Gujarat | Chandipura virus throws healthcare, administrative challenges

A suspected outbreak of Chandipura virus, a vector responsible for Acute Encephalitis Syndrome (AES), in Gujarat, has led to the death of 41 children while afflicting 124, even as doctors struggle to save lives in the absence of vaccine and testing apparatus.

The caseload of children suffering from the disease touched 124 within just 27 days of the first case detected in Panchmahal district. While 41 have died in Gujarat, one of fatalities have been reported from neighbouring Rajasthan.

The deceased children, all under 12 years of age, who were admitted in the last 27 days, displayed similar symptoms, first developing fever followed by convulsions and finally succumbing to inflammation in the brain.

Doctors in Gujarat believe the outbreak amongst children has been caused by Chandipura Vesiculo virus (CHPV).

Only 22 of 122 test positive for Chandipura virus

However, of the 122 samples sent for PCR (polymerase chain reaction) testing to National Virology Institute (NIV) in Pune, only 22 have been confirmed as CHPV cases, while one has been found to be a case of Enterovirus. Another sample has tested positive for both the pathogens.

Test results of 74 cases were sent to Gandhinagar on Thursday (July 25) while the results of the rest of the cases are still awaited.

“This has left the doctors in the dark about the rest of the 48 patients,” a doctor of Ahmedabad Civil hospital told The Federal.

No vaccine, rapid mortalities

“Adding to this, we have two new cases of Enterovirus that show similar symptoms as CHPV, but don't respond to the same anti-viral drugs. There is no specific treatment or vaccine available for Chandipura virus infection. The rapid mortality amongst children has been baffling for us. The course of treatment has been focused on supportive care,” the doctor said.

The doctor explains that both Chandipura virus and Enterovirus belong to the Rhabdoviridae family (same family as the virus that causes rabies) that is associated with encephalitic (brain swelling) illness and affects mostly children under the age of 15 years.

“Symptoms of Chandipura virus infection typically include fever, convulsions, and unconsciousness which usually progresses rapidly to coma and death in severe cases. So far, we think, the virus entered through the intestinal route by contaminated food or water,” the doctor added.

Health department on toes: Minister

In a media statement state Health Minister Rushikesh Patel said the department is working round the clock and has taken immediate measures to contain the outbreak.

“Health department is working on the front foot to contain the outbreak in the state. Over 50,000 people have been screened and all district and rural hospitals have been alerted to send samples of suspected cases to Gandhinagar. Surveillance is also being conducted across nearly 20,000 homes across the state for the presence of sandflies and mosquitoes. Around 1,500 houses have been sprayed with powder repellent to rid the area of the disease-carrying insects,” Patel said.

Delay in testing

Noticeably, the Gujarat government sent the samples of the suspected cases to NIV only after three weeks of the outbreak in the state. As the second case of suspected CHPV was admitted to GMERS hospital in Himmatnagar district, the Gujarat government had declared it to be an outbreak of the Chandipura virus, but it took three weeks since then to send the samples for PCR testing.

However, after the doctors demanded a prompter process, the government decided to send the sample to the Gujarat Biotechnology Research Centre (GBRC), the state-run Biosafety Level 2+ (BSL-2+) laboratory in Gandhinagar on July 22.

“We wish the new policy had been adopted from day one. GBRC in Gandhinagar is absolutely capable of handling DNA samples of patients with suspected Chandipura virus. In fact, during the COVID-19 pandemic, GBRC had successfully decoded the whole genome sequence of coronavirus,” said a doctor from GBRC.

Until now, Gujarat government had been sending all blood and cerebrospinal fluid (CSF) samples to the NIV, the BS-IV laboratory in Pune, Maharashtra. But the process has been slow so far with NIV sending results of only 74 out of 122 cases.

Cases outside Gujarat

Meanwhile, cases of suspected CHPV have crossed the borders of Gujarat. Three patients have been diagnosed in Rajasthan, two in Madhya Pradesh and one from Maharashtra.

In Gujarat, the highest number of patients with AES have been reported from Panchmahal district in Central Gujarat with 15 active cases. Ahmedabad City has reported 11 cases followed by Sabarkantha at 10, and Mehsana at seven. Aravalli, Kheda, Gandhinagar and Jamnagar districts have reported six cases each.

Of the total 42 deaths as of July 24, 41 are from Gujarat and one is from Rajasthan. The Panchmahal district in Gujarat has witnessed the highest number of deaths with seven children succumbing to the disease followed by four in Ahmedabad.