Why Children Face The Highest Risk Of Chandipura Virus

A fresh Chandipura virus outbreak in Gujarat has once again drawn attention to a disease that overwhelmingly affects children and can progress from a mild fever to life-threatening brain inflammation within hours. The Centre has deployed a National Joint Outbreak Response Team after Gujarat reported 35 laboratory-confirmed infections and 22 deaths among 184 suspected cases. All confirmed patients are children under 15 years, with a few cases also detected in neighbouring Rajasthan. The outbreak has highlighted a pattern seen in every major Chandipura outbreak in India: children bear the overwhelming burden of severe illness and death.

The question is why. Scientists do not point to a single cause. Instead, evidence from the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), the World Health Organization (WHO) and published research suggests that several factors overlap. Children are less likely to have protective antibodies, their immune responses differ from those of adults, the virus rapidly targets the brain, and their living environments often expose them more frequently to infected sandflies. Together, these factors make children, particularly those below 10 years, far more vulnerable to severe disease.

Limited immunity and a virus that attacks the brain

Chandipura virus belongs to the Rhabdoviridae family and was first identified in Maharashtra in 1965. Since then, outbreaks have been reported mainly from Gujarat, Maharashtra and Andhra Pradesh, almost always during the monsoon. According to WHO, the disease primarily affects children under 15 years and commonly presents as acute encephalitis syndrome (AES), a condition marked by inflammation of the brain that can progress rapidly.

One of the strongest explanations for the age pattern is immunity. Serological studies conducted by ICMR-NIV have shown that many adults living in endemic areas possess antibodies against Chandipura virus despite never recalling serious illness. Researchers believe these antibodies are likely the result of earlier subclinical or mild infections, allowing adults to develop some degree of immune protection over time. Adults can also contract Chandipura virus, but available evidence suggests many infections are mild or asymptomatic, reducing the likelihood of severe neurological disease.

Young children, however, are much less likely to have encountered the virus before. Without pre-existing antibodies, they face the infection with little natural protection. Researchers have also found that Chandipura virus is highly neurotropic, meaning it preferentially infects nerve cells. Once it reaches the central nervous system, it can trigger seizures, altered consciousness and coma within a short period. Scientists are still studying the precise biological mechanisms behind children's greater susceptibility. However, researchers believe differences in children's immune responses, combined with the absence of pre-existing antibodies, may contribute to more severe disease, although the exact mechanisms remain under investigation. Some studies have also examined whether poor nutritional status may worsen outcomes, although evidence remains limited and inconclusive.

Exposure increases the risk, while the disease leaves little time

Biology alone does not explain why children are most affected. Exposure also matters.

Chandipura virus is transmitted primarily by infected sandflies, particularly Phlebotomus species. WHO notes that while the virus has also been detected in mosquitoes and ticks during surveillance, sandflies remain the principal recognised vector. Their breeding increases during the monsoon, especially around mud houses, animal shelters, cracks in walls and damp surroundings.

Children in rural and tribal communities often spend more time playing outdoors or around livestock, increasing the likelihood of insect bites. This combination of frequent exposure and limited immunity places them at greater risk than adults.

Even after infection, early diagnosis remains difficult. The illness often begins with fever, headache, vomiting and weakness, symptoms that resemble many common viral infections. That similarity can delay medical attention until neurological complications begin to appear. Yet Chandipura virus is known for its unusually rapid progression. According to WHO, neurological complications may develop within 24 to 48 hours, and deaths can occur within 48 to 72 hours after symptoms begin. There is no licensed vaccine or specific antiviral treatment, which is why management depends almost entirely on supportive hospital care, including controlling seizures, reducing brain swelling and maintaining breathing. Early hospitalisation before neurological deterioration offers the best chance of survival.

A recurring pattern across outbreaks

The current outbreak follows a familiar epidemiological pattern. A major outbreak in Andhra Pradesh in 2003, later linked to Chandipura virus, involved hundreds of suspected AES cases, most of them children. Gujarat experienced another significant outbreak in 2024, and health authorities are again reporting that children account for all confirmed infections in the ongoing outbreak. WHO has also noted that Chandipura outbreaks in Gujarat tend to recur every four to five years.

According to the Union Health Ministry, the national outbreak response team is supporting surveillance, laboratory investigations, vector-control measures and active case finding in Gujarat and Rajasthan. These measures aim to detect infections earlier and reduce exposure to infected sandflies while researchers continue to investigate transmission patterns.

Decades of research and repeated outbreaks suggest children are not the primary victims of Chandipura virus by chance. Limited immunity, differences in immune response, the virus's ability to attack the brain and greater exposure to infected sandflies combine to place them at the greatest risk. Until effective vaccines or specific antiviral treatments become available, early diagnosis, prompt supportive care and sustained vector control remain the most effective ways to reduce deaths among children.