Thread by @oommen

#Nipah
India's inadequate surveillance systems & a history of 'mystery deaths'

From a 2003 article:
"A "mystery" disease in India's most populous state, Uttar Pradesh, that has so far affected 112 children and resulted in 43 deaths continues to baffle medical researchers. " 1/n

2/n

"The outbreak comes after a similar situation last year in Siliguri district in West Bengal and a suspected plague in the early 1990s. These outbreaks have highlighted India's serious weakness in identifying pathogens. "

3/n

" Ganguli's announcement that the Siliguri outbreak was caused by a measles variant was contradicted by researchers at the Delhi based National Institute of Communicable Diseases. "Six Siliguri samples were sent to [the US] CDC, and they turned out to be of Nipah virus," "

4/n
"Biraj Mohan Das, director of emergency medical services in India's health ministry, told the BMJ . But researchers at the national institute feel that the issue is still unresolved. "It very well could be a new virus, although we tend to think it is close to Nipah virus," "

5/n

Kerala's doctors have done a great job of getting the virus identified quickly, and it has helped the emergency response.

However, the question to ask is, how many Indians who died -over the last few decades - of sudden 'mystery diseases', may have actually does of #Nipah?

*Died of

6/n
Im told that one needs to sensationalise things a bit, at times. Here it is:

During Gorakhpur tragedy last year, where many children died of JE and Non-JE Acute Encephalitis Syndrome (AES), one thing that was ignored in media was the number of adults who died.

7/n

Now, in terms of encephalitis deaths, AES is the universe & JE is a subset.

Studies show that in Gorakhpur, incidence of JE declined from 1.9 /100,000 in 2010 to 0.5 /100,000 in 2012, & incidence of JE-negative AES, which causes a majority of the deaths now, stayed stable

8/n

Non-Japanese Encephalitis AES deaths are caused by enteroviruses like Chandipura virus, and, you guessed right, #Nipah virus. If you look at data on Non-JE AES deaths (nvbdcp.gov.in/Doc/je-aes.pdf), you will see most are reported from near WB, where we had known Nipah outbreaks.

9/n

My doctor friends tell me that in an emergency situation, AES deaths -say Chandipura virus, Nipah virus or other enteroviruses- can look similar to a doctor. JE would affect mostly children, but Nipah for example, will have an equal prevalence over age groups.

10/n

So we can further narrow down the question to; how many of the Gorakhpur deaths, or similar deaths every year of children and adults could potentially be caused by #Nipah?

11/n

Corollary:
According to (severely underreported) official data, Japanese Encephalitis (the "villain" in Gorakhpur) killed 254 Indians in 2017 while Non-JE AES killed 1097 the same year. Actuals could be 50-100 times more.
Of these, how many could have been #Nipah deaths?

12/n

Just found this news from yesterday's paper.

"The districts of Gorakhpur & Maharajganj, experts suspect, are highly susceptible to the presence of deadly Nipah virus" , it says.

Gorakhpur vulnerable to Nipah, feel PGI doctors

toi.in/XHExMb/a24gk via @TOILucknow

13/n
Lastly,
A map from a 2016 study titled "Acute Encephalitis Syndrome in India: The Changing Scenario"

ncbi.nlm.nih.gov/pmc/articles/P…
"Known" endemic regions of various viruses reported to cause Acute Encephalitis Syndrome (AES)in India.