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NEW DELHI: Almost half of children who died due to acute encephalitis syndrome (AES) in Bihar’s Muzaffarpur in mid-2019 had no history of litchi consumption, whereas majority of the rest were less than two years’ old and therefore not quite able to eat the fruit, preliminary studies have concluded ruling out litchi toxins as the cause of those deaths.

In the wake of these findings, Indian Council of Medical Research (ICMR) has ordered further investigation to ascertain the cause of sudden rise in deaths due to AES in Bihar last year. The Council will launch a study in April-May with the onset of summers to probe the matter, an official said.

“So far, majority of the investigations — by Indian as well as international researchers — have ruled out litchi consumption as a cause of these deaths. Hence, further probe is required to ascertain the cause and capture it,” the official told TOI.

In June 2019, Bihar witnessed a sudden spike in AES-related deaths with over 125 fatalities and more than 550 cases recorded in the state. While the state government had blamed heat wave and litchi toxins as the cause of these sudden deaths, public health experts and researchers have pointed to malnutrition and poor health infrastructure in the state to contain the disease.

Following the huge number of deaths, the Centre had appointed teams including researchers from ICMR, National Centre for Disease Control, National Institute for Nutrition as well as from Atlanta’s Centers for Disease Control and Prevention to Muzaffarpur to pin down the cause of the deadly disease.

Doctors, paediatricians and epidemiological experts from New Delhi’s AIIMS, Safdarjung Hospital and public health experts from WHO and UNICEF also conducted initial studies in Bihar to determine the cause.

Preliminary findings also indicated the cause is of “noninfective origin” — which means it is “not a virus, any bacteria, fungus or a living organism”. Health experts say it is difficult to believe litchi as the cause of deaths. “There is a particular component in the fruit which can contribute to reducing blood sugar level if too many are consumed on empty stomach but there has to be other factors,” said a public health expert working in Muzaffarpur.

Official data suggest the Bihar government had been indifferent towards improving child nutrition and healthcare in this district.

In Muzaffarpur, nearly 48% children under the age of 5 are stunted, 17.5% are wasted (too thin for their height), while 42% are underweight — a glaring sign of chronic under-nutrition, according to the National Family Health Survey (NFHS)-4.

