Doctors say treatment protocol recommended by expert group may harm patients
A committee of experts set up last year to look into the deaths of hundreds of children in eastern Uttar Pradesh of brain fever has recommended that every child with symptoms of Japanese Encephalitis (JE) or Acute Encephalitis Syndrome (AES) should be given single dose of the drug Doxycycline in villages where the diseases are endemic. JE is a form of Acute Encephalitis Syndrome and is characterised by inflammation of the brain and high fever.
The 11-member expert group committee, comprising experts from India and abroad, has also said that health workers in peripheral areas of eastern Uttar Pradesh and registered medical practitioners should be trained to identify disease symptoms and give first-aid before a patient is taken to Gorakhpur for medical treatment. The committee, which was asked to suggest ways for strengthening surveillance, treatment protocols and referral mechanisms for clinical care management of JE/AES, submitted its report to the Uttar Pradesh government last week.
“The damage to brain due to JE is limited. The main damage is caused by delay in reaching a proper medical facility. That is why first-aid becomes very important,” says P Nagabhushan Rao, chairperson of the committee.
The committee's recommendations has, however, drawn flak from some quarters. Even doctors treating patients suffering from AES at Baba Raghav Das (BRD) Medical College of Gorakhpur are critical.
'Doxycycline not a good idea'
“Administering Doxycycline 200 mg to all children with symptoms of JE is not a good idea. Symptoms like high fever exist for many diseases, including viral infection. Doxycycline settles in patients’ bones and can harm them. Almost every child who consumes the medicine gets diarrhoea and vomiting. This is one reason why this medicine did not become popular among the locals. These concerns should be addressed before giving Doxycycline to all suspected cases,” says Komal Kushwaha, principal and head of department of paediatrics, BRD Medical College.
He adds that this matter should be sorted out before implementing the recommendations. "We will have to administer the drug if the recommendations are implemented despite knowing that this will create troubles for non-JE children," says Kushwaha.
Are lice the carriers?
Another major recommendation of the committee to prevent JE and AES is to stop spread of lice by washing clothes in boiling water.
“So far the cause for AES/JE is known in only 11-12 per cent of the cases. For the rest, we still have to continue investigations. In this process we found that one possible agent for JE can be Rickettsia bacteria. Rickettsial infection spreads through head and body lice and there is evidence of large presence of lice in eastern Uttar Pradesh,” says Rao. He, however, says that spread of JE through lice is still to be proven and these are mere indications.
Kushwaha says possibility of Rickettsial infection causing JE is low.
“Rickettsia is found in the winter while JE spreads in monsoon, months preceding winters. This connection is far-fetched,” says Kushwaha.
However, Rao says that once the bacteria enters a body, it can cause harm for a long time.
The setting up of the committee and its recommendations have taken a long time. From 2006-2011, mass JE vaccination campaigns were conducted in 36 endemic districts of Uttar Pradesh for children aged one to 15 years. Though proportion of JE patients among all AES patients came down from 35 per cent to 2 per cent after vaccination was launched for JE, the number of children dying of AES has not declined much, making it necessary to ascertain other reasons of its spread to put control measures in place.
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