Gorakhpur hospital tragedy: Scrub typhus a major cause of encephalitis, reveals 2016 study

In what may help pinpoint the cause of encephalitis, a 2016 study on the disease in Uttar Pradesh’s Gorakhpur concluded that a high proportion of Acute Encephalitis Syndrome (AES) is caused by scrub typhus, a form of typhus. Over 70 children have died at BRD Medical College Hospital since 10 August , many reportedly for want of oxygen after vendors stopped supplying oxygen cylinders when their bills remained unpaid. Around 30 children have died over the past two days alone, many of them infants in the neonatal intensive care unit. The researchers, a group of 10 doctors, used the case-control method of study. In case-control study, researchers compare patients who have a particular disease with patients who do not have it, in order to determine the relationship between the risk factor and disease. The research, which was conducted between 17 August and 16 October, 2016, looked at children below the age of 15 admitted to BRD Hospital. To make a comparison between the affected and the non-affected, children of similar age not affected by encephalitis, residing in the same home or village as those affected by the disease, were also taken as a sample. [caption id=“attachment_3928337” align=“alignleft” width=“380”] File image of the BRD Hospital in Gorakhpur. PTI[/caption] The researchers collected blood samples from the patients as well as the healthy candidates to determine the presence of O tsutsugamushi IgM, the organism which causes scrub typhus, and IgG, a type of antibody. They detected O tsutsugamushi IgM in 63 percent of the patients and IgG in about 82 percent of the cases. During the research, it was found that the top three symptoms among the patients included seizures, altered mental balance and vomiting. Six of the eight fatalities during the period of study too were detected with O tsutsugamushi IgM. When compared with the healthy candidates, those with encephalitis were 30 times more likely to test positive for scrub typhus, the report concluded. Gorakhpur has been the epicentre of encephalitis since 1978, when the first case was reported. Since 1978, BRD Hospital has an average of over 200 deaths per bed , making Gorakhpur highly endemic to the disease. Encephalitis is a disease carried through mosquitoes, which breeds in unclean environments. Dr Om Shrivastav, a consultant on infectious diseases and immunology, says, “Japanese encephalitis, transmitted through the culex mosquito, cripples the affected individual. The mosquito breeds amongst some animals especially pigs but also on pools of water besides other places. Culex also breeds in places which are difficult to eradicate: Gardens, parks and similar areas. Public accumulation of waste is fertile ground for breeding of the culex and its eggs and poor sanitation is key to a rampant unbroken cycle of the virus.” The disease is curable through vaccinations but the poor healthcare system is a major impediment to its eradication. According to one report, India ranked 154 out of 195 countries in terms of access to healthcare, lagging far behind countries such as Bangladesh, Nepal, Ghana and Liberia. While India spends only 5 percent of its GDP on public healthcare, China spends 10.4 percent of its budget on healthcare. Nevertheless, the Gorakhpur tragedy seems to have forced the Centre to rethink its public health policy. Understanding that the government may not be able to provide all sorts of healthcare facilities, Union minister Nitin Gadkari said that NGOs and social institutions can come forward to improve the healthcare system across India. “Due to various factors such as non-availability of expert doctors, manpower, lack of funds and red tape, it becomes difficult to provide professional healthcare to patients at government health facilities. As such, inviting social institutions and entrepreneurs to run such facilities on government lands provided at nominal cost would help provide professional healthcare service to poor and middle class patients,” Gadkari remarked at a function held to inaugurate the first phase of Nagpur’s National Cancer Institute. However, Shrivastav stresses on preventing disease before it becomes a public concern. He adds, “The offensive against encephalitis requires a major public health offensive that examines all breeding sites and intermediate hosts especially pigs. Medical entomologists have a crucial role to play in identifying local factors that could break the cycle of breeding. Public health surveillance is invaluable in clamping events that will decimate the burden of the infection. High risk individuals need to be vaccinated after counselling. While making such steps mandatory does not work, the value of human life must be weighed against unvaccinated individuals.” The Gorakhpur deaths have set off protests in the national capital even as Congress demanded that a murder case be registered against those whose negligence resulted in the “massacre”. Under strident Opposition attack and calls for his resignation, Chief Minister Yogi Adityanath on Sunday warned of "exemplary" action against those found responsible for the tragedy. With inputs from PTI