A woman looks after her child at the encephalitis ward of the the Baba Raghav Das Hospital, Gorakhpur
A woman looks after her child at the encephalitis ward of the the Baba Raghav Das Hospital, Gorakhpur | Getty
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Encephalitis immunisation is not handled by experts, rendering it useless many times. Doctors also say patients reach them too late, resulting in hundreds of deaths.

Gorakhpur: Kishan was relaxed. His two-year-old son, Luv Kush, was protected against encephalitis, a serial killer in the region of eastern Uttar Pradesh to which they belong, because he had been given the teeka at a vaccination camp in Bhawaniganj.

But just a month later, the child started having seizures, along with high grade fever. Sometimes, he would get aggressive; the very next moment, he would start crying, complaining about being attacked by ghosts.

Diagnosed with acute encephalitis (AE), the child died of shock in August 2017 after spending three nights admitted at the BRD Medical College.

“I went to the local hospital for a vaccine as I did not want my child to die of this horrible disease. I had seen too many deaths in the neighbourhood. But the doctors at the hospital did not tell me that I had to return for another injection; after one injection, I was convinced that it was done,” Kishan said.

“What use are these injections?” he lamented.

Is immunisation not working?

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The case of Kishan and his son is not isolated – children across Uttar Pradesh have been dying of encephalitis despite being vaccinated. The state government claims 90 per cent of children have been covered under vaccination programmes, but the number of suspected and confirmed cases reported at hospitals in Gorakhpur alone has remained pretty much constant over the last few years.

In 2016, 426 children died of suspected or confirmed encephalitis at the Acute Encephalitis Syndrome (AES) ward of the BRD Medical College alone, while in 2017, the number was 379.

In almost 20 per cent of these cases, the children had already received vaccinations, a doctor at the medical college said.

Explaining these deaths, Dr Rakesh Saxena, spokesperson for BRD Medical College, said no vaccine assures 100 per cent protection, but only controls susceptibility. “Vaccines do not mean 100 per cent protection. It is because of the vaccines that not many patients are now diagnosed with encephalitis. These deaths mostly occur due to other reasons, including malnutrition, attacks by other viruses, and kidney failures,” he said.

But on the other hand, health experts blame the government for not holding immunisation camps with trained workers.

Warmer
An image of the children in a warmer, provided by Dr. Kafeel Khan

Fudged numbers?

From 2006 to 2010, mass immunisation campaigns were carried out for children up to 15 years of age. But a study done by doctors at the BRD Medical College in 2016 showed that only 2 per cent of children were actually vaccinated.

“These numbers are more on paper than a fact. In many cases, they give just one injection and do not care to give the booster dose, which defeats the purpose of vaccination,” alleged Dr Kafeel Khan, former nodal officer of the AES ward.

“The volunteers fudge numbers, and we come to know of it only when the kids are admitted to the hospital with symptoms of encephalitis despite vaccinations. In most cases, we see that the people who hold camps do not reach out to villagers to convince them to get immunised. What is the purpose of this exercise when a proper dose is not even given to the kids? How do they expect them to work?” he alleged.

Experts said these vaccines are effective only for two hours after the pack is opened. Each pack contains five vials, each of which costs between Rs 1,000 to Rs 1,500.

Health officers at the camp are advised to not open the pack unless there are six to seven children present for vaccination. However, this is often ignored, and most vaccines lose their potency. But they are still injected, leaving the children susceptible, it is alleged.

“These volunteers give vaccinations just to boost their records, without keeping in mind the precautions required in administering the medicine. Fake records are generated to escape action from the administration,” claimed a doctor at BRD Medical College who spoke on condition of anonymity.

Ad-hocism

To run the vaccination camps, the government has roped in anganwadi teachers to give injections to children. Even though the teachers have with them trained health experts, they themselves are not trained to administer the medicine.

“There is expertise required to administer these vaccines, since the injection is muscular and involves very young children. In most cases, the responsibility is given to anganwadi teachers, who at times give the injections in the wrong muscle because they are not trained for the job. The vaccine, thus, is not effective; in fact, it may lead to more complications. It is different from just giving any other injection,” Khan claimed.

According to doctors, the process of immunisation also suffers because the health workers at these camps do not maintain the required temperature to store these vaccines, which then leads to more wastage.

“If the vaccine is not kept at a specific temperature, it loses its potency. In most of these camps, the volunteers do not pay attention to maintaining the temperature. Then, even if they are given to children, they will not be effective. So, while on paper the medicine is administered, in reality, it will not give any result. The whole exercise becomes futile,” Khan said.

Abdul Rehman vouches for this. His five-year-old daughter died due to encephalitis despite getting both the required shots. “Do they even inject medicine or just water? These vaccines are nothing but a sham. I got all the injections for my daughter; and I have the hospital’s card to confirm it. Despite that, she died of the disease. But the government will never accept its fault,” Rehman told ThePrint.

“Who knows what medicines they are using? They’re certainly not effective, otherwise my daughter would have been alive.”

Delays in diagnosis

However, according to doctors at BRD, even more than failed vaccines, the delay in diagnosing the disease leads to the high number of deaths. The number of children affected by encephalitis may be much more than reflected in the records, a doctor said.

To detect encephalitis, a cerebrospinal fluid sample (CSF) is taken and tested. However, the problem is that the causative agent is most active in the samples only within the first 2-3 days of onset, while most children reach the hospital only at a later stage.

“A majority of children come to us very late, and hence, we are losing out on identifying the pathogens there. All the patients who come to us are referrals from private hospitals, and by the time they come here, they are already so critical that it is too late for us to do anything,” said Dr Bhupendra Singh, the current nodal officer of the AES ward at BRD Medical College.

“Also, the tests that are carried out on them give no results, so we do not really know if they are suffering from Japanese Encephalitis or Entero Viruses. Both fall under the umbrella of AES (acute encephalitis syndrome).”

Khan added: “In most cases, we also see that parents take their children to quacks. They give them medicines to suppress fever, which leads to complications, including seizures and frothing from mouth. By the time the kids come to us, they are far too critical; they mostly slip into a coma. When the diagnosis is late, it becomes difficult to save the kids.”

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