For more than a week, children in some districts of the state of Uttar Pradesh, in northern India, wake up with a high fever and drenched in sweat.
Many of them they complained of joint pain, headaches, dehydration, and nausea. In some cases, rashes that spread to the legs and arms were reported.
At least 50 people, mostly children , have died of fever and several hundred have been admitted to hospitals in six districts of the eastern part of the state.
None of the deceased tested positive for covid – 19.
At a time when India seems to be slowly reeling from a deadly Second wave of coronavirus, deaths in Uttar Pradesh have generated headlines about a “mystery fever” that is spreading through rural areas of the country’s most populous state.
Doctors in some of the affected districts (Agra, Mathura, Mainpuri, Etah, Kasganj and Firozabad) believe that dengue, a viral infection transmitted by mosquitoes, could be the principal pal cause of deaths.
They say that many of the patients were taken to the hospital with a low level of platelets (blood cells essential for clotting), which characterizes a severe form of dengue.
“Patients in hospitals, especially children, are dying very quickly,” says Dr. Neeta Kulshrestha, the highest-ranking health official in the Firozabad district, where 40 people, including 32 minors, died last week.
Transmitted by female mosquitoes, dengue is primarily a tropical disease and has been circulating in India for hundreds of years.
It is endemic in more of 100 countries, but around the 70% from the cases are in Asia.
There are four viruses that transmit the disease and children are up to five times more likely to die during a second dengue infection than adults.
The mosquito Aedes aegypti breeds inside and around the houses in containers that contain fresh water.
“Humans promote breeding places and only they can avoid them,” says the Dr. Scott Halstead, one of the world’s leading experts on mosquit-borne viruses os.
Almost 100 Millions of severe dengue cases (with severe bleeding and organ damage) are reported worldwide each year.
“The combined impact of covid – 19 and dengue epidemics can have potentially devastating consequences for populations at risk ” , according to the World Health Organization (WHO).
However, still it is not clear if A dengue epidemic is solely responsible for fever-related deaths in Uttar Pradesh.
In a state with more than 200 millions of people and traditionally poor sanitation standards, high levels of malnutrition in children and irregular medical care, cases of “mystery fever” are regularly reported after monsoon rains every two years.
Encephalitis
Japanese mosquito-borne encephalitis outbreaks, first identified in Uttar Pradesh in 1978, more than 6 have been charged. 500 lives since then.
The disease spread mainly through Gorakhpur and the adjoining districts bordering Nepal in the foothills of the Himalayas, all lowland and flood prone and which provide a breeding ground for mosquitoes that transmit the virus.
A vaccination campaign, which began in 2013, has caused a decrease in cases, but children continue to die.
Seventeen children have died of Japanese encephalitis in Gorakhpur so far this year and there have been 428 cases.
On 2014, given the increase in deaths from encephalitis and myocarditis (inflammation of the heart muscle), the scientists examined 250 affected children in Gorakhpur .
They found that 160 of them had antibodies against the bacteria that caused what is known as bush fever.
Also called scrub typhus, it is a bacterial infection that is transmitted through the infected viral mite bite s.
These settle in the flourishing vegetation of the villages after the monsoon rains.
The Scientists found the mites in the firewood that the villagers store inside their houses.
Often times, scrub typhus is spread when children handle firewood at home or defecate outdoors in the bushes infested with mites.
In a separate study, scientists also found that scrub typhus and dengue were primarily responsible for the cases of fever following the monsoon in six districts of eastern Uttar Pradesh between 2015 and 2019.
Another life-threatening bacterial infection called leptospirosis, which passes from animals to humans, and chikungunya, a mosquito-borne disease, explained the other fever-causing pathogens.
“So there were several ill ages linked to fever in the region after the monsoons ended, ”says V Ravi, professor of virology at the National Institute of Mental Health and Neurosciences (Nimhans), who led the second study.
“Systemic surveillance is needed to monitor and treat these diseases,” he added.
Previously, in 2006, scientists investigated another “mysterious” outbreak of fever-related deaths among children in Uttar Pradesh.
This time they found that children had died after consuming cassia beans, that grew abundantly in the western part of the state.
This food poisoning was the result of “poverty, hunger, lack of parental supervision, ignorance, children playing alone, the unavailability of toys and easy access to the plant “, concluded the scientists.
Clearly, only further research and genome analysis will reveal whether the latest wave of “mystery fevers” in India was triggered by dengue alone or by a number of diseases.
This It would mean training local clinics and hospitals in collecting samples from people with fever and sending them to laboratories for genome testing.
Also, there is no clear record of how these fevers started and progressed; and if the severity of the condition was determined by the long and arduous trips that people have to make to government hospitals for treatment.
Or if the affected children suffered from other conditions such as tuberculosis.
If the cause of the mysterious deaths is only dengue, this points to the government’s mosquito control programs, largely ineffective.
The intensity of transmission, according to Dr. Halstead, can only be determined by antibody tests, called serological surveys, by age group.
“If we do not investigate properly and regularly, many things will remain a mystery,” says an Indian virologist, who prefers to remain anonymous.
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