AES crisis in Bihar

 Over the past few weeks, there have been at least 100 cases of acute encephalitis syndrome – a neurological condition triggered by a biochemical imbalance in the body- in Bihar. In the city of Muzaffarpur, at least 118 children that have died after “inflammation and infection” that targets the brain. Two hospitals in the region alone have more than 400 children complaining of fever, dizziness and delirium have been admitted since the start of 2019. Acute Encephalitis Syndrome (AES), which has claimed more than 100 lives in Bihar’s Muzaffarpur region, is a serious neurological illness that causes inflammation of the brain. The health department of Bihar is yet to pinpoint the exact cause of these deaths. The department appears to be clueless with many finding a shield in the litchi (also spelt lychee) theory of encephalitis deaths as it deflects the blame from Nitish Kumar government to a seasonal fruit. Most victims are from lower socio-economic group which supplies almost all labour force to litchi orchards. The other factor that has compounded the problem appears to be acute shortage of doctors. In March 2018, state Health Minister Mangal Pandey told Bihar assembly that there was one doctor for 17,685 persons. In other words, there is 5.6 doctors for one lakh population in Bihar. Shortage of doctors is being cited as one of the reasons for high mortality among the AES patients in Muzaffarpur. An epidemic of AES would typically happen around mid-April to mid-June, at the start of monsoon and litchi season. The outbreak in Bihar is something called acute encephalitis syndrome – this is an “encephalopathy” not technically an infection i.e. “encephalitis”. The disease most commonly affects children and young adults and can lead to mortality. According to the National Health Portal (NHP), viruses are the main causative agents in AES cases, although other sources such as bacteria, fungus, parasites, chemicals, toxins and non-infectious agents have also been blamed. The head of department Paediatrics and Neonatology at Gurgaon Paras Hospital, shared two theories about the cause of the current epidemic-one, that it was caused by heat stroke and the other, it was caused by a toxin in the locally-grown litchi In malnourished kids, this cut-off from sources of energy other than glycogen can cause fever, convulsions and at times, a loss of consciousness. An encephalopathy, simply put, is an umbrella term for a disease, damage, or malfunction in the brain, ranging in symptoms that are mild (like memory loss or subtle personality changes) to severe (like dementia, seizures, coma, or even death). In a case of Acute Encephalitis Syndrome (AES) however, there is no bacteria or virus involved. This is not the first time the acute encephalitis syndrome (AES) has struck north India. According to a 2017 report, between 2008 and 2014, there have been more than 44,000 cases and nearly 6,000 deaths from encephalitis in India, particularly in Uttar Pradesh and Bihar. The deaths of over 100 children is not a mere statistics but a humanitarian crisis that requires immediate action. The centre has to take a more proactive step by declaring it as a national crisis and deploying medical teams to Bihar to contain the outbreak. It is not time for political blame game but a time for joint efforts to ensure that precious lives of children from poor backgrounds are protected.