By- Dr Navneet Ranjan(Public Health Specialist) : 138 cases of unknown disease epidemic (Japanese encephalitis?) have been reported from Muzaffarpur districts of Bihar in till 4th June 2011. About thirty six percent of these (n=50) have died. Few cases from the adjoining districts of Muzaffarpur have also been admitted to the hospitals at Motihari.
The majority of the affected villages have reported only single cases. The suspected encephalitis cases have not stopped for admission at Muzaffarpur’s Kejriwal Maternity Hospital (KDKMH) and Sri Krishna medical college & Hospital (SKMCH) KDKMH is admitting the maximum number of cases for treatment and some other cases are being referred to Patna medical college hospital. Blood samples and spinal fluid samples were collected by a team of doctors came from New Delhi and NIV, Pune. Doctors are treating the children for fever and convulsions so far with anti-viral, anti-bacterial and anti-convulsion therapy.
It can be suggested to do Entomological surveys (apart from lab investigation) in the affected villages that may reveal the high density of Culex tritaeniorhynchus and Culex vishnui group – the vectors of Japanese Encephalitis (JE) to confirm the diagnosis.
Public Health Interventions to combat this unknown disease
The interventions should start with since a vector borne outbreak is suspected, vector breeding site. Whilst the target would be the following blocks of Muzaffarpur districts Bochahan , Kanti, Kudhani, Minapur ,Mehshi, Kunhari,Sakara,Mushari,Paru and Marwan
Following steps are suggested along with Govt, PRI, and AWW:
1. Organize meetings in the affected villages, followed by adjoining villages. Mothers should be a major intervention group. Tell parents about benefits of using of free bed nets and their use throughout the year. About keeping children clothed, if they can afford to, about keeping cattle sheds etc clean and other routine vector control measures.
2. Warn parents of the danger signs; ask all fever cases to be immediately taken to the PHC.
3. All vector control measures should be activated, as are referral networks for sick children from PHCs to the govt hospitals and those necessary drugs are in stock.
4. Take this as opportunity to tell community about the importance of immunization, sanitation, etc.
5. Contact the local Doctors association and inform all private practitioners.