An Approach of Acute Encephalitis Syndrome in Muzaffarpur, Bihar; A Different Perspective
Acute encephalitis syndrome (AES) is a disease characterized by fever and mental confusion, disorientation, delirium, or coma. It could be due to various causes such as viruses, bacteria, fungus, parasites, spirochetes, chemical, and toxins. This chapter is an outcome of an Epidemiological investigation of AES occurred in Muzaffarpur, Bihar in 2011 which was done by a team consisting of experts from various disciplines. The team visited Muzaffarpur, from 14th to 20th July 2011 and reviewed the situation of deaths among children due to AES, as directed by the Authorities. A total of 147 cases of fever with altered sensorium were admitted between 11th June to 18th July 2011 in a private hospital and a Medical College Hospital of Muzaffarpur. Out of these, 54 patients died indicating case fatality rate of 36.73%. Clinico-epidemiological and environmental evidence supports the diagnosis of Acute Encephalitis Syndrome which has significant mortality, affecting predominantly rural population with poor sanitation and presence of wild rats. No significant association of litchi consumption and poor nutritional status of children with AES disease were found. Evidences suggest that there were increased chances of contacts between cases and wild rats during the period of occurrence of outbreak. Key observation was the sudden drop in incidence of cases with rainfall as during and just after the rain children abandons the outdoor games in farmlands/ litchi gardens due to accumulation of water in these areas and exposure from the rodents prevented Etiological agent could not be identified by laboratory tests. Time, place and person distribution of cases is suggestive of infectious disease of short incubation period (<1 day) having wider spectrum of sub clinical and clinical phases & lifelong immunity after first infection.
Dr. Anil Kumar
Directorate General of Health Services, Ministry of Health & Family Welfare, India.
National Leprosy Eradication Program, India
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