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CORRESPONDENCE
Year : 2012  |  Volume : 135  |  Issue : 1  |  Page : 131-132

Disappearance of a deadly disease acute hepatomyoencephalopathy syndrome from Saharanpur


Formerly Pediatrician & In-Charge, District Hospital, Saharanpur, Pediatrician, 101, New Awas Vikas Colony, Delhi Road, Saharanpur 247 001, India

Date of Web Publication1-Mar-2012

Correspondence Address:
R S Panwar
Formerly Pediatrician & In-Charge, District Hospital, Saharanpur, Pediatrician, 101, New Awas Vikas Colony, Delhi Road, Saharanpur 247 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5916.93436

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How to cite this article:
Panwar R S. Disappearance of a deadly disease acute hepatomyoencephalopathy syndrome from Saharanpur. Indian J Med Res 2012;135:131-2

How to cite this URL:
Panwar R S. Disappearance of a deadly disease acute hepatomyoencephalopathy syndrome from Saharanpur. Indian J Med Res [serial online] 2012 [cited 2020 Feb 26];135:131-2. Available from: http://www.ijmr.org.in/text.asp?2012/135/1/131/93436

Sir,

Apropos our earlier correspondence [1] , there has been a drastic reduction of the deadly disease affecting young children of Saharanpur district of western Uttar Pradesh (UP). The outbreaks of this unexplained acute brain disease in children was recurring every year, with very high (70-80%) fatality for over two decades. It was earlier known as "Saharanpur encephalitis" or "acute viral encephalitis of unknown origin". However, it was later found not encephalitis, but a multi-system disease affecting liver, muscle and brain and re-named "acute hepatomyoencephalopathy (HME) syndrome" caused by phytotoxins [2] . Later, the source of toxicity was found to be to the consumption of beans of a ubiquitous herb Cassia occidentalis by unsupervised young children of poor families [3],[4] . Cases occurred only in September through December every year coinciding with the poding season of this annual plant.

After publication of these studies, a meeting of all stakes-holders that comprised paediatricians, general physicians, local health and district administrations, health agencies, and media representatives was conducted in 2007 at the district headquarter city of Saharanpur, the worst affected district. Later, the local unit of Indian Academy of Pediatrics, with support from the health agencies [mainly UNICEF and National Polio Surveillance Project (NPSP)], district administration, and media launched a massive educational campaign in and around Saharanpur district to educate people about the poisonous nature of the weed. Pamphlets in local language were printed and distributed; the 'live weed' was exhibited/displayed at the registration counters of all hospitals and nursing homes, frequently-visited government offices, and at other public places. The task of massive uprooting of the weed was taken by the forest and Public Works departments. Instructions were given to village 'Pradhans' to employ labourers for destroying the weed from the neighbourhoods. Regular meetings were organized with 'Gram Panchayat' members and villagers were educated regarding the toxic nature of the plant. Media played a significant role in creating awareness among rural population. The entire operation was supervised by the district magistrate of Saharanpur. This massive campaign, sustained over 2 years led to drastic reduction in the number of cases in the district. As evident from the [Table 1], the total number of admissions in Saharanpur district hospital which has a special 'encephalitis ward' to admit these cases, fell from 100-200 cases admitted annually up to 2007 to 15-30 in 2008 and 2009 and to nil in 2010.
Table 1: Numbers of admitted cases and deaths in Saharanpur District Hospital, 2002-2010

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There is an urgent need to carry out similar awareness/education campaigns in all other affected districts of western UP and Uttarakhand. The lessons learnt are that there is no substitute to systematic and professional investigation of any outbreak of unknown cause [2],[3],[4] . This experience deserves wider publicity and public understanding. Healthcare professionals both in private and public sectors should have inquisitive mind and motivation to solve local problems by team approach. Public-private partnership in health sector can help achieving some difficult, unattainable targets. And, media can also play a very important constructive role in raising awareness among general public.

 
   References Top

1.Panwar RS, Kumar N. Cassia occidentalis toxicity causes recurrent outbreaks of brain disease in children in Saharanpur. Indian J Med Res 2008; 127 : 413-4.  Back to cited text no. 1
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2.Vashishtha VM, Nayak NC, John TJ, Kumar A. Recurrent annual outbreaks of a hepato-myo-encephalopathy syndrome in children in western Uttar Pradesh, India. Indian J Med Res 2007; 125 : 523-33.  Back to cited text no. 2
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3.Vashishtha VM, Kumar A, John TJ, Nayak NC. Cassia occidentalis poisoning - as the probable cause of hepatomyoencephalopathy in children in western Uttar Pradesh. Indian J Med Res 2007; 125 : 756-62.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Vashishtha VM, Kumar A, John TJ, Nayak NC. Cassia occidentalis poisoning causes fatal coma in children in western Uttar Pradesh. Indian Pediatr 2007; 44 : 522-5.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  



 
 
    Tables

  [Table 1]


This article has been cited by
1 Correspondence
Vipin M. Vashishtha,T. Jacob John,Sriram Pothapregada
Indian Pediatrics. 2014; 51(11): 936
[Pubmed] | [DOI]



 

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