The mystery deaths of hundreds of children in eastern Uttar Pradesh last year was likely caused by a bacterial infection that is transmitted through head lice, an expert group has concluded.
The group of 20-odd experts from India and abroad, which was set up on November 19 last year, submitted its report to the state government last week.
The findings of the report, which are yet to be officially released, are likely to change the focus of identification, prevention and treatment of Acute Encephalitis Syndrome (AES) both in UP and the rest of the country.
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The micro-organism suspected to cause the disease is Rickettsia prowazekii, which is transmitted through the faeces of lice. The expert panel has recommended “delousing” as the most important preventive mechanism, and treatment with Permethrin lotion. Skin biopsy and Immuno-Fluorescent Assay tests have been recommended in addition to existing tests to identify Rickettsia prowazekii. Doxycycline has been recommended in addition to the existing treatment protocol even before diagnosis is confirmed.
The group has also recommended that patients should not be made to share cots in hospitals, because “lice leave the dying patient and invade other patients”. The large number of patients and a shortage of beds has seen two or three children being put on the same bed at BRD Medical College, Gorakhpur, for years.
The group, headed by Andhra Pradesh encephalitis expert P Nagabhushana Rao, was asked to recommend “clinical care management protocols and surveillance guidelines for AES and JE (Japanese encephalitis) in Uttar Pradesh.”
The group was constituted after measures such as “vaccination against JE, environmental management, larval control, pig control as well as provision of India Mark II hand pumps and deep wells to counter enteroviral infections” failed to significantly reduce AES cases and mortality.
Members of the group included experts from the National Institute of Virology, National Vector Borne Disease Control Program, BRD Medical College, Gorakhpur, and experts from non-government organisation PATH. It also had experts from the Centers for Disease Control and Prevention, US, including Ken Earhart, director, Disease Detection Regional Center of CDC-India, as honorary members.
The experts analysed 276 AES cases that came to BRD Medical College, Gorakhpur, in 2013. Epidemiological analysis and clinical data analysis suggested “Rickettsial infection (Epidemic Typhus) caused by Rickettsia prowazekii is the most likely cause of AES.”
Pritu Dhalaria, convener of the group, said, “Treatment is very simple and death can be prevented if the patient is given a single dose of Doxycycline at an early stage. Mass delousing programmes must be carried out in all high-risk districts.”