On January 7, NV Kulkarni, a doctor in the western suburb of Pune’s Dhayari, treated at least 40 patients suffering from gastrointestinal problems in the township where he lives.
The next day, there were just as many patients with similar symptoms at his clinic. Kulkarni posted a message on the WhatsApp group of DSK Vishwa, a township of nine housing societies, warning residents of a stomach bug in the area. “At that time GBS was not suspected,” he said.
Around 10 days later, some patients began showing symptoms of paralysis and some were taken to the Deenanath Mangeshkar Hospital, where they were diagnosed with Guillain-Barré syndrome. A rare autoimmune disorder, GBS causes temporary or lifelong paralysis and numbness in limbs. It is triggered days or weeks after a viral or bacterial infection.
One of those who fell ill in the township was Pravin Vibhute, a 40-year-old chartered accountant. After taking some medicines, he travelled to Solapur for a function where he developed Guillain-Barré syndrome and breathing difficulties. On January 26, he died in hospital. This was the first of the five deaths in Maharashtra from Guillain-Barré syndrome since early January.
State health officials have traced the sudden spike in Guillain-Barré syndrome cases in and around Pune to a mix of bacterial and viral infections. The bacteria, campylobacter jejuni, spreads through contaminated water.
While health officials told Scroll that water was not the sole source of infections that developed into Guillain-Barré syndrome, residents are angry over what they see as the failure of the municipal corporation to supply safe water to the area.
“The water supply to Pune city is tested every day,” said Rohit Mate, who works at the office of his uncle, the former Khadakwasala sarpanch. He was referring to the water sent from the Khadakwasala dam on the Mutha river to Pune after purification. “But nothing is done for the drinking water supply to our villages,” he said.
The Pune Municipal Corporation is allowed around 11.5 TMC, or thousand million cubic feet, of water from Khadakwasala dam annually. But it needs more than this and has been demanding a greater water allocation from the irrigation department.
Residents from villages such as Kirkatwadi, Nanded gaon, Khadakwasala, which reported a high number of GBS cases, also complained that they had been receiving water without adequate chlorination and filtration.
The outbreak
Till February 6, there were 173 suspected GBS cases in and around Pune – of them 34 from Pune municipal corporation, 87 from nearby villages, 22 from Pimpri Chinchwad and the remaining from rural regions beyond Pune.
At least 55 GBS patients were in intensive care units across Pune, and 21 others on ventilator support.
In the last seven days, 18 new GBS cases have been detected by the state health department. Dr Nitin Ambadekar, director of Directorate of Health Services, said based on daily reports, it seems that the outbreak is inching towards its end. “Most GBS cases that are being reported to us are patients who were admitted several days ago,” he said.
Though the spurt in cases has led to scrutiny of water supply, health officials said bacteria spread through contaminated water was not the only source of the infections. Dr Babita Kamlapurkar, state epidemiologist, told Scroll that they suspect “multi-factorial infections led to the huge count of GBS in Pune”. “We can’t blame one infection,” she said.
Data from the state health department shows that stool samples of affected patients sent to the National Institute of Virology found multiple pathogens responsible for GBS. In at least 21 patients, norovirus infection was detected, while four patients reported campylobacter jejuni infection, and one Epstein-Barr virus, a commonly found virus in humans.
No corporators
The death of one of its residents and multiple complaints of diarrhoea at the DSK Vishwa township led the residents to hold a “janata durbar” on February 2, where they discussed restarting their filtration plant.
“At a personal level, we purify water. Everyone has a water purification [system] at home,” said Paras Mahale, a resident of DSK Vishwa. “But at society level, there is no purification system.”
Residents criticised the Pune Municipal Corporation for failing to provide civic amenities in these areas. “We pay taxes but we are not even getting any basic facilities from the PMC,” said Mahale.
Worse, they said that they could not approach any corporators for any help in the current situation.
Elections to 27 municipal corporations in Maharashtra have not been held since the terms of the elected bodies expired between 2020 and 2023. The term of the Pune Municipal Corporation ended three years ago in March 2022. As a result, there are no corporators for the new areas that came under civic limits after the elections were held in 2017.
“We are directly dealing with [civic] officials,” said Mahale. “There is no one to communicate [on our behalf].”
A contaminated well?
The source of water for the DSK Vishwa township and the three nearby villages that reported several GBS cases is a large well at Nanded Phata, along the Mutha river. State health minister Prakash Abitkar told the Hindustan Times that 80% of the reported cases of Guillain-Barré Syndrome are from areas around the well.
Water from the well is not treated or purified before it is supplied to the nearby villages and residential areas. It is only chlorinated, civic water supply department head Nandkumar Jagtap told The Indian Express on January 27.
DSK Vishwa, established around 22 years ago, has always received water from this Nanded well.
The well was first managed by the gram panchayat and later transferred to the Pune Municipal Corporation.
The Nanded well also supplies water to three villages close to the Khadakwasala dam: Nanded, Kirkatwadi and Dhayari. A health assistant at the Khadakwasala Primary Healthcare Centre told Scroll that three villages had reported at least 63 GBS cases.
The state government collected 3,868 water samples from across Pune for chemical analysis – 37 so far have been found contaminated.
‘You are quenching Pune’s thirst’
About 2 km down the road from DSK Vishwa is Kirkatwadi village.
Former sarpanch Gokul Karanjawane recalled that early in January, several children fell sick, suffering from vomiting and loose motions. Their hands and legs suddenly became heavy and stiff, they could not move their limbs, he said. Some patients started suffering from paralysis.
Of the 173 cases of GBS, there are at least 46 children and teenagers.
Karanjawane said that after the municipal corporation took over, it dismissed the gram panchayat workers, who chlorinated water meant for the village, and brought in contract employees.
“The corporation was going to construct a filtration plant at the dam with the zilla parishad,” he said. “Funds did not work out.”
Karanjawane said that upstream of the dam, several resorts and farmhouses have come up over the past few years and they discharge sewage directly into the dam. A sewage treatment plant is urgently needed, he added. “Otherwise, it could be worse in the future,” he said.
Two children from the village are still in hospital: one of them is a boy aged nine years and the other a girl, who was preparing to write Class 10 board exams.
Barely a kilometre ahead is Khadakwasala village, which lies along the dam. Rohit Mate, the nephew of former Khadakwasala sarpanch, said things are stable now but the situation in January had been “bhayanak” – terrifying. “People don’t know what happened. All they knew was that it was because of drinking dooshith paani – polluted water,” he said.
He said residents are now scared if they vomit or have loose motions. “They panic and go to the local doctors,” he said. “Bheeti aahe – there is fear.”
Mate alleged that the district administration had neglected the villages while ensuring clean water to Pune city. “It is our dharan, our dam too – the farmlands of our ancestors went into the dam. But this is our situation today,” he said. “You are quenching the thirst of Pune, but what about us? We need filtered water. We live near the dam; the dam water goes elsewhere but we have to drink polluted water.”
Multiple pathogens responsible
Following the spurt in GBS cases, the health department began a door-to-door survey to look for people with a history of infection, fever, diarrhoea or abdominal pain. Health officials admit that they have not found a large cohort of infected people. “It is possible several were asymptomatic,” a senior health official said.
Dr Umang Agrawal, an infectious disease expert, said it can take two to three weeks for symptoms of GBS to emerge after a person is infected by a pathogen.
He said the health department is unable to find infection in many people because most patients do not test positive for campylobacter once its symptoms subside.
“Campylobacter jejuni is the most common cause of GBS,” he told Scroll.
Campylobacter, he said, has proteins that mimic the nervous system. The body’s immune system cannot distinguish between the bacteria and the nervous system and often attacks the latter leading to paralysis. There is however no test to confirm GBS. “We can do only clinical diagnosis,” Agrawal said.
“The test to detect campylobacter is costly – about Rs 20,000 to Rs 30,000,” he said. The infection is also self-limiting in most cases, which means a patient recovers on his own. “That is why so many people do not test it,” Dr Agrawal said.
Several experts also pointed to a possible link with another outbreak in Pune that was flagged by the World Health Organization in late January – that of Zika virus. Pune recorded 125 Zika cases between January 1 and December 31 last year. Zika can also cause GBS, and its association in the latest spike cannot be ruled out. While all GBS patients have tested negative for Zika virus, Agrawal said tests at this point “may not really throw up Zika infection if the infection happened weeks or months ago”.
