Not Chandipura | What killed 50 children in Gujarat? No one seems to know
In 2 months, 78 children have died after suffering Chandipura-like symptoms for 12-72 hours, but only 28 deaths were confirmed to be caused by the virus; grieving parents are yet to get answers
Vinesh Prajapati and his wife Hansa could not fathom that they could suddenly lose their four-year-old daughter to what seemed to be seasonal fever.
On July 16, their daughter Devi was playing in the neighbourhood when Hansa dragged her home for dinner. “She was reluctant to eat. She never did that. So, I touched her body and found her to be warmer than usual. We did not think of it much as kids do get mild fevers during the monsoon," Hansa told The Federal.
“But by 4 am, she began vomiting and her condition deteriorated. My husband and I rushed her to a neighbourhood private hospital. They took a look at her and asked us to take her to the Civil Hospital in Ahmedabad. By the time we reached the Civil Hospital in Sola, it was 7 am and Devi was unconscious and shaking,” she recounted.
“By evening she was shifted to the PICU (paediatric ICU) and the next morning the doctors told us she was no more,” said the mother, breaking into loud sobs.
Devi Prajapati's blood test results came negative for Chandipura Vesiculo Virus (CHPV), better known as the Chandipura virus.
What killed the kids?
About 50 days since an acute outbreak of encephalitis in Gujarat, it is still not clear what killed dozens of children. Doctors and the distraught families await to know which pathogen could have taken the lives of so many children who were suspected to be infected with CHPV.
On August 25, Gujarat Health Minister Rushikesh Patel told the Assembly that there have been only 28 deaths due to CHPV. Since June 27, however, 78 children have died with similar symptoms – fever followed by vomiting and convulsions leading to death within 48 hours.
Of the 78 cases, only 28 were confirmed to be caused by the CHPV. The deaths of the remaining 50 children remain a mystery.
Tests don’t provide answers
The Gandhinagar Biotechnology Research Centre (GBRC) conducted Whole Genome Sequencing (WGS) of samples from CHPV-positive patients and found only one non-consequential mutation from previous strains.
It is not known what caused encephalitis in the children who were found negative for CHPV.
A series of tests are being run at the National Institute of Virology (NIV) in Pune, said a Gujarat health official.
Situation now under control
Currently, the outbreak is spread over 26 of the 33 districts including six major cities of Gujarat. Patients from Rajasthan, Madhya Pradesh and Maharashtra have also been admitted into Gujarat’s government hospitals.
The caseload as on August 27 was 178 children — 164 from Gujarat, seven from Rajasthan, six from Madhya Pradesh and one from Maharashtra.
It has been almost two months into the outbreak and now the caseload has plateaued. The last remaining sick children are being successfully discharged, slowly but steadily. But the government is yet to provide any kind of answers to the grieving parents whose children lost their lives suddenly, within 48-72 hours of hospital admission.
All these kids came with high fever and vomiting, progressed to convulsions and brain inflammation and died, Dr Chetan Trivedi, a former president of the Academy of Paediatrics in Gujarat, told The Federal.
Most samples test negative
In the first 22 days of the outbreak, the Health Department sent 12 samples to NIV Pune. The results of seven samples were sent back to Gujarat.
Of the seven cases, only six-year-old Kinjal Ninama from Mota Kanthariya village in Aravalli district was confirmed to be CHPV-positive.
The balance six samples tested negative — not just for Chandipura but also for Japanese encephalitis, enteroviruses, flaviviruses and the herpes simplex virus (HSV).
The Gujarat Cabinet decided on July 18 to send the samples to the GBRC for RT-PCR tests to determine the cause of deaths.
GBRC gets into the act
From the first week of August, the GBRC began a series of tests on 93 samples. These included Whole Genome Sequencing (WGS) and Next Generation Sequencing (NGS) of DNA samples of patients sent by hospitals and a few liver biopsies of deceased patients.
Human samples were also taken from family members and neighbours of the affected children, a health official told The Federal. “Adding to that, DNA samples were drawn from cows and buffaloes from the vicinity of patients’ homes to rule out suspicion of zoonotic origin of the infection,” he added.
Following the tests, 22 children were diagnosed with CHPV and two with enterovirus while the cause of death of the other children remained unknown.
Later, officials, doctors and researchers — picked after consultations with the National Joint Outbreak Response Team, the Directorate General of Health Services and the Indian Council for Medical Research (ICMR) — began seeking answers to the cause of death of the 50 children in Gujarat. They have not arrived at conclusions yet.
Another tragic case
Similar to Devi Prajapati, 12-year-old Ritwik Patel was admitted to the Civil Hospital in Vadodara but he passed away within 12 hours even before a course of treatment could be decided. Later, he too tested negative for CHPV and enterovirus.
“He had been admitted for only about 12 hours. Before we could even understand what was happening, we were told he had passed away,” Pradip Patel, Ritwik's bereaved father, told The Federal.
“The doctors and government officials said my son was affected by Chandipura virus but they have not given us any document of the diagnosis. We don’t know what happened all of a sudden. One day he was in school and the next day he died. We are yet to come to grips with the loss,” he added.
No time to mournIn 2 months, 78 children have died after suffering Chandipura-like symptoms for 12-72 hours, but only 28 deaths were confirmed to be caused by the virus; grieving parents aryet to get answers
Meanwhile, the affected families have been constantly visited by medical teams and government officials to collect samples for tests.