The toll in the encephalitis outbreak in Bihar’s Muzaffarpur district increased to 50 on Thursday after seven more children died of Acute Encephalitis Syndrome, the Hindustan Times reported. Of the 50 deaths, 48 have occurred this month.

Bihar’s Principal Secretary for Health Sanjay Kumar put the death toll at 47 till 10 am on Thursday but the hospital’s Medical Superintendent Dr Sunil Kumar Shahi said three more children died in the afternoon. Of the 145 patients admitted at the hospital with the disease, 34 are still undergoing treatment, he added. The affected children have come from districts such as Vaishali, Sitamarhi, Sheohar, East Champaran, and West Champaran.

A seven-member team of experts set up by the Union health ministry “is of the opinion that maximum cases reported are due to encephalopathy” and has approved the hospital’s treatment protocol, Dr Shahi said. On Tuesday, state health officials had claimed that a majority of the children who have died in two hospitals in Muzaffarpur suffered hypoglycemia and not Acute Encephalitis Syndrome.

The doctor told The Indian Express that the central team has directed that a separate ward for children be set up at the hospital along with a laboratory. “The team felt a laboratory at the hospital would provide reports quickly and help in the treatment of AES,” he added.

The state government has got health volunteers to distribute packets of Oral Rehydration Solution in encephalitis-prone areas, and have alerted about 1,200 primary healthcare centres to provide immediate treatment to patients. Bihar Health Minister Mangal Pandey is scheduled to visit Muzaffarpur on Friday to take stock of the situation.

The symptoms of Acute Encephalitis Syndrome, which causes fatal inflammation of the brain, include fever, mental confusion, disorientation, delirium, or coma, and onset of seizures. The Japanese encephalitis virus is the most common cause of Acute Encephalitis Syndrome in the country, causing 5% to 35% of the cases. But the syndrome is also caused by scrub typhus, dengue, mumps, measles, and Nipah and Zika viruses, according to The Indian Express. However, the cause remains clinically unidentified in several cases.