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Chamki Fever: Pil, Deaths And Lychee Connection

In June 2019.Acute Encephalitis Syndrome (Chamki Bukhar) has claimed the lives of 100 children in Bihar’s Muzaffarpur in the last fortnight. There are nearly 300 children admitted to the Intensive Care Units of the two local hospitals.According to official data, 83 children have died at Sri Krishna Medical College and Hospital (SKMCH), while 17 have lost their lives in Kejrilwal Hospital in the city.[1]

What Is AES / Chamki Bukar?
AES Acute Encephalitis Syndrome is not a disease; it is a type of Syndrome which comes under the umbrella of hypoglycemia, Japanese Encephalitis, Herpes meningitis, Race Syndrome, cerebral malaria, scrub typhus etc. All of them are grouped under AES as they have a classical triad of sudden onset of fever, convulsions and loss of consciousness. Basically AED affects the brain due to which these symptoms occur.[2]

AES due to JEV was clinically diagnosed in India for the first time in 1955 in the southern State of Madras now Tamil Nadu. During 201810485 AES cases and 632 deaths were reported from 17 states to the National Vector Borne Diseases Control Programmed (NVBDCP)'in India, with a case fatality rate around 6 per cent AES cases were reported mainly from Assam, Bihar, Jharkhand, Karnataka, Manipur, Meghalaya, Tripura, Tamil Nadu and Uttar Pradesh[3]

The Lychee Connection

Bihar’s Muzaffarpur is famous for Shahee Lychee. It has got the Geographical Indication (GI) tag in October 2018.[4]However, for deaths of these children, lychee is not only the undermined casue. Heatwave, malnutrition and several other factors combined have lead to this havoc.

This also makes the rumours false that lychee consumption can cause deaths and it leads to AES. The myth has been broken as follows-
In 2017, an article published in the Lancet, the oldest and unarguably the most prestigious medical journal, researchers had concluded that the deaths were not due to the infections or pesticides present in the crop. According to researchers, lack of food combined with toxins Hypoglycin and methylenecyclopropyglycine (MCPG) present in lychee seeds was the cause of illness.
The toxin stimulates from the liver and affects the brain in the absence of glucose leading to AES like symptoms. MCPG in unripe lychees can cause a sudden drop in blood sugar levels. It can also cause vomiting; if it is ingested in huge quantities it can also cause unconsciousness, death and coma. The toxin can cause high fevers and seizures in severely malnourished children.[5]

The delay in taking children to hospital and thus administering and correcting glucose levels was the cause of death.

Action By The Centre:
The Health Ministry stated that Union Health Minister Dr. Harsh Vardhan had instructed that a 100-bed paediatric intensive care unit be set up at the Sri Krishna Medical College Hospital, Muzaffarpur, where around 100 children have died of encephalitis, or brain inflammation.
Harsh Vardhan, who had visited Muzaffarpur last week, had also said five virology laboratories would be established in different districts of Bihar in consultation with the state, and that the Centre would support 10-bed paediatric ICUs in adjoining districts.

PIL At Supreme Court:

A PIL has been filed by Advocate Manohar Pratap who claimed that he was deeply pained and saddened by the deaths of more than 126 children, mostly in the age group of one to 10 years, in the past week and the figures were rising day by day. The petitioners have asked for the following before the Court:

That a writ of mandamus or other appropriate writ, order and direction must be issued directing the government at centre and state governments:
1. To constitute a medical board of experts in the medical field and immediately send it to Muzaffarpur, to immediately arrange 500 ICU (intensive care units) with required medical professionals to deal with the emergent situation which has occurred due to outbreak of Acute Encephalitis Syndrome,
2. To immediately arrange 100 mobile ICU (intensive care units) with required medical professionals to deal with the affected patients from the remote areas; to notify an extra-ordinary government order directing all the private medical institutions in the affected area to admit and provide treatment free of cost to the patients,
3. To take all possible preventive steps to stop the outbreak of the said disease called Acute Encephalitis Syndrome (AES) in the earlier epicenter i.e. Gorakhpur,
4. To widely publish and advertise the preventive steps and first aid which requires to be given to patient in case of identified Acute Encephalitis Syndrome (AES);
5. To provide stocks of the medicines, medical equipment and other technical support which are required for treatment of patients suffering from Acute Encephalitis Syndrome (AES);
6. To grant compensation of Rs. 10 Lakhs to surviving members of family of deceased who have died due to negligence of the state machinery; to constitute a fact-finding committee to determine the role of persons/entity negligent in treatment of children which has resulted in mass deaths.[6]

Concluding Observations
It can be inferred that the matter has been covered thoroughly by digital and print media. It is expected that the Apex Court will come with a suitable solution seeking action into this case. The deaths of the young children are a huge loss to the nation and let us pray for the ones who are fighting for their lives due to this epidemic.

End-Notes
[1] Encephalitis death of children in Bihar: Petition in SC, available at:http://www.ptinews.com/news/10647661_Encephalitis-death-of-children-in-Bihar--Petition-in-SC.html
[2] Acute Encephalitis Syndrome in India: The Changing Scenario, available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5043220/
[3] National Health Portal, AES, available at: https://www.nhp.gov.in/disease/communicable-disease/acute-encephalitis-syndrome
[4] Muzaffarpur ‘shahi litchi’ gets GI tag, Available at: https://timesofindia.indiatimes.com/city/patna/muzaffarpur-shahi-litchi-gets-gi-tag/articleshow/66297801.cms
[5] Association of acute toxic encephalopathy with litchi consumption in an outbreak in Muzaffarpur, India, 2014: a case-control study, The Lanchet; Available at:https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30035-9/fulltext
[6] WRIT PETITION (CIVIL) NO. 780 OF 2019, Supreme Court of India.

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