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Eluru outbreak

Dr. Rajalakshmi VK (AIIMS)MBBS

December 11, 2020

December 11, 2020

Eluru outbreak
Eluru outbreak

More than 600 people have fallen sick and one has died from an unknown illness in Eluru, Andhra Pradesh, between 5 December and 11 December 2020.

The epilepsy-like symptoms—including seizures, seizures with convulsions, loss of consciousness and temporary loss of memory—and the mystery shrouding the cause of this illness have raised alarm.

Teams of experts from the All India Institute of Medical Sciences, the World Health Organization, the Indian Council of Medical Research, the National Institute of Virology, the National Centre for Disease Control, the National Institute of Nutrition, Centre for Cellular & Molecular Biology, and the Indian Institute of Chemical Technology are looking for potential causes of the Eluru sickness.

So far, experts have done lab tests (including blood tests, urinalysis and cerebral spinal fluid tests) and CT scans on patients, checked the local water for contamination and pollutants, checked drinking water and milk samples for the presence of heavy metals like lead, examined the potential effects of chlorine from bleach-based disinfectants and looked at pesticide residue on fruits and vegetables as part of the ongoing investigations to determine the cause of the Eluru sickness.

Though the Eluru illness can happen to people of any age and gender, being a resident of Eluru (all cases have been reported from this area) and being young—most of the patients so far have been children or adults aged 20-30—seem to be the risk factors.

According to experts, the disease doesn't seem to be contagious or chronic in nature.

Based on the experts' early findings and suspicions, here's what we know about the symptoms, possible causes, diagnosis and treatment of the Eluru outbreak.

Eluru outbreak symptoms

The epilepsy-like symptoms of this illness include:

Eluru outbreak causes

The exact cause of the Eluru illness is not known yet. These are a few potential causes suggested by experts:

  • Old batteries: The team of experts from the All India Institute of Medical Sciences, New Delhi, which is looking into the Eluru outbreak of December 2020 has proposed that recycling of batteries—which contain lead and other metals—may be the cause. The investigating team said they had found lead and nickel in more than half (25 out of 45) of the blood samples they tested. The samples were taken from people who reported symptoms of this mysterious illness.
    Experts have also suggested that old batteries in garbage dumps may have leaked lead, which could have found its way into the groundwater. A former bureaucrat has also suggested that PVC pipes used to transport water may be a source of lead poisoning.
  • Bleach chlorine: The local municipal corporation and district administration are looking into the possibility that chlorine released from disinfectants may be the reason for these illnesses. During the COVID-19 pandemic, chlorine-based disinfectants are being used in many areas to stop the spread of the SARS-CoV-2 virus.
  • Other virus or bacteria: The first conjecture by the doctors on the ground was that a virus or bacteria could be behind the illness. However, doctors have found no proof of this so far. 
  • Pesticides and insecticides: Experts are looking into the claim that organochloride chemicals used to kill mosquitoes (through anti-mosquito fogging) and in pesticides may be the reason for this illness. Based on early thinking, though, experts say this is unlikely given the low number of respiratory problems and deaths reported in patients with the symptoms of the Eluru illness.
  • Having said that, some experts are looking into any connection between flash floods in Eluru in October-November 2020 and high exposure to pesticides.
    Experts and authorities are also looking into sources like the water supply, fruits and vegetables through which these chemicals could have gotten into the patients' bodies.

Expert teams from the All India Institutes of Medical Sciences, the World Health Organization, the Indian Council of Medical Research, the National Institute of Nutrition, Centre for Cellular & Molecular Biology, and the Indian Institute of Chemical Technology who are looking into the cause of this outbreak.

What has been ruled out so far

  • The Andhra Pradesh Health Department has specifically ruled out the viruses that cause:
  • Water pollution has also been ruled out as a cause for now, based on tests conducted on local water samples.
  • Normally, pesticides can also mix with river water and local water sources through run-off from the fields. However, informal surveys show that people who used bottled drinking water also got the Eluru illness.

Eluru outbreak diagnosis

Currently, doctors are diagnosing this illness based on geographical location and symptoms. According to Census 2011, the latest Census data that is available, Eluru covers 7,742 square kilometres of area in coastal Andhra Pradesh and has a population of 2.2 lakh.

While there is no cause for panic, if you live in Eluru and experience the above-mentioned symptoms, you should go to a hospital for a proper check-up.

Remember that of the first 300 people who were admitted to hospital with the symptoms of this "mystery illness" over 100 were discharged within a couple of days. The state government has asked health experts to follow the recovery of these patients, to look out for any adverse changes.

Eluru outbreak treatment

There is no fixed treatment for the Eluru illness as the cause is not yet known.

For now, doctors are giving supportive treatment like fluid therapy to provide relief from symptoms and revive patients.

Having said that, if lead poisoning is found to be the cause then chelation therapy could help patients.

Eluru outbreak prevention

As the cause of the disease is unknown, it is difficult to say what people can do to prevent it.

However, public health experts and the authorities are looking for the cause and potential sources of contamination. Determining—and addressing—these should help to prevent future outbreaks.



References

Doctors for Eluru outbreak

Dr. Nisar Ahmed Dr. Nisar Ahmed Emergency Medicine
4 Years of Experience
Dr Ramit Singh Sambyal Dr Ramit Singh Sambyal Emergency Medicine
7 Years of Experience
Dr. Aakash Harakhchand Shah Dr. Aakash Harakhchand Shah Emergency Medicine
5 Years of Experience
Dr. Sandeep Kumar Dr. Sandeep Kumar Emergency Medicine
1 Years of Experience
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