In parts of eastern Uttar Pradesh,encephalitis is a dreaded serial killer,one that shows up every autumn and takes away hundreds of lives,and stunts others for ever. What was once Gorakhpurs annual affliction also affects areas in Bihar,and now even Delhi. The disease,which causes brain inflammation,is usually labelled acute encephalitis syndrome,for lack of a clear diagnosis in each case. After 2,500 children were killed in 2005 from what was then diagnosed as Japanese encephalitis,a vaccination programme was started. However,the disease continues to visit every year this year,it has killed more than 300 people so far. While Japanese encephalitis is known to spread through mosquitoes it has a clear line of treatment and can be combated with larvicidal sprays and fogs acute encephalitis syndrome is a more diffuse phenomenon. The lack of a precise diagnosis is worrying in itself,and reflects either a lack of technical expertise or direction and commitment in the health system. A group of concerned doctors and citizens from Gorakhpur have even written letters in blood to the prime minister and various politicians,asking for the disease to be treated with the attention that a recurring public health emergency calls for. Most cases of encephalitis are caused by viruses,and the transmission channel could vary. Doctors need to pinpoint whether the infection travelled via mosquitoes,human contact or what medical terminology calls the faecal-oral route. Either way,the single enabling factor for encephalitis is poor sanitation in the area,open defecation and the fact that utensils are washed close by,shoddy drainage systems. It confirms that India lives in several centuries simultaneously while much of the world controlled infectious diseases by fixing waste-disposal and plumbing systems in the early 20th century,we still struggle with basic sanitation norms. Hygiene education and awareness-raising is part of it,but the larger questions of poverty and squalor must also be confronted. In the immediate term,someone needs to take charge of the outbreak,end the lobbing of accountability between the Centre and state,improve health information and hygiene as well as provide competent medical help. Encephalitis is predictable enough,it must be caught and controlled in time.
