September 13, 2005

Children bear brunt of Indian encephalitis outbreak

By Kamil Zaheer

LUCKNOW, India (Reuters) - With tears in his eyes, Indian
farmer Ram Kumar Dwivedi rushes to the side of his convulsing
son Vimal and begins pumping his chest with his hands to help
the nine-year-old breathe.

Vimal is one of thousands of Japanese encephalitis patients
in the impoverished, northern state of Uttar Pradesh, where
more than 700 people have died over the past few weeks.

The disease, first identified in Japan, is caused by a
virus spread by mosquitoes and affects the brain. Symptoms
include high fever, severe headaches and convulsions and can
lead to paralysis, coma and death.

Most of the victims are children belonging to poor families
-- they account for 80 percent of the deaths so far in northern

The state-run King George's Medical College hospital in the
state capital Lucknow is the best medical facility in the
region. But there were no doctors or nurses to immediately
attend Vimal in the crowded pediatric ward.

They were busy coping with newer cases pouring in from the
state's eastern districts.

"He used to play and run around and was full of life. Now
look at him," Dwivedi said, pointing to his scrawny, almost
lifeless son who lay naked on a metal cot in the ward, the
paint peeling off the walls.

Dozens of children lie on metal cots around him, their
exhausted parents holding them in their arms or pumping air
through manual ventilators for hours on end.

The doctors are not sure how many will survive. Of the 172
children admitted to the hospital with the disease in little
more than the past month, 43 have died.


The outbreak is the most serious in India in more than two

It could have been prevented, or at least minimized, with
an early and thorough vaccination campaign for children, who
are more susceptible to the infection because their immunity
levels are low.

But Uttar Pradesh neglected vaccination drives despite
smaller outbreaks nearly every year for more than two decades,
experts said. Thousands of vaccine doses are now arriving but
they are of little use for the hundreds already infected.

"The nature of the epidemic this year shows that it cannot
be left for chance that the cases will not be many," said Eimar
Barr, UNICEF's deputy director for India.

"Some years you get lucky, sometimes you don't."

Vaccinations would have also prevented survivors suffering
awful side-effects of the disease.

Health officials say Japanese encephalitis has a fatality
rate of between 30 and 60 percent. But many who survive are
physically or mentally handicapped because of damage to the
brain and other parts of the nervous system.

The disease is not new to Uttar Pradesh but authorities
noticed a spike in cases during the middle of the monsoon
season in late July.

Nearly 3,000 cases have been officially reported since. But
voluntary groups say the number would be higher as children in
rural areas often die before they are brought to hospital.

Encephalitis is common in China and Southeast Asia but the
number of cases have fallen sharply in China because of a
vigorous vaccination program during the past decade.

UNICEF says Indian authorities should import millions of
vaccine doses or sharply increase local production to prevent
another outbreak in 2006 during the monsoon season when
stagnant water makes it easier for mosquitoes to breed.

Mahendra Bhandari, head of King George's hospital, said was
deeply saddened to see so many children dying. But with limited
resources and his staff overwhelmed, there was little he could

"It is a calamity of the worst kind," he said.