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Japanese encephalitis death toll nears 1,000 in India and Nepal, doctors overwhelmed

GORAKHPUR, India (AP) _ An encephalitis outbreak has killed nearly 1,000 people _ almost all of them children _ in India and neighboring Nepal, as too few doctors struggle to care for thousands of sick children in outdated hospitals.

The death toll in India's northern Uttar Pradesh state stood Monday at 767, after 27 more deaths were reported overnight. Nepal has logged 204 deaths.

Every day, parents from the poorest corners of India's most populous state pour into the small town of Gorakhpur, some carrying unconscious children whose limp bodies flop from side to side as they're raced into one of the Japanese encephalitis wards at the B.R.D. Medical College.

But by the time many children arrive, there's little that can be done even to make them more comfortable. The tiny, often bare-chested children have oxygen masks taped to their faces _ a grim scene stretching across two hospital floors.

For the handful of overworked doctors scurrying from patient to patient, it's an especially frustrating sight because the disease is easily preventable. Vaccines exist and measures can be taken to minimize exposure to the mosquitoes that spread the disease from pigs. But the tired physicians say such solutions might as well not exist without money and a strong political will to ensure that help reaches these poor, rural families.

Dr. O.P. Singh, director-general of health for Uttar Pradesh, has said it would cost about $58 million to vaccinate the more than 7 million children aged 15 and under in the most-affected areas. The state's entire health budget is $25 million.

``It's too hard for us also to see so many children and to see some dying and some handicapped and knowing this is a ... disease that can be controlled by removing all pigs from society,'' said Dr. K.P. Kushwaha, a pediatrician overseeing the encephalitis wards.

Japanese encephalitis, closely related to West Nile virus, is found only in Asia, where it's the leading cause of neurological infection. The World Health Organization says about 50,000 cases are reported annually, including 15,000 deaths, but many more go unreported.

Eastern Uttar Pradesh is especially prone to the disease because it is a prime rice-growing region that breeds mosquitoes. Its bowl-shaped geography allows little drainage after rains. Also, farmers often raise pigs close to where people live.

The disease sickens only about 1 in 250 people infected _ with children from 1 to 15 the prime prey. Most adults in affected areas have developed immunity.

The illness causes sweltering fevers, convulsions and comas, and can leave permanent damage. The WHO estimates that up to 75 percent of survivors suffer lifetime disabilities, ranging from paralysis to mental retardation to sometimes-violent behavioral problems.

In the dilapidated hospital in Gorakhpur, about 40 miles from the border with Nepal, Kushwaha is one of only about a half dozen doctors caring for children suffering from the disease.

The bespectacled man with warm eyes and a kind, weary face, bounces between the various units _ intensive care, general and recovering _ checking machines and oxygen tanks while signing papers and answering a horde of worried parents' questions.

He has worked at the hospital since 1978 and seen bad outbreaks before, but nothing like this. The onslaught began in late July and is starting to show some signs of slowing, although Kushwaha estimates the actual number of infected children is four to five times higher than those seeking treatment at the hospital.

The overload has forced doctors to place two children to a bed, even in the intensive care unit.

For many children, the virus is just too strong. Golu, a tiny 2 1/2-year-old boy, looked as if he were sleeping peacefully as his grandfather wrapped a blanket around him and carried his body out of the hospital for burial.
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