How Muzaffarpur achieved zero AES deaths five years since its most deadly outbreak

On an early August morning, when two-year-old Mohammad Waris suddenly fell ill and developed a high fever in a village under the Mushari block in Muzaffarpur, Bihar, his father, Mohammad Manzoor, acted swiftly. Fully aware of the deadly acute encephalitis syndrome (AES), locally known as chamki bukhar, he immediately rushed Waris to a nearby primary health centre (PHC) for treatment.

After receiving preliminary care, the child  was admitted to the paediatric intensive care unit at the government-run Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur on August 3, 2024. He was discharged on August 7, 2024, returning home in good health. Awareness and timely treatment saved Waris’s life after being diagnosed with AES, which doctors attributed to low blood sugar levels or hypoglycemia.

Saroj Kumar, a resident of Majhaulia in Muzaffarpur, faced a similar situation last month when his four-year-old son, Shiva Kumar, was also rushed to a nearby PHC and later admitted to SKMCH. Shiva received treatment for AES and was eventually discharged. Both Manzoor and Saroj acknowledged that awareness of AES has now reached everyone, leading people to seek immediate medical attention, unlike in the past.

As Gujarat faces a surge in AES cases, Bihar’s experience with this deadly disease offers valuable insights. According to reports, Gujarat recorded over 70 AES deaths by August 8, 2024.

In 2019, Bihar experienced a severe AES outbreak, primarily in Muzaffarpur and neighbouring districts. Muzaffarpur, also known as the Land of Litchis, gained notoriety for the deaths of over 100 children, the majority of whom were from impoverished families. Several studies have suggested children who consume large quantities of litchis, especially on an empty stomach, are at increased risk of developing AES.

Five years since the outbreak, Muzaffarpur has successfully achieved zero AES-related deaths as of August 9, 2024, despite the record-breaking heat witnessed this summer. Child deaths due to AES typically peak in May and June, during scorching summer months when the mercury exceeds 40 degrees Celsius.

Since the 2019 outbreak, there has been a concerted effort to raise awareness in rural areas and improve preparedness at all levels, from primary health care to district and tertiary hospitals.

Most Muzaffarpur parents, particularly those in rural areas, are now familiar with prevention tips and do not hesitate to rush their children to the nearest hospital if AES symptoms appear. This change is largely due to facility preparedness and community-level awareness initiatives, part of the state government’s strategies to reduce AES cases and mortality.

Satish Kumar, Muzaffarpur vector-borne disease control officer, confirmed to this reporter that no deaths due to AES have been recorded so far this year in the district, even though 28 cases have been reported. “This is a significant achievement. AES cases have decreased compared to previous years as well,” he said.

SKMCH superintendent Kumari Vibha confirmed that children suffering from AES were admitted to the paediatric intensive care unit, where they received successful treatment.

Kumar attributed this success to the collaborative efforts of medical officers, hundreds of Jeevika Didis, Aanganwadi and ASHA workers, auxiliary nurses, midwives, elected panchayat members, Vikas Mitras, Tola Sevaks, cluster resource centre coordinators and officials from block to district levels.

“We have been working on the ground, holding regular meetings in every panchayat, leading door-to-door awareness campaigns and educating people on what to do if a child is suspected of having AES. All doctors, health workers and non-medical staff have been trained to treat and manage AES cases,” he explained.

An official from the Bihar health department, who was previously involved in AES prevention measures, noted that Muzaffarpur has become synonymous with child deaths due to the disease in recent years. A lack of awareness and inadequate facilities and preparedness were major contributors to the deaths.

“Vulnerable families now understand that they must rush to a PHC because any delay could endanger the life of an AES-affected child. Each PHC now has an AES ward with two dedicated beds, proper medication and other facilities as per standard operating protocol. This infrastructure was lacking four to five years ago and treatment was primarily dependent on SKMCH, which only had 30 beds for AES cases. Now, SKMCH has a 100-bed, well-equipped paediatric intensive care unit,” he added.

During the COVID-19 pandemic in 2020 and 2021, targeted prevention strategies worked well to keep AES under control. In 2020, 43 children in were admitted to SKMCH with AES and seven died from the disease, according to official data and in 2021, 39 children were admitted, with seven fatalities — significantly lower than the 2019 numbers. Official data shows that 111 children died that year and over 431 children were admitted.

“We worked hard to spread awareness of AES among vulnerable groups, particularly the poorest of the poor and conveyed the message to seek immediate hospital treatment to save lives,” Ajay Kumar, Muzaffarpur civil surgeon, told this reporter.

Gopal Shankar Sahni, head of SKMCH’s paediatric department, acknowledged that prevention measures have played a major role in reducing AES cases in Muzaffarpur and preventing deaths. “Parents are now aware of simple precautions. Children should not be allowed to play outside in the scorching sun and they should not sleep on an empty stomach. If a child develops a high fever, they should be rushed to the nearest hospital immediately. The first one or two hours are crucial in reducing the mortality rate,” said Sahni, who has been treating AES-affected children for years.

However, the state overall recorded four AES deaths and a total of 70 cases as of July 31, 2024, stated Sanjay Kumar, an official from the state vector-borne disease control department.

Over the past one and a half decades, more than 500 children have died from AES, primarily in Muzaffarpur and its neighbouring districts of Vaishali, Sitamarhi, Samastipur, Sheohar, East and West Champaran.