When the number of deaths of children who died from Acute Encephalitis Syndrome (AES) in Muzaffarpur Bihar crossed 100 in more than two weeks, it brought back confusing memories from Gorakhpur, about two years ago.

More than 70 children have died on a daily basis in Gorakhpur Uttar Pradesh, a tragedy that raises questions involving government hospitals where it happened, doctors and suspected lack of supply of oxygen cylinders.

Lack of readiness
Both incidents are similar, because they reflect the State's lack of readiness to deal with seasonal encephalitis, experts say, urging health authorities to have a standard operating procedure (SOP) that begins before the alarming months arrive.

However, the Muzaffarpur outbreak is different, because it is not classic infectious encephalitis that occurs in several countries during the rainy months, said V Ravi, Senior Professor and Head (Neurovirology), NIMHANS. Over the years, a mid-summer encephalitis outbreak in this region has been linked to toxic substances in lychee fruit coupled with low blood sugar in children.

AES can be caused by organisms (bacteria, viruses), poisons etc. and treated / managed depending on the causative agent.

And even though lychees have many good qualities, problems arise when children have them on an empty stomach. "Children take fruit from the ground and bite the seeds too. Schools are closed for summer, so children don't get their midday food. They will finally sleep on an empty stomach. Toxin and low blood sugar are fatal for children, "explained Ravi, who has about four decades of experience dealing with encephalitis cases and is currently completing a five-year study on its prevalence in West Bengal, Uttar Pradesh and Assam. This study was funded by the US Centers for Disease Control and Prevention. "This is dramatic, when the child fell into a coma and died the next day," he said.

When lychee-links are revealed, there is a campaign to warn parents. This did not produce a case last year. However, communication failed this year, said Ravi. Authorities should notify parents in April of encephalitis related to lychees and tell them to make sure their children eat before going to bed, he added.

In the type of encephalitis that can be treated with doxycycline, he said, "It's nice to see a child near death, get up and walk instead. This is very satisfying. But there is no pediatric syrup from this drug. "He added that pharmaceutical companies did not show interest because" encephalitis is the king of orphan diseases ".

Gagandeep Kang, Executive Director of the Translational Health Science and Technology Institute, underlined the need for SOPs in hospitals. There needs to be a good diagnostic setting to identify the causes and trained clinical staff to provide quality care. Health administrators also need to have a prevention strategy, he added.