stroke in children in Muzaffarpur, Bihar, India. Ann Trop Med Hlth. 2013; 6: 89?95
View in Article | Crossref | Scopus (6)
Islam, S. Outbreak of illness and deaths among children living near lychee orchards in northern Bangladesh. Hlth Sci Bull. 2012; 10: 15?21
View in Article
Paireau, J, Tuan, NH, Lefran?ois, R et al. Litchi-associated acute encephalitis in children, northern Vietnam, 2004?2009. Emerg Infect Dis. 2012; 18: 1817?1822
View in Article | Crossref | PubMed | Scopus (15)
Shrivastava, A, Kumar, A, Thomas, JD et al. Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study. Lancet Glob Health. 2017; (published online Jan 30.)http://dx.doi.org/10.1016/S2214-109X(17)30035-9.
View in Article
John, TJ and Das, M. Acute encephalitis syndrome in children in Muzaffarpur: hypothesis of toxic origin. Curr Sci. 2014; 106: 1184?1185
View in Article
Spencer, PS, Palmer, VS, and Mazumder, R. Probable toxic cause for suspected lychee-linked viral encephalitis. CDC Emerg Inf Dis. 2015; 18: 904?905
View in Article | Crossref
Ludolph, AC, Hugon, J, Dwivedi, MP, Schaumburg, HH, and Spencer, PS. Studies on the aetiology and pathogenesis of motor neuron diseases. 1. Lathyrism: clinical findings in established cases. Brain. 1987; 110: 149?165
View in Article | Crossref | PubMed | Scopus (79)
Madhusudanan, M, Menon, MK, Ummer, K, and Radhakrishnanan, K. Clinical and etiological profile of tropical ataxic neuropathy in Kerala, South India. Eur Neurol. 2008; 60: 21?26
View in Article | Crossref | PubMed | Scopus (20)
Papademetriou, MK and Dent, FJ. Lychee production in the Asia-Pacific region. Regional Office for Asia and the Pacific. 2002. Food and Agriculture Organization. RAP Publication 2002/04. ftp://ftp.fao.org/docrep/fao/005/ac684e/ac684e00.pdf. ((accessed Jan 7, 2017).)
View in Article
Houbin, C. The production and uses of litchis in China. South China Agricultural University. http://ir4.rutgers.edu/GMUS/presentation pdf/day1Chen.pdf. ((accessed Jan 7, 2017).)
View in Article

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30046-3/fulltext

 

[Ronan Kelly]

ANDHRA PRADESH
Boy dies of suspected encephalitis
SPECIAL CORRESPONDENT FEBRUARY 05, 2017 23:33 IST
UPDATED: FEBRUARY 05, 2017 23:33 IST


ONGOLE: A 4-year-old boy died of high fever in Kumarole village of Prakasam district late on Saturday.

Though the boy tested negative for swine flu, he succumbed to suspected encephalitis, District Medical and Health Officer J. Yasin said.

Taking a serious note of the incident, Transport Minister Sidda Raghava Rao reviewed the situation with health officials on Sunday.
...
http://www.thehindu.com/news/nation...of-suspected-encephalitis/article17198329.ece

 

[Ronan Kelly]

?Litchi disease? report: Lancet makes amends after failing to give ?credit?
R. Prasad CHENNAI: FEBRUARY 05, 2017 00:00 IST
UPDATED: FEBRUARY 05, 2017 04:14 IST
...
In response to the article carried in The Hindu on February 3 about Dr. Jacob John raising ethics issues about the way the authors of the Lancet Global Health paper had failed to properly acknowledge his team?s work on the Muzaffarpur mystery disease, the journal has got in touch with Dr. Mukul Das, one of the authors of the Current Science papers, for more details.
...
?Dr. John and I would jointly be sending our response on Monday or Tuesday,? says Dr. Das. ?It is very decent of Lancet to have got in touch with us and seek our clarification on this issue. That shows Lancet is careful of its credibility, careful that any such issue is immediately sorted out. I admire Lancet . This is what we want from every journal publisher, every investigator and every paper. Caesar's wife must be above suspicion,? says Dr. John. ?We never complained to Lancet or the media. It is the media that got in touch with us as they knew about our work. That makes us happy.?
...
http://www.thehindu.com/todays-pape...-failing-to-give-‘credit’/article17196070.ece

 

[Ronan Kelly]

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[Ronan Kelly]

http://nvbdcp.gov.in/Doc/je-aes-cd-28Feb17.pdf

 

[Ronan Kelly]

http://nvbdcp.gov.in/Doc/je-aes-cd-March17.pdf

 

[Ronan Kelly]

Tamil Nadu
11-year-old boy dies of ?mysterious? fever
SPECIAL CORRESPONDENT TIRUCHI APRIL 09, 2017 22:17 IST
UPDATED: APRIL 09, 2017 22:17 IST

Japanese Encephalitis suspected

An 11-year-old boy of Puthanatham died of ?mysterious? fever on Saturday.
...
He said that the serum of Shajudeen has been sent for examination to figure out the reasons for the death. As per the preliminary reports, he might have died of Japanese Encephalitis (brain fever).
http://www.thehindu.com/news/cities...-dies-of-mysterious-fever/article17898455.ece

 

[Ronan Kelly]

Jharkhand
OVER 35,000 CHILDREN RECEIVE VACCINATION
Friday, 21 April 2017 | Nityanand Dubey | Garhwa | in Ranchi

Altogether 35,585 children administered vaccine of Japanese Encephalitis in the district by April 19.

According to Dr. N K Razak,out of 35585 , 6393 are from the age of 1 to 5 yrs, 12303 are the age group of 5 to 10 yrs and 16889 childrens from the age group of 10 t0 15 have been administered administered the vaccine.The vaccination programme is going on.
...
http://www.dailypioneer.com/story.p...l_key=over-35000-children-receive-vaccination

Punjab
Posted at: Apr 21, 2017, 2:11 AM; last updated: Apr 21, 2017, 2:15 AM (IST)
Japanese encephalitis claims life in Zirakpur
Victim may have contracted virus during Bihar visit

Satinder Pal Singh
Zirakpur, April 20
Japanese encephalitis, caused by a mosquito-borne virus, has claimed the life of a 20-year-old labourer at Lohgarh village here. This is the first death caused by the virus in Zirakpur this year.
The victim has been identified as Arshad. His blood samples had tested positive for Japanese encephalitis at the PGI. Dr Gagandeep Singh Grover, State Programme Officer, National Vector-Borne Disease-Control Programme, said the victim, Arshad, a resident of Bihar, was taken ill on April 5. He was admitted to JP Hospital, Zirakpur, on April 7 where his condition deteriorated. Arshad was referred to the PGI on April 9. He died on April 11.
Dr Grover said the patient had travelled to Bihar and might have contracted the virus there.
...
http://www.tribuneindia.com/news/cha...ur/395173.html

Uttar Pradesh
UP CM Yogi Adityanath wants a polio-like surveillance for encephalitis

Shailvee Sharda | TNN | Apr 19, 2017, 10.11 PM IST

LUCKNOW: Chief minister Yogi Adityanath wants a polio like surveillance strategy for elimination of encephalitis in the state. In 2016, over 3,921 acute encephalitis (AES) cases were reported in UP of which 3410 of these were from Gorakhpur and Basti divisions.
The CM along with health minister Sidharth Nath Singh and top officials in the department met world health organisation country director Dr Henk Bekedam to discuss encephalitis and other issues here on Wednesday.
...
http://timesofindia.indiatimes.com/c...w/58266425.cms

 

[Ronan Kelly]

Uttar Pradesh

...
http://www.patrika.com/news/gorakhp...nath-area-by-encephalitis-hindi-news-1559806/

Uttar Pradesh has seen 112 cases with 36 fatalities so far this year. For comparison's sake
Year Cases Fatalities
2016 192 41 to April 30
2015 197 39 to April 30

The figures quoted above are from the NVBDCP monthly reports and are available on FluTrackers in the Encephalitis thread for that year. The figures for 2016 and 2015 being quoted in the Patrika are incorrect. The numbers of Encephalitis cases being reported from Uttar Pradesh this year is not unusual. - Ro

 

[Ronan Kelly]

True to pre-poll promise, UP govt led by Yogi Adityanath focuses on encephalitis
The Yogi Adityanath government is reviving facilities to contain Encephalitis that has killed 50,000 kids in eastern UP in past 30 years.

INDIA Updated: Apr 27, 2017 07:16 IST
Rajesh Kumar Singh
Hindustan Times, Lucknow
...
According to the department?s data, 128 patients have already been admitted to the Baba Raghav Das Medical College and Hospital, of which 40 have died.
...
http://www.hindustantimes.com/india...ncephalitis/story-clzi9O6MebEnh5Nwbt2QsN.html

 

[Ronan Kelly]

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[TD="class: sorting_2, width: 9%, bgcolor: #FFE2E2"]
[/TD]
[TD="width: 5%"]60 months[/TD]
[TD="width: 7%"]Female[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]April 29, 2017
Time : 10:34 am[/TD]
[TD="width: 6%"]City : Bijnor
Distt. : BIJNOUR
State : UTTAR PRADESH[/TD]
[/TR]
[TR="class: gradeX odd, bgcolor: #FFDDDD"]
[TD="class: sorting_1, width: 9%, bgcolor: #FFC4C4"]Acute Encephalitis Syndrome[/TD]
[TD="class: sorting_2, width: 9%, bgcolor: #FFD1D1"]
[/TD]
[TD="width: 5%"]120 months[/TD]
[TD="width: 7%"]Female[/TD]
[TD="width: 7%"] [/TD]
[TD="width: 6%"] [/TD]
[TD="width: 6%"]Alive[/TD]
[TD="width: 6%"]April 27, 2017
Time : 1:28 pm[/TD]
[TD="width: 6%"]City : jalore
Distt. : JALLORE
State : RAJASTHAN[/TD]
[/TR]
[/TABLE]

http://idsurv.org/display-data.php

 

[Ronan Kelly]

http://nvbdcp.gov.in/Doc/je-aes-cd-April17.pdf

Note that in this thread we have also reports of a confirmed fatal case of Encephalitis from Punjab and a fatal suspected case from Tamil Nadu. - Ro

 

[Ronan Kelly]

Encephalitis knocks again in Bihar, more than 300 children die in 6 years



Praveen Thakur | ETV Bihar / Jharkhand
Updated: May 7, 2017, 12:32 PM IST
Every year, in the summer season, in Uttar Pradesh, including Muzaffarpur, in the nearby districts, the AES, which has wreaked havoc on the innocent, has once again knocked on the Encephalitis. So far, AES has been confirmed in six children, out of which two children have died.

The death of AES, ie acute encephalitis syndrome, is also starting this year. This year Muzaffarpur, Vaishali and Sitamarhi districts have been affected by AES, knocked out in the first week of April. Two children of Sitamarhi and Vaishali districts have died. At present a child is admitted to SKMCH. The pleasant thing is that three sick children have returned home after being healthy.

Death figures

According to official statistics, 24 of the 59 patients died in 2010. In 2011, out of 121 patients, 45 died. Of the 336 children killed in 2012, 120 died in 2012, 39 out of 124 deaths in 2013, 86 out of 342 deaths in 2014,


The year 2016 has been a bit relieved. Four of the 30 patients died this year. These figures are from Muzaffarpur district only, while children in Eastern Champaran, Sitamarhi, Shivar, Vaishali, Western Champaran and Samastipur districts have been facing ailments. Experts have not got success so far in every effort that has been made in the last six years to detect the knocking disease in 1995. Due to

high alert,

the causes of AES have not yet been ascertained, but the State Health Committee has issued strict instructions in this regard. Civil surgeon of Muzaffarpur, Dr. Lalita Singh said that all PHCs and additional PhCs have been alerted to prevent the disease. AES ward of eight beds has been prepared at Sadar Hospital, whereas two PICU wards in SKMCH have been prepared for AES. Along with physicians for treatment of AES 24-hour round the clock, ANM has been deployed at SKMCH and Sadar Hospital.

From Pune to Atlanta, the samples have been sent in the

last five years from New Delhi, Pune to Atlanta to detect the causes of the sample, but the actual causes of the disease have not been ascertained. Under the SOP made by the team, treatment with fixed protocol is to be done. So far, the experience shows that as soon as the sick children are reaching the hospital, the more hope of survival increases. Samples have been dispatched from Pune to Atlanta in the last five years but the actual causes of the disease have not been ascertained. In such cases, the protocols under the SOP created by the team of doctors of experts have to be treated with fixed protocol. So far, the experience shows that as soon as the sick children are reaching the hospital, the more hope of survival increases. Samples have been dispatched from Pune to Atlanta in the last five years but the actual causes of the disease have not been ascertained. In such cases, the protocols under the SOP created by the team of doctors of experts have to be treated with fixed protocol. So far, the experience shows that as soon as the sick children are reaching the hospital, the more hope of survival increases.
http://hindi.news18.com/bihar/muzaf...encephalitis-found-in-north-bihar-985128.html