New Delhi: The number of children to have died in Bihar’s Muzaffarpur this month, possibly from Acute Encephalitis Syndrome (AES), has reportedly climbed to 43. The state government has, however, claimed hypoglycemia – low blood sugar – as the cause of deaths.
The government said that 12 districts are currently under watch, though the deaths have so far been confined to Muzaffarpur.
Officials are currently saying that about 34 of the deaths have been due to AES. About 20 of these children died in a government hospital, the Sri Krishna Medical College and Hospital, and seven of them died in a private hospital, Kejriwal Hospital.
The former hospital has reportedly taken in 117 patients with AES since January – 102 of them were admitted in June.
Bihar saw a severe outbreak of the disease in 2012 – when 120 children apparently died. In 2014, there were 90 deaths. AES was first reported in Muzaffarpur in 1994.
Chief minister Nitish Kumar said: “The government is serious. Teams of experts and doctors are keeping a close watch on the situation.”
Politics and bureaucratic speak around AES
Hypoglycaemia is a common feature of AES. Indian Express reported that 98% of children admitted with AES also have hypoglycaemia, according to government data.
However, there has been considerable political posturing over encephalitis deaths with the governments of Uttar Pradesh and Bihar over the last several years. These governments often say publicly that they are committed to decreasing these deaths and then often insist that many children’s deaths in the summer months which are suspected to be of encephalitis are actually not.
“All cases come under the broad term of AES, but people consider it a disease when it is just a syndrome. Hypoglycaemia is the specific reason for most deaths,” said the medical superintendent of the government hospital where a large number of these deaths are occurring. He said they avoid using the term AES “because of the wrong perception it creates.”
According to him, out of the 36 deaths, 30 were due to hypoglycaemia, some accompanied by an electrolyte imbalance. The reasons for the other six deaths are not known.
The Bihar government’s director-in-chief of disease control told journalists: “None of the deaths, so far, have been caused by AES. The casualties were a result of hypoglycaemia – abnormally low level of sugar in the blood or deficiency of sodium and/or potassium – caused by intense heat and humidity.”
The Bihar government’s decision to cite the deaths as being due to hypoglycaemia and not AES is a technical categorisation and politically helpful to keep down “AES numbers,” but may not give a fully accurate picture of the situation in the state.
A parallel can be seen with the UP government, where during the Gorakhpur tragedy in 2017 – when a number of children died allegedly from encephalitis and a shortage of oxygen – the state maintained that the cause of their death was the ailments they were admitted to hospital for and not the sudden cut in oxygen.
What are the links between AES and hypoglycaemia?
“Hypoglycaemic encephalopathy” is a medical condition that occurs due to extremely low blood glucose of lower than .9 mmol/L. Patients are seen to have confusion, mental and behaviour disorders and lags in their responses. If untreated, patients can go into a coma.
A 2014 paper on the epidemiology of AES in India, co-authored by scientists who are also government of India officials, quotes research that says cases of AES in Muzaffarpur have shown inconsistent fevers and hypoglycaemia, among other things. Children are often seen to be “quite well” until evening but are “seriously ill” by morning with abnormal brain functions and seizures. Undernutrition is also a “consistent associated factor.”
The paper also says that many of the AES cases in Muzaffarpur are seen between April to June and many of the cases are also hypoglycaemic. This association between hypoglycaemia and AES has been seen in North Vietnam.