Encephalitis may not be real cause of children's deaths in Muzaffarpur; investigation necessary into possible toxins in lychees
FirstpostAny instance of Acute Encephalitis Syndrome, anywhere in the country, is seen as yet another instance of acute viral encephalitis, supposedly caused by the Japanese encephalitis virus, and is seen as yet another opportunity to order mass vaccination against it. All the known features of the outbreak — victims being poor, young rural children of a narrow age group, involvement of only malnourished children, failure to identify an etiological agent, including the Japanese encephalitis virus, despite intensive investigations year after year, absence of the infection in vector mosquitoes — point toward non-infectious pathology. In a similar instance in western Uttar Pradesh, where recurrent outbreaks of an unknown brain disease were responsible for the deaths of hundreds of young poor children year after year, the Union government instituted massive campaigns of Japanese encephalitis vaccination in many districts. Later, it was discovered that the consumption of a local weed, cassia occidentalis and a multisystem illness, “acute hepatomyoencephalopathy syndrome" was responsible for the recurring outbreaks, not viral encephalitis. So, what India needs is a well-coordinated, systematic outbreak investigation approach with an appropriate methodology to investigate all these recurring outbreaks of an unknown etiology, rather than clubbing them under one head of viral encephalitis and resorting to empiric preventive measures like mass Japanese encephalitis vaccination.