Inept response as mystery fever grips Uttar Pradesh
it was in October 2002 that media reports surfaced about children succumbing to a mysterious infectious fever in Saharanpur town of western Uttar Pradesh (up). The disease struck neighbouring districts too. Within the first two weeks the toll reportedly mounted to 100 in the area. The local administration first denied that there was an outbreak and then dismissed it as an annual occurrence.
The National Institute of Communicable Diseases (nicd), the nodal body for epidemiological research, was not even aware of the development till the media reported it. The institute's team has till now confirmed Japanese encephalitis (je) in three of the samples collected. Even this has been contradicted by one of its own entomologists. "We have still not detected the cause," says team leader Awadesh Kumar.
It is noteworthy that the real reason behind the Saharanpur epidemic figuring prominently in the news is the rivalry between two medical officers -- chief medical superintendent (cms) V P Bhatnagar and chief paediatrician Gopal Krishna. Information about the disease was apparently leaked to settle personal scores. Meanwhile thanks to the authorities' ostrichism, the disease has neither been classified nor notified.
These systemic shortcomings can be traced to the lack of focus on new infectious diseases in India's health policy of 1963 and its draft policy of 2001. Apart from malaria, other diseases receive scant attention. Even now, more weight is lent to therapeutic interventions than outbreak prevention. When precautions are taken, they do not have a scientific basis. "Strict protocols of 'what, how and when' samples should be prepared and collected," points out N S Deodhar, ex-director of All India Institute of Hygiene and Public Health in Kolkata.
Surprisingly, nicd does not have a classical definition for an outbreak or epidemic. It only acts on requests received from state administrations and evinces nothing more than an "academic" interest in fevers and outbreaks. States, on their part, are wary of declaring an epidemic as it can cause panic. Further, the state health department has the onerous task of preventing epidemics by spraying insecticides and dispensing medicines.
In Saharanpur, nicd was looking only at viruses -- that too vector-borne and related to je. Going by the institute's poor track record (not even one new virus identified from a rash of mysterious fevers over 20 years), it cannot be relied upon to get to the bottom of the Saharanpur epidemic.
"Early detection is possible only if bodies like nicd are made autonomous," feels nicd director K K Datta. But would this help control diseases?
The absence of evidence in Saharanpur has led to many agencies sowing seeds of doubt. The Industrial Toxicology Research Centre, Lucknow, went to the extent of claiming that a pesticide was killing the children. Even as the up town awaits nicd's verdict (expected around January 25, 2003), new mysterious fevers have reared their head across the country.
In Karnal, Haryana, just before the onset of winter at least 15 to 20 children die of Japanese encephalitis. Sadly these victims are considered a part of the natural cycle of the disease. Vinod Khosla, deputy director, entomology division, district health services, Chandigarh, says it is impossible to vaccinate each child. And the civil surgeon of Karnal, H B D Arora, seems to have become comfortably numb: "If 15-20 kids die of Japanese encephalitis every year, it is an acceptable loss."
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