Encephalitis death toll nears 1,000 in India and Nepal
An encephalitis outbreak has killed nearly 1,000 people – almost all of them children – in India and neighbouring Nepal, as too few doctors struggle to care for thousands of sick children in outdated hospitals.
At the start of the week, the death toll in India’s northern Uttar Pradesh state stood at 767. Nepal has logged 204 deaths.
Every day, parents from the poorest corners of India’s most populous state pour into the small town of Gorakhpur, some carrying unconscious children whose limp bodies flop from side to side as they’re raced into one of the Japanese encephalitis wards at the BRD Medical College.
But by the time many children arrive, there’s little that can be done to even make them more comfortable. The tiny, often bare-chested bodies are placed with oxygen masks taped to their faces – a grim scene stretching across two hospital floors.
For the handful of overworked doctors scurrying from patient to patient, it’s an especially frustrating sight because the disease is easily preventable. Vaccines exist and measures can be taken to minimise exposure to the mosquitoes that spread the disease from pigs. But the tired physicians say such solutions might as well not exist without money and a strong political will to ensure that help reaches these poor, rural families.
Dr OP Singh, Uttar Pradesh state’s director-general of health, has said it would cost about £30m (€44.5m) to vaccinate the more than 7 million children aged 15 and under in the most-affected areas. The state’s entire health budget is £13m (€19.3m).
“It’s too hard for us also to see so many children and to see some dying and some handicapped and knowing this is a vector disease that can be controlled by removing all pigs from society,” said Dr KP Kushwaha, a paediatrician overseeing the hospital’s Japanese encephalitis wards.
The Japanese encephalitis virus – closely related to West Nile Virus – is found only in Asia, where it’s the leading cause of neurological infection. The World Health Organisation says about 50,000 cases are reported annually, including 15,000 deaths, but many more go unreported.
Eastern Uttar Pradesh is especially prone to the disease because it is a prime rice-growing region that breeds mosquitoes in its puddles and rice paddies. Its bowl-shaped geography allows little drainage after rains. Also, farmers often raise pigs close to where people live.
The disease sickens only about 1 in 250 people infected – with children from 1 to 15 the prime prey. Most adults in affected areas typically have developed natural immunity.
The illness causes sweltering fevers, convulsions and comas, and can leave permanent damage.
The WHO estimates that up to 75 percent of survivors suffer lifetime disabilities, ranging from paralysis to mental retardation to sometimes-violent behavioural problems.
In the dilapidated hospital in Gorakhpur, about 40 miles from the border with Nepal, Kushwaha is one of only about a half dozen doctors caring for children suffering from the disease.
The bespectacled man with warm eyes and a kind, weary face, bounces between the various units – intensive care, general and recovering – checking machines and oxygen tanks while signing papers and answering a horde of worried parents’ questions.
He has worked at the hospital since 1978 and seen bad outbreaks before, but nothing like this. The onslaught began in late July and is starting to show some relief, with up to 45 patients admitted to the worst ward each day compared to 60 patients at the height of the outbreak last month. But the filth and desperation are visible everywhere as grieving parents wail and layers of grime cover the floors.
Kushwaha estimates the actual number of infected children is four to five times higher than those seeking treatment at the hospital. One day, there were 98 patients – all but 10 of whom were suffering from Japanese encephalitis – in a ward equipped for only 54 patients.
The overload has forced doctors to place two children to a bed, even in the intensive care unit, which houses the hospital’s only seven ventilators designated for the disease. Most of the children lie unconscious with their eyes rolled back and their small chests heaving as the machines breathe for them.
So far, nearly 550 of the more than 2,000 people admitted to the hospital have died from the disease, doctors said. About 240 are currently hospitalised there.
For them, the virus is just too strong. Golu, a tiny two-and-a-half -year-old boy, looked like he was sleeping peacefully as his grandfather wrapped a blanket around him and carried his body out of the hospital for burial.
