The Fever Factory

This is a horror story that repeats itself every year in India at the onset of monsoons. The only change in the script this year is the high death toll—it has already crossed the 170 mark—and its immediate cause: a new strain of viral encephalitis sweeping across large parts of Andhra Pradesh and Maharashtra. The epidemic, spread by infected mosquitoes, has already taken almost ten districts of AP in its sweep and claimed 116 lives. At the time of going to press, the death toll in Maharashtra stood at 54.

Despite the fact that the first case was reported over a month ago (it started in Karimnagar in AP and Vidarbha in Maharashtra), health authorities are still clueless about the identity of the virus. What has added to the confusion is the fact that experts initially suspected it to be an outbreak of Japanese Encephalitis (JE). However, only three of the 60 samples collected so far in the state have tested positive for JE. Preliminary tests in Maharashtra too have proved JE negative.

The highest fatalities, mostly children, have been reported from rural areas in AP, typically for want of timely medical intervention. Doctors say diarrhoea, followed by high fever, delirium, convulsions and then irreversible coma are some of the common symptoms of this killer disease. Most alarmingly, children showing symptoms of this strain of viral encephalitis have been succumbing within 10 to 12 hours. Says Dr Nagabhushan Rao, a senior Hyderabad paediatrician: "The mortality rate has been almost 60 per cent. This is totally unacceptable. It's important that these children are moved to the nearest medical facility where the necessary treatment can be immediately started."

Rao and other senior doctors say that the epidemic has more in common with a similar outbreak of viral fever in Warangal in June last year. Doctors also feel that the lack of knowledge about the exact cause of the viral fever doesn't in any way hamper efforts to effectively treat it. "We know this is meningioencephalitis and are giving supportive and symptomatic treatment. The exact knowledge of the virus is only of epidemiological and academic interest," says Dr N.C.K. Reddy, superintendent of the Niloufer Hospital, which is treating about a dozen such cases.

Still, the high mortality rate of the fever has sent a panic wave in many districts of the state. Outpatient facilities in most hospitals have been packed to capacity with worried and confused parents rushing children to hospitals with any signs of fever or diarrhoea, which are not per se uncommon at this time of the year. Some are even giving their children homoeopathic medicines as a prophylactic against the fever even though there is no clinical test to prove the efficacy of such medication. Andhra health minister Kodela Siva Prasada Rao, however, insists that this outbreak of viral encephalitis is endemic, and not epidemic. "Malnutrition, poor sanitation and mosquitoes are the main cause for the outbreak," he maintains.

In Maharashtra, the opposition is accusing the state health department of not taking necessary preventive measures. Under some public pressure, chief minister Sushilkumar Shinde has ordered a probe into why the health authorities failed to control the spread of the epidemic. The government's defence is that it can do little to prevent a viral strain that's becoming endemic to the Asian region. Says state health director Subhas Salunke: "You can't blame the health department alone. Encephalitis cases are being reported even in countries like Malaysia. This is a fast progressing virus. Most patients dismiss this as ordinary fever and by the time they bring the child to the hospital it is too late."

Meanwhile, for the image-conscious Chandrababu Naidu, still recovering from the bad press over a spate of 'heat wave' deaths, this has been yet another public relations disaster. In a belated damage control move, he has announced a special Rs 25 lakh grant for each district to launch major clean-up and mosquito eradication drives. However, for the families who have already lost their children, it's yet another case of too little too late.