Inadequate research facilities fail to tackle mystery disease

A "mystery" disease in India's most populous state, Uttar Pradesh, that has so far affected 112 children and resulted in 43 deaths continues to baffle medical researchers. The most they are able to say after three months is that the disease is caused by viral encephalitis—but the identity of the virus remains elusive. A lack of suitable research facilities in the country has added to the problem. "The first case was detected on 12 October but we received the news only on 25 November," Dr Gayatri Sharma, the Uttar Pradesh director general of medical and health services, told the BMJ . The disease is not an epidemic, and all the cases involve children aged 3-12 years in Saharanpur and Muzaffarnagar districts, with a few cases in Ghaziabad and Baghpat, she added. The three month delay in detecting the causative agent, a furore in the media, and contradictory statements by different agencies have forced the government to appoint a committee, headed by Nirmal Kumar Ganguli, director general of the Indian Council of Medical Research, to investigate. The outbreak comes after a similar situation last year in Siliguri district in West Bengal and a suspected plague in the early 1990s. These outbreaks have highlighted India's serious weakness in identifying pathogens. Ganguli's announcement that the Siliguri outbreak was caused by a measles variant was contradicted by researchers at the Delhi based National Institute of Communicable Diseases. "Six Siliguri samples were sent to [the US] Centers of Disease Control, and they turned out to be of Nipah virus," Biraj Mohan Das, director of emergency medical services in India's health ministry, told the BMJ . But researchers at the national institute feel that the issue is still unresolved. "It very well could be a new virus, although we tend to think it is close to Nipah virus," a senior scientist told the BMJ . But the institute's work on the Siliguri virus is at a standstill, as neither the institute nor any other Indian facility has the right level of biosafety needed to handle dangerous pathogens. "Such a facility is surely needed in a country of India's size, and the World Health Organization would extend any technical assistance India would need in this regard," said Tej Walia, WHO representative to India. In 2001 the comptroller and auditor general of India indicted the National Institute of Virology, in Pune, for non-completion of a microbial containment complex that could protect workers against unusual pathogens and act as a deterrent against biological warfare attacks, despite the fact that billions of rupees were spent on the project over 23 years.