In view of the rising incidents of deaths due to AES/JE in Muzaffarpur and adjoining areas in Bihar, Union Health Minister Harsh Vardhan has issued instructions for deployment of eight advanced life-support (ALS) ambulances in the affected districts.

Accordingly, eight additional ALS ambulances were pressed into service for transportation of critical patients under the National Health Mission (NHM), a statement issued by the health ministry said. The central teams comprising 10 pediatricians and five paramedics each had started working on the ground, in coordination with the state government, it added. The teams were sent to Bihar on June 19.

Vardhan further informed that 16 senior district officials and medical personnel were sent to the vulnerable blocks for monitoring and early identification of cases and ensuring daily reporting. Their headquarters were also shifted to these blocks, he said, adding that the district collector was involved in the process now and was personally taking responsibility for the same.

The collector had deputed senior deputy collectors (SDCs) or district-level officers to lead various block teams, Vardhan was quoted in the statement as saying. These teams would be assisted by a district-level medical officer and a medical officer in-charge (MOIC) to do the overall work at the block level, the statement said. It added that the authorities in Bihar were given instructions to switch to daily surveillance and monitoring for detecting early warning signs of the disease.

"The state government has started a social audit, along with an active case-finding campaign through a house-to-house survey, and is moving the prospective patients to the nearest PHC for early intervention. Surprise checks are also being conducted at the PHCs by SDCs.

"Additionally, the early morning inspection of anganwadi centres is also being undertaken by SDCs and child development project officers (CDPOs). They are also giving ORS to each house in the affected villages," the statement said.

The auxiliary nurse midwives (ANMs) and accredited social health activists (ASHAs) were directed to visit every house to raise awareness on Acute Encephalitis Syndrome/Japanese Encephalitis (AES/JE) by distributing pamphlets and brochures, it said, adding that awareness was also being created through other measures such as announcements through microphones and inter-personal communication.

Also, a team of experts from the Indian Council of Medical Research (ICMR) was deployed at the Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur for making the virology laboratory operational at the earliest, Vardhan was quoted as saying in the statement. He added that the multi-disciplinary team deployed earlier was reviewing all the case records of the AES patients admitted to the hospital in 2019.

"The team is reviewing the case records of discharged and deceased AES patients at SKMCH, using a standardised tool to know the reasons for mortality. We expect to complete the activity in the next two to three days. A similar exercise will be undertaken at the Kejriwal Hospital," the Union health minister said.

The multi-disciplinary team will systematically collect clinical, nutritional and epidemiological information from the AES patients hospitalised since May 18. Blood, urine and CSF samples will be collected from these patients to rule out infectious aetiology. It would also carry out a case-control study (by taking household/village controls) to reconfirm the role of missing meals and litchi consumption (including the quantity), the statement said.

Orientation training of all pediatricians of SKMCH will also be conducted in batches over the next few days on clinical case management and the treatment protocol of AES and the new teams will be briefed about case assessment, investigations and the treatment protocols already in place. They would also be requested to continue with the same, the statement said.