Six months ago, Madan Madkami, 25, and Baidehi Madkami, 22, of Dangaskhal village in Malkangiri district in Odisha were delighted by the birth of their baby girl. The couple are now mourning her sudden death. “We rushed to the hospital when she had a high fever but the doctor could not save her life,” the young mother cried. “My baby left me.”

The Makdami baby is one of 30 people, mostly children, who have died in a recent outbreak of Japanese encephalitis in Malkangiri. Malati Alba, a daily labourer from Tekguda village has had sleepless nights while her son has been in hospital. Alba already lost her a daughter last Friday to the disease.

“My daughter Sushmita had loose motion and vomiting with mild fever,” said Alba. “I thought it was due to seasonal change.” The two-year-old girl’s chest started trembling intensely on Thursday, her mother said. When taken to a local hospital, a doctor who suspected encephalitis referred the child to the Malkangiri district hospital where she died the next morning.

Rising toll

Panic has gripped Malkangiri with every day adding to the death toll from Japanese encephalitis. Three children died on Monday taking the count to 30 in just 25 days. Out of 34 blood samples drawn from ill children sent to the Regional Medical Research centre 15 have tested positive for the Japanese encephalitis virus.

The disease has hit 18 villages across Malkangiri with the Kalimela, Mathili and Podia blocks worst affected The first recorded incidence of Japanese encephalitis in Malkangiri district was in 2011. Between 2011 and 2014, 15 children have died of the disease but there were no fatalities in 2015.

The funeral of six-month-old Sweety, daughter of Baidehi and Madan Madkami. Photo: Sarada Lahangir.

“The children affected by this diseased showed symptoms like fever, vomiting and fatigue,” said Sashibhusan Mohapatra, additional district medical officer of Malkangiri. “If the disease is not diagnosed earlier, swelling occurs around the brain and the patient ultimately dies. The number of deaths is increasing as patients are admitted to hospital on last moment.”

The Japanese encephalitis virus is a flavivirus related to the dengue, yellow fever and West Nile viruses, and is spread by mosquitoes. The Japanese encephalitis virus is the main cause of viral encephalitis in many countries of Asia with an estimated 68,000 clinical cases every year. According to the World Health Organisation, 24 countries in South-East Asia and the Western Pacific have endemic Japanese encephalitis virus transmission, exposing more than 3 billion people to infection. Japanese encephalitis cannot be cured but only treated to relieve severe clinical symptoms and patients need support to overcome the infection.

Environment for virus transmission

“In tribal village of Malkangiri district unhealthy environment and mosquito bite are the factors responsible for the outbreak of Japanese encephalitis,” said Uday Shankar Mishra, Malkangiri’s chief medical officer. “Massive breeding of mosquitoes, which are responsible for the disease, generally takes places in the human habitations where the pigs stay.”

Health officials in Malkangiri are looking to remove pigs, which are carriers of the encephalitis virus, in affected areas to control the epidemic. But this is a tough task. Malkangiri has a mostly tribal population where families keep goats and pigs in their houses and rely on the meat for food. Woth no other source of income, many residents in rear the goats and pigs for a living.

“If you tell them not keep pigs they will not listen to you,” complained Malati Kabasi, a village health worker.

The district administration has also intensified mosquito eradication and cleaning programmes in the affected areas, Mohapatra said.

Meanwhile state health minister Atanu Sabyasachi Nayak visited the district along with health and animal resources secretaries and a team of doctors. “We are trying to control the situation on a war footing manner,” Nayak said. “A team of doctors and specialists, who have come from Bhubaneswar, would be camping in this district and will take appropriate measures to bring the disease under control.”

The minister has also announced a sanction of Rs 50 lakh from the National Health Mission to the district health authorities to buy medicine and necessary equipment to control the outbreak.