The Lancet Global Health on January 31, 2017, published the results of a collaborative investigation by Indian and U.S. authorities revealing the causes of a mysterious outbreak in Muzaffarpur, Bihar which has claimed the lives of hundreds of children. From 2013 to 2014 the U.S. Centers for Disease Control (CDC), in close collaboration with National Centre for Disease Control, India (NCDC) and other Indian health officials investigated a recurring outbreak of an unexplained neurologic illness among young children in Muzaffarpur, Bihar. These recurring outbreaks begin each year in mid-May and peak in June, coinciding with the litchi harvesting season. Children from poor socioeconomic backgrounds in rural Muzaffarpur comprise most of those affected. The illness is characterized by acute seizures and changed mental status, and is associated with high mortality.
The findings of that investigation, published on January 31 in the leading medical journal The Lancet Global Health, have, for the first time, comprehensively confirmed that this illness is associated with litchi fruit consumption and the effects of naturally occurring (litchi) toxins.
Based on the results of this collaborative investigation, public health recommendations targeted at preventing illness and reducing mortality were provided to state and national health authorities. This included recommendations to minimize litchi fruit consumption among young children in the affected area, to ensure that children receive an evening meal throughout the outbreak period, and to rapidly assess and correct blood glucose levels in any child suspected of having the outbreak illness. These recommendations should be broadly adopted and implemented.
The application of a comprehensive and systematic approach to investigating illness, including the key role of the CDC/NCDC-led India Epidemic Intelligence Service officers in the field, was critical to successfully identifying the etiology and risk factors for this illness, and led directly to recommendations to prevent illness and deaths from this outbreak. This collaborative investigation exemplifies the benefits of Indo-U.S. public health collaborations, such as Global Health Security, and highlights the potential of these partnerships to contribute toward identifying interventions that can reduce morbidity and mortality in India.