‘Mystery’ Diseases: A Tale of Pathogens & Persistence

‘Mystery’ Diseases: A Tale Of Pathogens & Persistence

Mount Abu, Rajasthan: Seventeen people in Kachchh, who developed fever and respiratory distress towards the end of August 2024, died in quick succession between September 3 and 9, prompting authorities to rush teams to the affected area--villages Bekhada, Sanhrovand, Medhivandh and Morgar in Lakhpat taluka, and Bharavandh and Valavari in Abdasa taluka.

“Door-to-door visits to every household helped to identify others who were sick, and they were all started on symptomatic treatment,” Jayesh Katira, deputy director, epidemic in Gujarat’s health department, told IndiaSpend.

But the authorities struggled to name the disease, prompting the media to report the outbreak as a “mystery” disease (see here and here).

“When the causative organism or agent of a disease, and its mode of transmission from one person to another hasn’t been identified, lay people and the media tend to label it ‘mysterious’,” said Anil Kumar, principal advisor, National Centre for Disease Control, and president, Indian Association of Epidemiologists.

Back in Kachchh, samples drawn from the patients were sent for testing to the National Institute of Virology in Pune.

“When we face an unknown disease, we test for diseases that have recently been seen in different parts of the country as well as for seasonal diseases that may have just emerged,” Katira explained.

Tests for the Nipah virus, the Hantavirus, Crimean Congo haemorrhagic fever and other viral infections occurring in humans all came negative, and so did the zoonotic link. Essentially, the samples were also tested for diseases originating in cattle.

However, “microbiology tests showed that a single patient was infected by various types of bacteria, which we believe worsened a simple viral infection,” added Katira. So, “we attributed the deaths to an airborne respiratory infection.” Daily surveillance and treatment helped contain the outbreak, with two more people succumbing in the ensuing week. The Kachchh experience suggests that an outbreak of disease, no matter how virulent, can be brought under control with the right intervention.

“Epidemiologists don’t call diseases ‘mysterious’, because the cause of occurrence and channel of transmission can always be identified with careful investigation,” said Kumar.

Sometimes, he agreed, “the environment can cause the causative agent to undergo some change, in which case the investigation can take time.” The term ‘mysterious’ suggests that the disease cannot be figured out or controlled, which is not the case. Kumar recommends the scientific terminology: “an illness of unknown aetiology”.

Pathogen combinations have made diseases hard to identify. Comorbidities also increase vulnerability to acute diseases According to the WHO, underlying malnutrition is believed to have compounded the severity of illness in Panzi, the Democratic Republic of Congo. In Kachchh, Katira pointed out that the affected area is mostly inhabited by a cattle-rearing community. “Due to the inclement weather, they would have faced some hardship, and may also have skipped meals, due to which their immunity may have been compromised.”

Rainfall exacerbates the outbreak of disease

Poor infrastructure in rural India can increase disease fatalities. Kachchh and other parts of west Gujarat saw 75% more than normal rainfall during the 2024 monsoon season, a factor that could predispose the area to disease outbreaks. Heavy rain creates particularly challenging conditions for those living in kuccha homes. Heavy rain also cuts off access to health services for many people.

IndiaSpend reached out to the chief medical & health officer of Rajouri, Manohar Lal Rana, the state surveillance officer for Jammu Division Harjeet Rai, and the senior superintendent of police, Rajouri, Gaurav Sikarwar, to understand how such toxicity might have developed, what sort of exposure might the community have had, and over how much time would the disease have developed. They declined to comment, saying the matter was still under investigation.

Teams from many reputed hospitals across the country have visited the area to investigate the cause of disease. A source in the know, who did not want to be named as he was not authorised to speak to the media, made this interesting statement: “Now if people in the affected area develop the same symptoms, no one will die.” The source indicated that “when the first few people fell sick, the caregivers were clueless. They had never seen anything like it so they had no precedent to follow.” “It is only after losing so many victims and having so many expert medical teams visit the area and share their opinion, that the local health staff would be able to treat a patient with similar symptoms,” said the source. Essentially, health professionals in basic health centres lack the experience to treat many diseases. Low acceptance of modern medicine still a concern in rural India

No disease is too complicated to explain to the public. Confirming the cause of mortality is tricky sometimes. Still, experts caution against mislabelling outbreaks.

“We must steer clear of labelling any diseases as ‘mysterious’ or too complicated to explain to the public,” Jayaprakash Muliyil, epidemiologist and consultant, Department of GI Sciences, Christian Medical College, Vellore, told IndiaSpend. “There is always a cause of disease, and India has sufficient trained epidemiologists to identify diseases.”

Muliyil stressed the need to share scientific information with people “in the interests of public health, even if it means informing people that the diagnosis of a disease is still a work in progress”.

Back in Badhal, everyone knows that high-level teams from various big institutions have investigated the deaths. But the sarpanch Farooq lamented, “we still don’t know the cause, and so, we remain fearful.”

“People no longer celebrate events together,” said Farooq. “Nor do they want to eat or drink anything in each other’s homes. Everyone thinks their family could suffer the same fate. If you get to know [the cause of the disease], please let us know too.”

(Courtesy: https://www.indiaspend.com/; A full version of the article is present at the site)