Fruit scare

Encephalitis is not only threatening lives in Bihar, but also the livelihood of litchi farmers as unconfirmed reports link the disease to the fruit

 
By Alok Gupta
Last Updated: Saturday 04 July 2015 | 02:50:09 AM

Children suffering from acute encephalitis syndrome have to fight for space at SKMCH hospital

Muzaffarpur in Bihar is as infamous for encephalitis as it is famous for its shahi litchis. Acute encephalitis syndrome (AES) has been a leading cause of child deaths in the state. Till the time of filing this report, 210 children across Bihar had died of AES since May this year. According to official figures, since 1994, Muzaffarpur alone has witnessed 995 AES-related deaths of children. Unofficial estimates put this figure at at least 1,800 in the district utterly lacking healthcare infrastructure.

The disease is now giving sleepless nights to litchi farmers in the state as several reports have surfaced in the media on the probable link between AES and eating litchi. Any confirmed evidence will put at stake the livelihood of thousands of farmers as the state’s economy depends on litchi cultivation to a large extent. According to the Food and Agriculture Organisation, litchi is the ninth most produced fruit in India and Bihar is its biggest producer. Muzaffarpur is one of the leading producers in the state.

Could litchi be the culprit?

Although there are no studies that directly link litchi to AES, media reports claim that litchis have chemicals similar to those found in ackee (Blighiasapida), a Jamaican fruit, which causes acute encephalopathy disease in children called Jamaican vomiting sickness. Some reports have also linked pesticide use in litchi cultivation to AES. Link between litchi and encephalitis, if proved, will affect the livelihood of thousands of farmersVishal Nath, director of National Research Centre for Litchi (NRCL), a research body that promotes litchi farming, denies the link. “Farmers in Bihar are not rich enough to buy pesticides. And even if they use pesticides, they use the very mild ones,” he says.

Scientists at NRCL have been flooded with queries from farmers and consumers. “Litchi is grown in Tripura, Assam, West Bengal, Bihar, Himachal Pradesh and Punjab. If litchi causes AES, why are there no AES-related deaths in the other states?” Nath asks (see ‘Irresponsible reportage can harm business’).

Dhananjay Singh, a litchi farmer, says farmers in the region are always in touch with NRCL to ensure better produce. “I received a lot of queries from my buyers in Delhi and local consumers. Fortunately, our business did not suffer,” he says.

Creaky healthcare, shifty virus

While farmers might heave a sigh of relief for now, children continue to succumb to AES in hospitals. In the intensive care unit (ICU) of Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur, Roushan Ali, 16, sits stone-faced on a stool. Beside him is the body of his 11-year-old brother, Parvez. “He is dead, he is dead,” Roushan mutters. Outside the ICU, a woman clutches the body of her three-year-old daughter. A group of men, apparently her relatives, wait for her to loosen her grip so that they can take away the body for the last rites.

Corpses of children, wailing mothers and unconscious children in hospital beds, with a web of tubes running through their hands and legs, are a common sight at SKMCH. Children battle for lives in the ICU, in the wards, in spaces between the beds and in the fanless corridors of the hospital. Doctors and nurses rush from one patient to another to save whoever can be saved.

Braj Mohan, head of the paediatrics department, SKMCH, who has been working in the hospital for the past 18 years, says that the symptoms of AES have changed drastically. “Till 2010, AES afflicted children had three prominent symptoms—high fever, seizure and frothing. In the past few years, children suffering from AES have not reported fever,” he says, adding that this year patients have also reported low sugar levels. The medical fraternity is, therefore, clueless about the measures to be taken.

The situation is worsened by inadequate number of beds, doctors and nurses, and lack of basic infrastructure like electricity and speedy ambulance service. Emergency ambulance services are not very effective because most drivers have quit due to non-payment of salary. Radha Devi brought her four-year-old daughter, Munni, to SKMCH after a two-hour journey by bus and autorickshaw. “We called the ambulance, but it did not come. I could not waste time waiting for it,” she says.

Deepak Kumar, principal health secretary, claims the government has adopted a policy of providing speedy medical aid to AES patients. At least 80 ambulances have been pressed into service. “We want to solve the acute infrastructure crisis at SKMCH. By next year, we plan to build ICUs with a capacity of 100 beds,” he adds.

In a bid to control AES-related deaths, the Bihar government launched a Japanese encephalitis drive in the state in 2012. The move helped control deaths due to Japanese encephalitis virus in Gaya and Sheohar districts. Muzaffarpur remains a challenge because the encephalitis that has surfaced in the district is caused by an unknown virus.

`Irresponsible reportage can harm business'
 
Vishal Nath,Vishal Nath, director, National Research Centre for Litchi (NRCL), says there is no scientific evidence to prove that acute encephalitis syndrome (AES) in children is caused by litchi and that conclusions cannot be drawn from mere suspicions. Edited excerpts from an interview:
 
Has NRCL done any research on the link between litchi and AES?

NRCL promotes scientific cultivation of litchi. We do not do research on AES. But we have supported researchers from the National Institute of Virology and National Centre for Disease Control in finding the cause of the disease. Few months ago they carried out research to find out if rats and bats that eat litchi could spread AES.

What were the findings?

The findings were not shared with us. We were informed by other sources that no confirmed link could be established between litchi and AES. How do the reports on litchi causing AES affect NRCL and litchi farmers?

It is a matter of great concern. As a researcher I do not rule out that litchi can cause AES. But there should be scientific evidence. The media should be careful with its reportage. Litchi business was at stake this year because of these unconfirmed reports. Fortunately, it did not translate into losses. But the situation might worsen if the links are not disproved at the earliest. Farmers are also concerned. Many victims of AES are children of these farmers. They are equally worried that the crop they cultivate could kill children.

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  • Dear Author, I need a

    Dear Author,
    I need a little clarification of my thoughts- As of May 9 2014, the report presented in DTE webpage, titled "Lychee, a probable reason for acute encephalitis syndrome" Authored by Jyotsna Singh, suggested that the cause of the mysterious illness was more than likely to be the metabolic complications resulting from the compound hypoglycine-A present in these fruits. The article even mentioned the involvement of the renowned Indian Virologist Dr. Jacob John with the investigation proceedings.

    However, the latest edition of DTE has hinted more towards a possibility that the disease tends more towards a mysterious virus related infection rather than a lychee related metabolic complication.

    How much sure can we be now that the illness is of viral origin?
    Can you please clarify on what new scientific evidence this transformation of belief has been made?
    Please provide the web-links or sources of scientific literature that can help understand this case better.

    Thanking You,
    A concerned citizen

    Posted by: Anonymous | 4 years ago | Reply
  • The cause of AES is yet to be

    The cause of AES is yet to be identified. Experts are exploring a variety of probable causes. The article published in Current Science indicated that lychee could be a possibility but a direct link is yet to be made. Similarly, there is lack of evidence to link any virus directly to the disease.
    Such uncertainity is unfortunate. The disease is spreading to new areas and we are unable to do anything to either control its spread or treat people affected by it

    Posted by: Vibha Varshney | 2 years ago | Reply
  • In that case, has the

    In that case, has the possibility of infection by a new emerging virus been ruled out?
    A few years back in 1998, in Malaysia, an epidemic outbreak occurred in the city of Ipoh. The symptoms were very similar to Japanese Encephalitis and the government took immediate actions to prevent JE spread, especially among pig farmers who were the most affected. However, the infection turned out to be caused rather by a new virus, "Nipah" previously unknown. The virus had jumped from Fruit-Bats to Pigs and then to Pig Farmers, then to all other people of the villiage, similar such Nipah outbreak through Fruits had also occured in Bangladesh in the 2000s.
    The Bihar case also seems to have suttle correlations between the malaysian and Bangladeshi Nipah Cases- The involvement of Fruits, Symptoms similar to JE and the Proximity of Bihar to Bangladesh (Easy migration for Infected Bats)
    So, has the Virologists' report ruled out "Nipah" Virus
    Case Reference: "Spillover" by David Quammen
    Concerned Citizen

    Posted by: Anonymous | 4 years ago | Reply