AES_blog_study

  The AES outbreak!

(A study)

-By Krishanu Choudhury

(Department of Molecular Biology, Tezpur University)

The recent  deaths of children in Bihar’s Muzaffarpur and in some parts of UP has given me chills go down my spine. The children died due to Acute Encephalitis Syndrome(AES) which is prevalent in Bihar and UP region. The AES prevalent in those areas from 15-20 years and was famous in those regions by the name of “Chamki bukhaar”.  

Acute encephalitis syndrome is characterized by an acute onset of fever and clinical neurological manifestation that includes mental confusion, disorientation or coma. Viruses especially flaviviruses have  mainly attributed to be the cause of AES in India although other sources such as bacteria, fungi, parasites, chemicals and toxins have been reported  over the past few decades. The causative agent of AES varies with season and geographical location, and predominantly affects population below 15 years. Keeping in mind the wide range of causal agents and the rapid rate of neurological impairment due to pathogenesis, clinicians face the challenge of a small window period between diagnosis and treatment.

The history of AES in India dates way back and has paralleled with that of the Japanese encephalitis virus(JEV) since its first report in 1955 from Vellore, Tamil Nadu. Thereafter. sporadic  cases of AES and outbreaks in India have been the leading cause of premature deaths due to the disease. In between 1975 and 1999 when more JEV and AES cases were reported were reported with frequent outbreaks that resulted in JE endemic regions near major river basins like Ganga and Brahmaputra including states of UP, Bihar, Assam and parts of Tamil Nadu. Litchi virus was the latest virus that caused AES outbreak in Muzaffarpur, Bihar. 

Virologists and Neurobiologists from the National Institute of Virology(NIV) and National Brain Research Centre(NBRC) have identified another causal agent in the form of “toxin-mediated illness”. Investigators hypothesized the causal agent as a toxin prevalent in the litchi fruit. In some cases, pathogenesis lead to encephalopathy with hypoglycemia. The toxin which aided hypoglycaemia was later identified as methylene cyclopropyl glycine found in litchi seed. About sixty three percent of the patients infected with AES in Muzaffarpur died due to hypoglycemia.

Several government initiatives have been undertaken to educate and improve the hygiene of people living in the JE and AES endemic regions. Governmental and NGOs have been instrumental in providing proper nutrition to the AES-affected population as most of the affected people belong to the lower economic strata of the society. There have been initiatives to help people of the endemic zones for alternative professions such as pig-rearing since pigs are the primary host for JE viruses. The first vaccine was developed in joint collaboration between NBRC and NiV  named as Vero cell-derived purified inactivated JE vaccine-JENVAC.

A senior scientist from NBRC named  Dr. Anirban Basu discovered Minocycline, a second generation tetracycline which has been proved to be effective against AES in animal model. The clinical study was done by the HoD of Paediatrics, King George Medical University which was successful for patients infected with AES. But ICMR will further study it clinically.

The tragedy that happened this year in Bihar’s Muzaffarpur  was due to lack of attention from the government’s side and also due to lack of proper healthcare facilities and professionals. At last but not the least, let’s believe in Doctors and medical science in making India free from AES just like we made India polio free.

       LET’S FIGHT AGAINST THIS EVIL AND MAKE INDIA A SAFER PLACE TO LIVE!