Cassia occidentalis toxicity causes recurrent outbreaks of brain disease in children in Saharanpur.

Three recent papers in IJMR have made a great impact on our clinical practice in Saharanpur, Uttar Pradesh. We, in-charge of the paediatric division of the Government District Hospital of Saharanpur, have been under severe stress on account of the recurring annual outbreaks of unexplained acute brain disease in children, with very high (70-80%) mortality. National agencies including National Institute of Communication Diseases (NICD), Delhi and National Institute of Virology (NIV), Pune have investigated the outbreaks every year for many years and have diagnosed the disease as ‘acute viral encephalitis of unknown origin’. Under the assumption that many if not most of these cases, were due to Japanese encephalitis (JE), a mass vaccination campaign was conducted in the district in 2006, using the live attenuated SA-14-14-2 vaccine. The community co-operated extremely well and a total of 9.28 lakhs children aged 1-15 yr out of the target of 10.6 lakhs, were immunized during May and June 2007 (Government of UP, UNICEF and PATH joint action) (Aggarwal BL, personal communication, 2007). However, even in 2007 we got many children with the same illness who gave a history of receiving JE vaccination. About a quarter of cases were vaccinated, virtually disproving JE aetiology.